Dr Dhruva Ramachandran Dr Dhruva Ramachandran

Illawarra Medical Centre Illawarra Medical Centre

229 Illawarra Crescent 229 Illawarra Crescent
Ballajura 6066 Ballajura 6065
PrescrilF4148 92086400 Fax: 08 92481611 PrescriEeNcP8 92086400 Fax: 08 92481611
2382382 2382382
Patient's Medicare no. 6122027429-2 6122027429-2
Patient's Medicare no.
Pharmaceutical
benefits Pharmaceutical
benefits
entitlement no. _________ entitlement no
Concessional or dependant PBS Safety Net Concessional or dependant
RPBS beneficiary or PBS Safety entitlement cardholder RPBS beneficiary or PBS Safety
Net concession cardholder (cross relevant box) Net concession cardholder
Patient's name Non PBS57
PBS Safety Net Patient's name
GaudNguyen Tin "Cin" Nguyen
Address entitlement
Address
cardholder (crossalupe
relevant 6066 57 Gaudalupe Drive
Drive ID: 507442 Ballajura 6066
Date 06/06/2015 Tin "Cin" box) not permitted
pg(XXXXXXRV3XX Script Date 06/06/2015 Script ID: 507442
XX Brand WXXXXX XXXX Brand substitution not permitted
substitution Non P
Ballajura
Aerius 5mg Tablet Aerius 5mg Tablet
1 Before bed after meals As directed for 1 week 1 Before bed after meals As directed for 1 week
Quantity: 7. 2 repeats. Quantity: 7. 2 repeats. _______
Otrivin Adult 1 mg/ml Nasal Spray Otrivin Adult 1 mg/ml Nasal Spray
Apply Twice a day to affected areas Apply Twice a day to affected areas
Quantity: 1*10mL. 2 repeats. Quantity: 1*10mL. 2 repeats.
2 items printed.. 2 items printed.

......._,...
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Dr Dhruva Ramachandran Dr Dhruva Ramachandran

MBBS, MAFP, FRACGP, DFM, DPD MBBS, MAFP, FRACGP, DFM, DPD

Turn over for privacy notice Turn over for privacy notice
I

dellil1iiiii111111311111111111 Date of supply

Agent's address

Issued under Poisons Reg. 37(1)(ba) Issued under Poisons Reg. 37(1)(ba)
PB023 1408

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