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Medication Ticket

DAY 1

(Name of Patient) (Date Ordered)

23 y.o
Room No.

8: 00 am

Hospital No.

(Patient’s Address) (Age)

Ferrus Sulfate ( Hemarate) 1 tab OD in Am


(Medication as ordered)
Hatague F. Mutia M.

(Prescribing Doctor) MUSN CI

(Name of Patient) (Date Ordered)

23 y.o
Room No.

8: 00 am

Hospital No.

(Patient’s Address) (Age)

Folic Acid ( Folvite) 1 tab OD in Am


(Medication as ordered)
Hatague F. Mutia M.

(Prescribing Doctor) MUSN CI

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