Prescription List
Date: 01/01/2083
Patient Information
Patient Name: Brenda Boyle
Date of Birth: 03/15/2050
Address: Eugene, OR 97401
Contact Number: 222 555 7777
Email: brenda@you.mail
Physician Information
Medication List
Medication Name | Dosage | Frequency | Duration | Start Date | End Date | Notes |
|---|
Amoxicillin | 500 mg | Twice a day | 7 days | 01/01/2055 | 07/01/2055 | Take with food |
Lisinopril | 20 mg | Once daily | Indefinite | 01/01/2055 | N/A | Take in the morning |
Ibuprofen | 400 mg | Every 6 hours (PRN) | As needed | 01/01/2055 | N/A | Only for pain, max 4 doses |
Metformin | 500 mg | Twice a day | Ongoing | 01/01/2055 | N/A | Take with meals |
Additional Instructions
Store medications at room temperature unless otherwise specified.
Follow the exact dosage and timing prescribed.
Contact [YOUR NAME] immediately if any side effects occur.
Review medication with your physician during follow-up on 01/15/2055.
Signature
Physician's Signature:
Patient's Signature:
Emergency Contact
In case of emergency, contact [YOUR COMPANY NAME] at [YOUR COMPANY NUMBER].
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