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Patient details

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Age

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DOB

Phone

Address

Vitals

Height (cms)

Weight (Kgs)

Temp (F)

BP (mm.Hg)

Pulse (b.p.m)

Resp. rate

Spo2 (%)

Notes

Complaints

Findings

Investigations

Diagnosis

℞

Drug	Dose & freq.	Duration	Instructions	Actions
Tab. PARACETAMOL	650mg TID	7 days	If fever >100 F	delete edit add
Tab. PANTOPRAZOLE	40mg OD	7 days	Before breakfast	delete edit add

Followup and advise

Advise

Followup date

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Drug

Dose&Freq.

Duration

Instructions

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