A Medical prescription template shows how a medical practitioner and physician have framed their instructions for their patients. Such kind of prescriptions governs the plan of health care for an individual patient and helps in proper treatment.
Sample Medical Prescription Template
Name of the patient: ___________________________________
Date of birth: ____________ Age: _______________
Contact Details: _______________________ [mention complete contact details of a patient]
Date: ____________ [Mention the date on when the prescription is being written]
Diagnosed with: ___________________ [Name of the illness that the patient is suffering from]
Blood pressure: _________________ Pulse rate ________________
Drug Unit (tablet, ox or syrup) Dosage (per day)
_____________ __________________ _____________
_____________ __________________ _____________
_____________ __________________ _____________
_____________ __________________ _____________
______________ __________________ _____________
Examination to be done (if any): ___________________________________ [mention the name of the examination that a patient needs to do
Things to follow: _________________________________ [mention if there are any health regimes a patient needs to follow regularly]
Signature of the physician: ________________________
Date: ___________________