No. of designated medical institution: x		Prescription No.: x8
Name: Scccccccc	Gender: female	Age: x
Patient No.: x	Charging type: common public expense	Clinic department: Mental Health Care Division

 

Diagnosis: anorexia x
Name of medicine	Specification and quantity		Detailed using method		Remarks
Fluoxertine hydrochloride dispersible tablets	20 mg* 28 tablets ×3.00 box		60 mg/oral taking 1/ daily/x days
Sensitivity test:		Pharmacy: outpatient pharmacy		Physician signature (seal):x

 

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.