PRESCRIPTION
FOR A NEWLY DIAGNOSED CASE OF TYPE II DIABETES MELLITUS
Name : Doctor’s name:
Age : Reg No.:
Sex:
Address:
DIAGNOSIS:
NEWLY DIAGNOSED TYPE II DIABETES MELLITUS
Rx
·
Tab. METFORMIN 500mg
Dispense 60 tablets
1 tablet to be taken twice daily
before breakfast and lunch for 1 month
·
Tab. GLIMEPRIDE 2mg
Dispense 60 tablets
1 tablet to be taken twice daily
before breakfast and lunch for 1 month
Advice: diet control, regular
exercise
Review after 1 month
Signature of the doctor
Date
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