Great Clinic Donna Lee
665 Roadsby Road DEA: ________________________
Longview, FL 333222
Tel:000-000-0000
Fax: 000-000-0000
Patient Name & Address Date of Birth
John Carl Lacerna 11/19/2001
Medical Record #
,
0000000058
Prescriptions
Rx: Paracetamol 500 mg [tablet]
Disp #: 10
Sig: q.6h tablet By Mouth p.r.n.
Refills: 0 (Zero)
Take every 6 hours as needed for fever/pain.
Rx: Ibuprofen 400 mg [tablet]
Disp #: 10
Sig: q.8h tablet By Mouth p.r.n.
Refills: 0 (Zero)
Take every 8 hours as needed for pain.
Signature:________________________________
Date: 2025-03-11