Hospital Prescription
[YOUR COMPANY NAME]
Patient Information
Name: Talia Jacobs
Date of Birth: January 15, 2050
Patient ID: 123456789
Prescribing Physician Information
Physician Name: [YOUR NAME]
License Number: ABC123456
Specialization: Internal Medicine
Contact Information: [YOUR EMAIL]
Prescription Details
Date of Prescription: March 1, 2080
Medication Name: Amoxicillin
Dosage Form: Capsule
Strength: 500 mg
Quantity: 30 capsules
Instructions for Use:
Take one capsule by mouth every 8 hours for 10 days.
Take with food to avoid stomach upset.
Finish the entire course of medication even if symptoms improve.
Refills Authorized: 0
Substitution Allowed:
Warnings and Precautions
Seek immediate medical attention if you experience any severe allergic reactions such as difficulty breathing, hives, or swelling of the face, lips, tongue, or throat.
Inform your physician of any existing medical conditions, particularly kidney disease, asthma, or a history of allergies.
Additional Notes
Physician Signature:
[YOUR NAME]
Date: March 1, 2080
Pharmacy Use Only
Date Dispensed: ___________________
Dispensed by: _____________________
Notes: _____________________________
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