Professional Documents
Culture Documents
BOARD REGULATION
NO 1, SERIES 2014
Comprehensive Amendments to
Board Regulation No. 3 Series 2003,
Indicate if NEW or
RENEWAL
Old S2-license for
surrender
PRC
signature
X
D c ript
R.
AIN LOREN
T FR Z
ANC O LOR
ion
10 ISH E
F3 OSP NS
ITAL
NAM
DAT E:_____
E _
ADD :05/01 _______
Prescription
____
/
____ RESS__ 2015
____
__ _ LOR_EN S
DR. LORENZ_O ____ ___
AINT FRANCIS H
OS_PI ___L_
__TA
____ 2
____
____
__
0F 3
___
NAME:__________
5
DATE:05/01/201
__ __ __
ADDRESS____ ___
__ ________________
________________ /201 5
d on 06/01
To be purchase
i pt i o n
r
Pre. LsORcENZO LOORSEPINTSAL 3
DR H
T F RANCIS
AIN
2015
0F 3 T E :0 5/01/
_ DA
_ _____ _ _
:_ _ __ _ __ ___ ___
NAME SS________ __________
E __
ADDR __________
_ _
______
USE OF SPFDD/ YELLOW PADS
Zolpidem
Buprenorphine
UNLAWFUL ACTS AND
PENALTIES
1. UNNECESSARY PRESCRIPTION OF
DANGEROUS DRUGS
-prescribing of dangerous drugs to any person
whose physical or physiological condition
does not require the use or in the dosage
prescribed therein
SCHEDULE
1
SCHEDULE SCHEDULE IV
4 (PSYCHOTROPICS)
a) Valid prescription
b) requisition sheet
i. shall be legible
ii. Specify complete name of the practitioner
iii. specify name, qty, form and strength of the
drug
iv. Specify the ward or dispensary where drug
is required
v. originally signed and dated by the nurse and
medical practitioner
vi. Countersigned by the pharmacist who
supply the drugs
REQUISITION SHEET
Shall bear the Hospital
Heading
Date
Pharmacists Decision
Remarks: qty of
unused, verbal order,
Signed by the ward out of stock procured
nurse before from another
Reference to submission to pharmacy outside the
requisition sheet pharmacist hospital
ADMINISTRATION SHEET
-controlled drug to be administered to patients from
unit dose or ward must be written for periods not to
exceed one (1) day