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  • DD 1289 Control

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    Doctor Motrin
    133 views2 pages
    A sample prescription form from the USS Castro medical facility provides medication instructions for a patient named Martin Castro. The form lists the patient's name, date of birth, military identification number, department, and berthing information. It also includes spaces for the prescribing physician to fill in medication details such as name, dosage, quantity, and expiration date. The patient signs to acknowledge receipt of the prescribed medication.

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    Original Title

    DD 1289 CONTROL

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    A sample prescription form from the USS Castro medical facility provides medication instructions for a patient named Martin Castro. The form lists the patient's name, date of birth, military identification number, department, and berthing information. It also includes spaces for the prescribing physician to fill in medication details such as name, dosage, quantity, and expiration date. The patient signs to acknowledge receipt of the prescribed medication.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    133 views2 pages

    DD 1289 Control

    Uploaded by

    Doctor Motrin
    A sample prescription form from the USS Castro medical facility provides medication instructions for a patient named Martin Castro. The form lists the patient's name, date of birth, military identification number, department, and berthing information. It also includes spaces for the prescribing physician to fill in medication details such as name, dosage, quantity, and expiration date. The patient signs to acknowledge receipt of the prescribed medication.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    SAMPLE DD 1 �lll!

    r11
    DOD PRESCRIPTION
    1289 SAMPLE
    ( If u(ldW 12 y,ari, gtv• sge. I
    NAME: ALLERGIES:
    DOB:
    DODID:
    DEPT / DIV: CO SIGNATURE:

    BERTHING / RACK: ___________________________


    MEDICAL FACILITY
    USS CASTRO

    ORL or ml,

    NR
    MFGR; Ei)(P DATE:
    LOT NO: flLLl!D BY:

    MARTIN CASTRO
    C21- HM2 NPI: 0529
    � NUMBER S!ONATURI!, RANILAND Dl!�flEI!
    SAMPLE EotTION OF 1 JAN tiO MAY BE USED, SAMPLE
    I HAVE RECEIVED
    __________TABS / CAPS / OTHER:_________
    OF___________________

    PATIENT NAME:

    DOB:

    CONTACT INFO:

    ADDRESS:

    BERTHING / RACK:

    PHONE #:

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