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Prescription duration

Starting date

Ending date

Days of pickup

Daily

Weekly

Other frequency

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

First pickup date

Frequency in days

Posology

Daily dosage (mg)

DIE

BID

TID

QID

Patient must be here every dosage

Dose #1 2 mg tablets 8 mg tablets 12 mg tablets 16 mg tablets

Dose #2 2 mg tablets 8 mg tablets 12 mg tablets 16 mg tablets

Dose #3 2 mg tablets 8 mg tablets 12 mg tablets 16 mg tablets

Dose #4 2 mg tablets 8 mg tablets 12 mg tablets 16 mg tablets

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