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The document contains prescription forms from Drogalife Drugstore located in Brgy. 111, Poblacion, La Carlota City 6130. Each form has spaces to provide information such as generic name, brand name, manufacturer, lot number, dosage strength, expiry date, directions for use, prescribing physician, dispensing pharmacist, and patient name. There are 6 identical prescription forms shown.

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Dee Belarmino
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We take content rights seriously. If you suspect this is your content, claim it here.
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3K views1 page

White Label

The document contains prescription forms from Drogalife Drugstore located in Brgy. 111, Poblacion, La Carlota City 6130. Each form has spaces to provide information such as generic name, brand name, manufacturer, lot number, dosage strength, expiry date, directions for use, prescribing physician, dispensing pharmacist, and patient name. There are 6 identical prescription forms shown.

Uploaded by

Dee Belarmino
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Prescription Forms

DROGALIFE DRUGSTORE DROGALIFE DRUGSTORE

BRGY. 111, POBLACION, LA CARLOTA CITY 6130 BRGY. 111, POBLACION, LA CARLOTA CITY 6130

Generic name: Generic name:


Brand name: Brand name:
Manufacturer: Lot no.: Manufacturer: Lot no.:
Dosage strength: Expiry date: Dosage strength: Expiry date:
Direction for use: Direction for use:
Pharmacist: Pharmacist:
Physician: Physician:
Name of Patient: Name of Patient:

DROGALIFE DRUGSTORE DROGALIFE DRUGSTORE


BRGY. 111, POBLACION, LA CARLOTA CITY 6130 BRGY. 111, POBLACION, LA CARLOTA CITY 6130

Generic name: Generic name:


Brand name: Brand name:
Manufacturer: Lot no.: Manufacturer: Lot no.:
Dosage strength: Expiry date: Dosage strength: Expiry date:
Direction for use: Direction for use:
Pharmacist: Pharmacist:
Physician: Physician:
Name of Patient: Name of Patient:

DROGALIFE DRUGSTORE DROGALIFE DRUGSTORE


BRGY. 111, POBLACION, LA CARLOTA CITY 6130 BRGY. 111, POBLACION, LA CARLOTA CITY 6130

Generic name: Generic name:


Brand name: Brand name:
Manufacturer: Lot no.: Manufacturer: Lot no.:
Dosage strength: Expiry date: Dosage strength: Expiry date:
Direction for use: Direction for use:
Pharmacist: Pharmacist:
Physician: Physician:
Name of Patient: Name of Patient:

DROGALIFE DRUGSTORE DROGALIFE DRUGSTORE


BRGY. 111, POBLACION, LA CARLOTA CITY 6130 BRGY. 111, POBLACION, LA CARLOTA CITY 6130

Generic name: Generic name:


Brand name: Brand name:
Manufacturer: Lot no.: Manufacturer: Lot no.:
Dosage strength: Expiry date: Dosage strength: Expiry date:
Direction for use: Direction for use:
Pharmacist: Pharmacist:
Physician: Physician:
Name of Patient: Name of Patient:

DROGALIFE DRUGSTORE DROGALIFE DRUGSTORE


BRGY. 111, POBLACION, LA CARLOTA CITY 6130 BRGY. 111, POBLACION, LA CARLOTA CITY 6130

Generic name: Generic name:


Brand name: Brand name:
Manufacturer: Lot no.: Manufacturer: Lot no.:
Dosage strength: Expiry date: Dosage strength: Expiry date:
Direction for use: Direction for use:
Pharmacist: Pharmacist:
Physician: Physician:
Name of Patient: Name of Patient:

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