PRESCRIPTION FOR A PATIENT SUFFERING FROM LEPROMATOUS LEPROSY

PRESCRIPTION FOR A PATIENT SUFFERING FROM LEPROMATOUS LEPROSY

Name : Doctor’s name:

Age : Reg No.:

Sex:

Address:

DIAGNOSIS: LEPROMATOUS LEPROSY

· Tab. RIFAMPICIN 600mg

Dispense one tablet

one tablet to be taken orally under doctor supervision 30 min before food

· Tab. CLOFAZIMINE 100mg

Dispense 3 tablets

3 tablets to be taken stat orally under doctor supervision

· Tab. CLOFAZIMINE 50mg

Dispense 30 tablets

1 tablet daily self-administered for 1 month

· Tab. DAPSONE 100mg daily

Dispense 30 tablets

1 tablet daily self administered for 1 month

Review after 1 month

Signature of the doctor

Date

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