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No. of designated medical institution: x |
Prescription No.: x8 |
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Name: Scccccccc |
Gender: female |
Age: x |
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Patient No.: x |
Charging type: common public expense |
Clinic department: Mental Health Care Division |
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Diagnosis: anorexia x |
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Name of medicine |
Specification and quantity |
Detailed using method |
Remarks |
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Fluoxertine hydrochloride dispersible tablets
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20 mg* 28 tablets ×3.00 box |
60 mg/oral taking 1/ daily/x days |
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Sensitivity test: |
Pharmacy: outpatient pharmacy |
Physician signature (seal):x |
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Amount of medicine: x.00 Yuan |
Prescription date: 0x June 30, x4 |
Reviewed/deployed by (seal): |
Checked/dispatched by (seal) |
* Tips of pharmacist: Please take the medicine according to doctor’s advice. The prescription is valid within three days. Please count the medicine at the counter. The medicine dispatched cannot be replaced.
