Binh Thuan Medical Service

Dr.DONGS Polyclinic

Phan Thiet, Date... 30....../....12......./...2011..................

Name of the subscriber (patient):
Date of brith:
Address:
Room 609,
Nam
Diagnosis :

CAROLINE ALSERWALL
23.12.1985 - Sex: Female.............
Bamboo village resort, Phan Thiet, Viet
Sun allergy on face

TREATMENT
Drugs :
1Soli-medon 40 mg
X
01
Bottles/ Ampules/ Tablets/ Packets/
Creame
Morning1bot.Afternoon.Evening
InjectionIM

Drinking/ To apply (.minutes before meal/minutes

after meal
2Cetirizin
10 mg
X
10
Bottles/ Ampules/ Tablets/
Packets/ Creame
Morning1 tab.Afternoon.Evening 1 tab
( 5 days)

Injection

Drinking/ To apply (30.minutes before meal/minutes

after meal)
3Prednisolon 5mg
X
20
Bottles/ Ampules/ Tablets/ Packets/
Creame
Morning2 tabs.Afternoon Evening 2 tabs
( 5
days)
Injection Drinking/ To apply (.minutes before meal/ 30minutes
after meal)

Surgery: ..........................................................................................................
Bandage change :
Instrutions :
- No alcohol for a week
Doctors Signature:

Add: 29A Nguyen inh Chieu- Ham Tien ward - Phan Thiet City - Binh Thuan
Province - VIET NAM
Tel/ Fax : (+84)62 3741213
Mobile :
(+84) 918210504 - Email :
dr.vohongdongbt@yahoo.com.vn