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Upazila Health Complex
Kalihati, Tangail.
kalihati@uhfpo.dghs.gov.bd
Prescription #ID: 21
General Information
Patient Name
*
Address
*
Phone
*
Age
*
Date
*
Date Format: DD slash MM slash YYYY
Gender
*
Male
Female
Patient Additional Information
Patient Problems
Diagnostic Test
X-ray
ECG
Ultrasonography
Blood
Urine
Kaufgh
Others
Other Diagnostic Test
Prescription Information
Drug Name #1
*
Unit(Tablet/Syrup)
*
Dosage
*
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Drug Name #2
Unit(Tablet/Syrup)
Dosage
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Drug Name #3
Unit(Tablet/Syrup)
Dosage
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Drug Name #4
Unit(Tablet/Syrup)
Dosage
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Drug Name #5
Unit(Tablet/Syrup)
Dosage
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Drug Name #6
Unit(Tablet/Syrup)
Dosage
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Drug Name #7
Unit(Tablet/Syrup)
Dosage
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Drug Name #8
Unit(Tablet/Syrup)
Dosage
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Drug Name #9
Unit(Tablet/Syrup)
Dosage
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Drug Name #10
Unit(Tablet/Syrup)
Dosage
Dosage
1 + 1 + 1
0 + 1 + 0
1 + 0 + 1
0 + 0 + 1
1 + 0 + 0
Prescription Generated by Smarterdevs LLC
