About patient:
Firs Name, Surname
Adam McIntosh
Address
London, 24 Walmer Gardens
Date of Birth
27.01.2000
Age
23 Yrs.
Pharmacy:
NHS: 123 123 1234
Total Pharmacy, Trinity Square, Axminster EX13 5AP
Private prescription
Finasteride 1mg tablets Take one daily 84 tablets
Signature of prescriber:
Date: 06.06.2025
About GP:
Firs Name, Surname
Dr. A Smith
Address
London, 24 Walmer Gardens
GPhC number:
2075280
Phone
(0)123 456 7890