About patient:
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Firs Name, Surname
Adam McIntosh
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Address
London, 24 Walmer Gardens
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Date of Birth
27.01.2000
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Age
23 Yrs.
Pharmacy:
NHS: 123 123 1234
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Total Pharmacy, Trinity Square, Axminster EX13 5AP
Private prescription
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Finasteride 1mg tablets Take one daily 84 tablets
Signature of prescriber:
Date: 04.12.2024
About GP:
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Firs Name, Surname
Dr. A Smith
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Address
London, 24 Walmer Gardens
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GPhC number:
2075280
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Phone
(0)123 456 7890