Patient Medication Profile

LopezCare Profile

Date: December 1, 2020

PATIENT <,
INFORMATION
,,

Velasquez Address: #19 Bernal St., Brgy. Maligaya,

Sampaloc, Manila
Reynaldo A.
< < <

Prescriber’s Name: Dr. Rene Emilio Gutierrez.

Date of
Sex: Birth: Age: 55
Male May 18, years Special Precautions: Allergic to Amoxicillin
1965 old

MAINTENANCE MEDICATIONS << < <<

Drug Dosage
Route of Special
Frequency
<,,,, <<<
<

Generic Brand Form Strength Administration Instructions

Name Name
Losartan Cozaar® Tablet 50 mg Oral 1x/day -
Rosuvastatin Roswin® Tablet 10 mg Oral 1x/day Take at bedtime

PRN MEDICATIONS
(PRO RE NATA/ WHEN NEEDED)
<< < <<

Drug Dosage
Route of Special
Frequency
<,,,, <<<
<

Generic Brand Form Strength Administration Instructions

Name Name
Every shortness
<<

Albuterol Ventolin Inhaler 100 mcg Oral inhalation 2 puffs of breath

®

OTHER MEDICATIONS << < <<

Drug Dosage
Route of Special
Frequency
<,,,, <<<
<

Generic Brand Form Strength Administration Instructions

Name Name
Ascorbic - Tablet 500 mg Oral 1x/day Take after lunch
acid

Doctor’s Comments/ Changes:

Disclaimer:
This Medication Profile has been created after referencing the patient’s dispensing and medical history and personal interview. It depends
upon the accuracy and completeness of the information provided by the patient. It remains at all times the patient’s responsibility to advise
the pharmacist of any changes to their medication regimen. 
Pharmacist: Ma. Ellasanora N. Lopez Patient Name: Reynaldo A. Velasquez
Signature: ellalopez Signature: ravelasquez
Date: December 1, 2020 Date: December 1, 2020

Profile no.: LopezCare Pharmacy®

01235