Free Prescription Label PDF Form
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Preview - Prescription Label Form
Prescription Labels
When you go to a doctor, for a
The label on your prescription has important information. This information will be on the label. Some labels may have it in a different order.
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Main Street Pharmacy |
(612) |
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1200 Main Street North, Minneapolis, MN |
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Dr. R. Wilson |
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Rx No: 300443 |
01/04/2005 |
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JOHN JOHNSON |
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Dose: TAKE ONE TABLET BY MOUTH, DAILY. |
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Zocor Tabs Mfg Merck |
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Qty: 30 |
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REFILLS: 3 BEFORE 12/08/05 |
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Number 1 is the name, address and phone number of the pharmacy that filled the prescription. This is from "Main Street Pharmacy".
Number 2 is the name of the doctor. Doctor R. Wilson prescribed this medicine.
Number 3 is the prescription number, which begins with the abbreviation "Rx" or "No". This prescription number is 300443.
Number 4 is the name of the patient. This medicine is for John Johnson. No one else should take this medicine.
Number 5 tells how much medicine to take and when to take it. This may be written after the word "Dose". John should take 1 tablet once a day.
Number 6 is the name of medicine, and the name of the company that manufac- tured it. This medicine is called "Zocor", and Merck makes it.
Number 7 is the number of tablets. This may be written after the abbreviation "Qty" or the word "Quantity". This prescription is for 30 pills.
Number 8 is the number of refills available. When no refills are available the number will be "0".
Number 9 is the expiration date of the prescription. This may be written after "refill before" or the abbreviation "Exp". This is the last date the pharmacy can refill the prescription.
For more information about OTC medicine labels see OTC Labels. For more information about warning labels see Warning Labels.
For more information about the side effects of medicine see Side Effects.
The LaRue Medical Literacy Exercises were created by Charles LaRue through a grant from the Minnesota Department of Education under the supervision of the Minnesota Literacy Council.
©2005 MN Dept of Education
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Similar forms
The Prescription Label form serves a vital role in the healthcare system, providing essential information about medication. Several other documents share similarities with the Prescription Label form in terms of purpose and content. Below are seven documents that are comparable to the Prescription Label form:
- Medication Administration Record (MAR): This document tracks the administration of medications to patients, detailing dosage, time, and the individual responsible for giving the medication. Like the Prescription Label, it ensures that patients receive the correct medication at the right time.
- Patient Medication Information Leaflet: This leaflet provides patients with detailed information about their medications, including potential side effects and usage instructions. Similar to the Prescription Label, it aims to educate patients about their treatment.
- Medication Reconciliation Form: This form is used to compare a patient's medication orders to all medications that the patient has been taking. It ensures continuity of care, much like the Prescription Label, which summarizes the prescribed medication for easy reference.
- Drug Utilization Review (DUR) Report: This report evaluates the appropriateness of prescribed medications. It shares the goal of ensuring safe and effective medication use, similar to the information provided on a Prescription Label.
- Operating Agreement: Similar to the above documents, an Operating Agreement provides crucial information regarding the management and operation of an LLC, ensuring that all members are well-informed about their roles and responsibilities. For further details, you can refer to the pdftemplates.info/operating-agreement-form/.
- Pharmacy Dispensing Record: This document records the details of medications dispensed by a pharmacy, including patient information and medication specifics. Like the Prescription Label, it is crucial for tracking medication history.
- Clinical Trial Consent Form: This form outlines the details of a clinical trial and the medications involved. It serves to inform participants, akin to how the Prescription Label informs patients about their medications.
- Medication Therapy Management (MTM) Plan: This plan outlines a patient's medication regimen and management strategies. It is similar to the Prescription Label in that it aims to optimize therapeutic outcomes for patients.