Dental Clinic Prescription
Dental Clinic Prescription
[YOUR COMPANY NAME]
Date: October 8, 2055
Prescription No.: DC-2055-00123
I. Patient Information
|
Field |
Details |
|---|---|
|
Patient Name |
Cyrus Ortiz |
|
Age |
42 |
|
Gender |
Male |
|
Contact Information |
222 555 7777 |
II. Prescription Details
|
Field |
Description |
|---|---|
|
Diagnosis |
Tooth abscess |
|
Prescription Type |
Antibiotics, Pain relief |
|
Medication Name |
Amoxicillin 500 mg / Ibuprofen 400 mg |
|
Dosage |
1 tablet every 8 hours for 7 days |
|
Route of Administration |
Oral |
|
Duration |
7 Days |
|
Special Instructions |
Take medication with food, avoid alcohol |
|
Next Appointment |
October 15, 2055 |
III. Medications
|
Medication |
Dosage |
Frequency |
Duration |
|---|---|---|---|
|
Amoxicillin 500 mg |
1 tablet |
Every 8 hours |
7 days |
|
Ibuprofen 400 mg |
1 tablet |
As needed for pain relief |
As needed |
IV. Additional Instructions
-
Complete the full course of antibiotics even if you feel better before finishing them.
-
Do not consume alcohol while taking antibiotics.
-
Use a soft-bristled toothbrush to avoid irritation of gums.
-
Rinse with antiseptic mouthwash twice daily.
V. Doctor's Information
|
Field |
Details |
|---|---|
|
Doctor's Name |
[YOUR NAME], DDS |
|
License No. |
9876543210 |
|
Contact Information |
[YOUR EMAIL] |
VI. Signature
Signature:
Date: October 8, 2055
