Doctor Receipt Template

July 1, 2011

A Doctor Receipt template is a document which defines the format in which a doctor receipt is designed. These types of receipt are prepared by doctors, physicians or hospitals to provide the medical prescription details of the treatment suggested by doctor. The template provides information regarding medicines prescribed to patient and it also includes the bill of medical treatment.

Sample Doctor Receipt Template

Receipt number_____________
Patient name____________ Age_______ Sex________
(This section provides general information about patient.)
Dieses/illness_________________ (The details of the medical treatment given will appear here.)
Drugs/medicines prescribed__________________
Tests and special treatment prescribed__________________
Results and reports of tests______________________
(Here the details of medical prescription will appear, filled by doctor.)
Further precautions and alerts suggested by doctor________________
Further test and operation or surgeries prescribed by doctor_______________
(This section gives information about future test/operations, Medicare prescribed by doctor.)
Next date of meeting___/___/___ (Here the doctor will mention the next date when the patient has to see him.)
Doctor Fee__________
Bill of medicines___________
Charges of medical tests_______________
(Here the medical treatment fee and charges will appear.)

Download Doctor Receipt Template in Word Format

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