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DEPARTMENT OF PHARMACY
1
Prescription blank
Color : white
Measurement / size
Form
Name
:
Address
:
License of practice :
Bandung, .
R/
Pro
:
Age :
Address :
Patient information
Date
R/ symbol or Superscription
Medication prescribed or Inscription
Dispensing direction to pharmacist or Subscription
Directions for patient or Signa (to be placed on label)
Refill, special labeling and/or other instructions
Prescribers signature, address and other pertinent
information
5
1.
Patient information
- The full name
- Address
- Age and/or weight
2.
Date
The time they are written and received and filled in
the pharmacy.
Important for the medication record of the
patient.
Drug abuse control < 6 months after the date
prescribed.
3.
R/ = symbol or superscription
Contraction of the Latin verb recipe
Meaning take thou or you take
6
10
Abbreviation
ad
ac
bid
cap
collut
collyr
dtd
dil
f
gtt
hs
I
III
Meaning
To, up to
Before meal
Twice a day
Capsule
A mouth wash
An eye wash
Les such doses be given
Diluted
Make, let it be made
A drop
At bed time
One
three
Indonesia
Sampai
Sebelum makan
Dua kali sehari
Kapsul
Cuci mulut
Cuci mata
Larutkan
Buatlah
Tetes
Malam hari
Satu
Tiga
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2.
3.
4.
5.
6.
7.
8.
9.
Marry Jones
1114 Grady Avenue
Athens, Georgia 123456
Date : 5-16-06
R/
Codeine Sulfate Tabs 30 mg
Dispense tabs No.12
Sign. Tab i q 6h prn pain
Refills : 0 Label : yes
John Brown, MD (signature)
1600 Main Street
Atlanta Georgia
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Patients name
: Marry Jones
Address: 1114 Grady Avenue
Date : 5-16-06
R/
Codeine Sulfate Tabs 30 mg No.XII
S. tab 1 . q . h . Prn pain
_________#______________
Refill
Label
: 1234
:
John Brown, MD
1600 Main Street
Atlanta Georgia
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PHYSICIANS PRESCRIPTION
In Indonesia
Name
:
Specialist
:
Address
:
License of Practice
Prescriber information
Bandung,2006
R/
Date
Superscription
Inscription
Subscription
Signatura
Patient information
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CLASSES OF PRESCRIPTION
1. Formula officinales ( Precompounded )
2. Formula Magistrales ( Compounded )
1. Precompounded
name of preparation ; Amoxycillin, Intermoxil
dosage form i.e.tablet, capsule, syrup, ointment
single dose
frequency of administration
duration of therapy
R/
R/
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2. Compounded
R/
Acetaminophen
Chlorpheniramin maleate
Dextrametorphan HBr
Sach. Lactis
M.f.pulv dtd No.IX
S.3.d.d pulv.1
250 mg
2 mg
10 mg
q.s.
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Individual patient
Dose
Dosage form
Route of administration
Duration of medication
No or minimum adverse drug interaction
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Rasional Prescribing :
1.
2.
3.
4.
5.
6.
19
1.
20
0,24 g
7,2 g
120 ml.
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5. Latin is regularly employed for the name of the ingredients and for
the directions for compounding, when in doubt as to the correct Latin
expression write in English.
6. When writing for more than the ordinary dose of the potent drug, as
for
R/Strychnine Hydrochloride 10 mg. ( initial ) !
7. This part of the prescription usually consist of:
a. The Basic or principal active ingridient.
b. The Adjuvant or that which assists its action
c. The Corrigens ( Corrective ) or that which correct its operations.
d. The Vehicle or Excipient which imparts an agreeable form.
R/Magnesil Sulphatis .......Basic........ ...R/Thiophylini
Extra.Sennae. Lig .........Adjuvant...... Ephedrini HCL.
Tinct. Cardam. Co. ......Corrective......Phenobarbital
Aquam q. s. ad. .........Vehicle..........Sach. Lactis. q. s.
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M. D. S. gutt. nasal
M. D. S. gutt. auric
M. D. S. gutt. Opth
M. D. S. collyrium
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OFTEN, W H E N and IN
s. d.d.
= S. 1. d.d.
= semel de die = 1x/day
b. d.d.
= S. 2. d.d.
= bis de die
= 2x/day
t. d.d.
= S. 3. d.d.
= ter de die
= 3x/day
q. d.d.
= S. 4. d.d.
= quarter de die = 4x/day
p. r. n.
= pro renate
= if necessary
n. s. = si necesse sit = if necessary
s. o. s.
= si opus sit
= if necessary
u. i. = usus internus = internal medicine
p. i. = pro injectionem
= untuk suntikan
part. dol. Applic.= part dolente applicatum pakai pada bagian yang sakit
lo. Aig.= locus aigen = tempat bagian yang sakit
lo. Dol.= locus dolens = tempat terasa sakit
Ext. s. alut.
= extenus supra alutan
= oleskan pada kulit lunak
ext. s cort
= extende supra cortium = oleskan pada kulit keras
ext. cres
= extende cra
= oleskan tebal - tebal
fem. Intern
= remoris internis paha bagian dalam
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