INFORMATION ON YOUR REPEAT PRESCRIPTION

Patient I.D. 9999
Mrs Susan Patient
Burton Crescent
Headingley
LEEDS LS6 4DN

Your patient ID number is your unique number which you can quote when ordering your repeat prescription

Your name and address
Please tick box for medicine(s)
you require
Please allow 48 hours before collection

Instructions on how to use this form
Date Printed 02/03/2004

This slip was printed on this date
Co-codamol Tabs 8/500  [ ]
Take two four times a day as required
Quant: 100 tabs

Name of medication
How to take your medication
How many were issued
Quinine Sulphate tabs 30mg [ ]
Take one at night
Quant: 56 tabs
As above
Seretide 100 Accuhaler Dry
powder for inhalation
1 puff twice daily
Quant: 1 inhaler(s)
As above
Review date: 04/04/2004

These items can be re-ordered up until this date then they have to be re-authorised by your doctor before further prescriptions are issued. Your doctor may ask to see you for review of your medication.
Flu vaccine is available from October

Watch for messages here