Medical Prescription Template

June 23, 2011

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: ___________________

Download Medical Prescription Template in Word Format

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