12 Sample Prescriptions for Different Types of Doctors and Healthcare Professionals

This page is dedicated to providing you with examples and sample prescriptions for various types of doctors! Whether you are in need of a prescription for a specific condition, or simply curious about what a typical prescription looks like, this page has you covered. We have organized the samples by specialty, including prescriptions for Dentists, cardiologists, gynecologists, Andrologists, Sexologists, Urologists, Hematologists, and more. Each sample prescription includes important information such as the patient’s name, date, medication, dosage, route, frequency, and notes and recommendations from the doctor.

These sample prescriptions are a great resource for anyone who wants to better understand the information provided by their doctor and the medication or treatment being prescribed. If you have any questions or concerns, please consult with your healthcare provider. Browse through our collection of sample prescriptions and find the information you need to take control of your health and well-being.

Sample Prescription # 1 – For a Dentist

Prescription for: [Patient Name]

Date: [Date]

To [Dentist Name],

I am writing this prescription for [Patient Name], who is under my care for dental treatment. The following medications are being prescribed to aid in their recovery:

Amoxicillin 500mg: Take two capsules three times a day for 7 days.
Ibuprofen 200mg: Take two tablets three times a day as needed for pain relief.
Chlorhexidine Mouthwash 0.12%: Rinse with 10ml for 30 seconds twice a day after brushing for 7 days.

Please monitor the patient’s progress and report any adverse reactions or unusual symptoms to me as soon as possible.

Best regards,

[Your Name],
[Your Title]
[Your License Number]

Sample # 2 – For a Cardiologist

Prescription for: [Patient Name]

Date: [Date]

To [Dentist Name],

I am writing this prescription for [Patient Name], who is under my care for dental treatment. The following medications are being prescribed to aid in their recovery:

Amoxicillin 500mg: Take two capsules three times a day for 7 days.
Ibuprofen 200mg: Take two tablets three times a day as needed for pain relief.
Chlorhexidine Mouthwash 0.12%: Rinse with 10ml for 30 seconds twice a day after brushing for 7 days.

Please monitor the patient’s progress and report any adverse reactions or unusual symptoms to me as soon as possible.

Best regards,
[Your Name],
[Your Title]
[Your License Number]

Sample # 3 – For Ophthalmologists

Prescription for: [Patient Name]

Date: [Date]

To [Ophthalmologist Name],

I am writing this prescription for [Patient Name], who is under my care for ophthalmic treatment. The following medications are being prescribed to aid in their recovery:

Prednisolone Acetate 1% Eye Drops: Instill one drop in the affected eye four times a day for 2 weeks.

Tobramycin 0.3% Eye Drops: Instill one drop in the affected eye three times a day for 2 weeks.

Artificial Tears: Instill one drop in each eye as needed for dry eye symptoms.

Please monitor the patient’s progress and report any adverse reactions or unusual symptoms to me as soon as possible.

Best regards,
[Your Name],
[Your Title]
[Your License Number]

Sample # 4 – For Dermatologist

Prescription for: [Patient Name]

Date: [Date]

To [Dermatologist Name],

I am writing this prescription for [Patient Name], who is under my care for dermatological treatment. The following medications are being prescribed to aid in their recovery:

1. Tretinoin 0.05% Cream: Apply a thin layer to affected areas once a day before bedtime.
2. Mometasone Furoate 0.1% Ointment: Apply a thin layer to affected areas twice a day for 2 weeks.
3. Hydrocortisone 1% Cream: Apply a thin layer to affected areas as needed for itching or redness.

Please monitor the patient’s progress and report any adverse reactions or unusual symptoms to me as soon as possible.

Best regards,

[Your Name],
[Your Title]
[Your License Number]

Sample # 5 – For a Neurologist

Prescription for: [Patient Name]

Date: [Date]

To [Neurologist Name],

I am writing this prescription for [Patient Name], who is under my care for neurological treatment. The following medications are being prescribed to aid in their recovery:

Gabapentin 300mg: Take one capsule three times a day for pain management.

Levodopa/Carbidopa 100/25mg: Take one tablet three times a day to improve mobility.

Memantine 10mg: Take one tablet once a day to improve memory and cognitive function.

Additionally, please advise the patient to participate in physical and occupational therapy to help manage their symptoms.

Please monitor the patient’s progress and report any adverse reactions or unusual symptoms to me as soon as possible.

Best regards,

[Your Name],
[Your Title]
[Your License Number]

Sample # 6 – For a Dietitian & Nutritionist

Prescription for: [Patient Name] Date: [Date]

To [Dietitian Name],

I am writing this prescription for [Patient Name], who is under my care for nutrition management. The following diet plan is recommended to aid in their health and wellness:

1. Daily Caloric Intake: [Insert recommended daily caloric intake based on patient’s age, gender, weight, height, and activity level].
2. Macronutrient Ratio: [Insert recommended macronutrient ratio based on patient’s goals, such as weight loss, weight maintenance, or weight gain].
3. Hydration: Encourage the patient to drink at least 8 cups of water per day, along with low-sugar, non-alcoholic beverages.

Food Group Recommendations:

1. Grains: [Insert recommended serving size and frequency of whole grains, such as brown rice, whole wheat bread, and oatmeal].
2. Proteins: [Insert recommended serving size and frequency of lean proteins, such as chicken, fish, beans, and tofu].
3. Vegetables: [Insert recommended serving size and frequency of non-starchy vegetables, such as broccoli, spinach, and bell peppers].
4. Fruits: [Insert recommended serving size and frequency of low-sugar fruits, such as berries, apples, and pears].
5. Dairy: [Insert recommended serving size and frequency of low-fat dairy products, such as milk, yogurt, and cheese].
6. Fats: [Insert recommended serving size and frequency of healthy fats, such as olive oil, avocados, and nuts].

Please monitor the patient’s progress and adjust their diet plan as needed to ensure they are meeting their health and wellness goals.

Best regards,

[Your Name], [Your Title] [Your License Number]

Sample # 7 – For Obstetrician/Gynecologist

Prescription for: [Patient Name] Date: [Date]

To [Obstetrician/Gynecologist Name],

I am writing this prescription for [Patient Name], who is under my care for gynecological treatment. The following medications are being prescribed to aid in their recovery:

1. Metronidazole 500mg: Take two tablets twice a day for 7 days for bacterial vaginosis.
2. Levonorgestrel 0.75mg: Take one tablet once a day for emergency contraception.
3. Calcium Carbonate 600mg: Take two tablets three times a day to support bone health.

[Patient Name] should also inform their gynecologist of any other medications they are taking, including over-the-counter supplements and herbal remedies.

By following this prescription and working with their healthcare team, [Patient Name] can expect to see improvement in their symptoms and overall gynecological health.

Please monitor the patient’s progress and report any adverse reactions or unusual symptoms to me as soon as possible.

Best regards,

[Your Name], [Your Title] [Your License Number]

Sample # 8 – For Pediatrician

Prescription for: [Patient Name] Date: [Date]

To [Pediatrician Name],

I am writing this prescription for [Patient Name], who is under my care for pediatric treatment. The following medications are being prescribed to aid in their recovery:

1. Amoxicillin 250mg/5ml: Give 2.5ml three times a day for 10 days for bacterial infection.
2. Acetaminophen 160mg/5ml: Give 4ml every 4-6 hours as needed for fever and pain management.
3. Multivitamin Drops: Give 1 drop daily to support overall health and nutrition.

In addition to the above medications, please advise the following to the parents or guardians of the patient:

1. Encourage the patient to get plenty of rest and stay hydrated.
2. Ensure that the patient follows a balanced diet with plenty of fruits and vegetables.
3. Keep the patient’s follow-up appointments and bring any concerns or questions to the next visit.
4. Avoid exposing the patient to any known allergens or irritants.

Please monitor the patient’s progress and report any adverse reactions or unusual symptoms to me as soon as possible.

Best regards,

[Your Name], [Your Title] [Your License Number]

Sample # 9 – For Psychiatrists

Prescription for: [Patient Name] Date: [Date]

To [Psychiatrist Name],

I am writing this prescription for [Patient Name], who is under my care for psychiatric treatment. The following medications are being prescribed to aid in their recovery:

1. Escitalopram 10mg: Take one tablet once daily in the morning for depression.
2. Clonazepam 0.5mg: Take one tablet at bedtime as needed for anxiety.

In addition to the above medications, I would like to recommend the following to the patient:

1. Attend regularly scheduled therapy sessions with a mental health professional.
2. Engage in regular physical activity, such as going for a walk or participating in a sport.
3. Practice stress management techniques, such as deep breathing, meditation, or yoga.
4. Avoid alcohol and recreational drugs, as they can interfere with the effectiveness of the prescribed medications.
5. Seek support from friends and family members, or consider joining a support group.

Please monitor the patient’s progress and report any adverse reactions or unusual symptoms to me as soon as possible.

Best regards,

[Your Name], [Your Title] [Your License Number]Top of Form

Sample # 10 – For Urologist (Female Patient)

Patient name: Sarah Smith Date: 2023-02-10

Medication: Tamsulosin (Flomax) Dosage: 0.4 mg Route: Oral Frequency: Once daily, before bedtime

Doctor’s Recommendations:

1. Take the medication at the same time each day to maintain consistent levels in the body.
2. Avoid driving or operating heavy machinery for at least 4 hours after taking the medication.
3. Contact your doctor if you experience any symptoms of hypotension, such as dizziness or fainting.

Suggestions:

1. Drink plenty of water to help prevent urinary tract infections.
2. Maintain a healthy weight and avoid constipation to reduce the risk of urinary problems.
3. Practice good hygiene, such as wiping from front to back after using the toilet.

Important notes:

1. This medication is for benign prostatic hyperplasia (BPH).
2. Inform your doctor if you are taking any other medications or have any allergies.
3. Contact your doctor immediately if you experience any persistent or worsening symptoms.

Signed, Dr. Michael Johnson Urologist

Sample # 11 – For Andrologists/Sexologists (Male Patient)

Patient name: John Doe

Date: 2023-02-10

Medication: Sildenafil (Viagra)
Dosage: 50 mg
Route: Oral
Frequency: As needed, 1 hour before sexual activity

Doctor’s Recommendations:

1. Avoid taking more than 1 dose per 24 hours.
2. Avoid taking the medication with a high-fat meal as it can decrease the effectiveness.
3. Avoid consuming alcohol as it may increase the risk of side effects.

Suggestions:

1. Practice safe sex.
2. Maintain a healthy lifestyle, including regular exercise and a balanced diet.
3. Address any underlying psychological or relationship issues that may be affecting your sexual health.

Important notes:

1. This medication is for erectile dysfunction.
2. Contact your doctor immediately if you experience any adverse reactions.
3. Keep this medication out of reach of children.

Signed,

Dr. Jane Doe
Andrologist/Sexologist/Urologist

Sample Prescription # 12 – For Hematologists

Patient name: Michael Brown

Date: 2023-02-10

Medication: Ferrous sulfate (Feosol)
Dosage: 325 mg
Route: Oral
Frequency: 2 tablets, 3 times daily with meals

Doctor’s Critical Notes:

Monitor for symptoms of iron overload, such as joint pain or abdominal discomfort.

Avoid taking this medication within 2 hours of taking any antacids or calcium supplements.

Inform your doctor if you have a history of gastrointestinal bleeding or any other bleeding disorders.

Suggestions:

Maintain a balanced and varied diet, including sources of iron such as red meat, poultry, and leafy greens.

Avoid taking this medication on an empty stomach, as it may cause nausea or stomach upset.

Take this medication with a full glass of water to improve absorption.

Important Notes:

This medication is for the treatment of iron-deficiency anemia.

Store this medication in a cool, dry place and protect it from light.

Contact your doctor immediately if you experience any adverse reactions or symptoms of anemia.

Signed,

Dr. Elizabeth Lee
Hematologist

Disclaimer: The sample prescriptions and medicine names provided on this page are for informational purposes only and should not be used for actual medical treatment. The information contained in these sample prescriptions may not reflect the most up-to-date medical knowledge or practices and should not be relied upon as professional medical advice. Always consult with a licensed healthcare provider for proper diagnosis and treatment recommendations. The use of the medication names and dosages provided in these samples is for illustration purposes only and should not be used to self-diagnose or self-treat any medical condition. The use of any medication or treatment should only be done under the supervision of a licensed healthcare provider. This page is not intended to replace the advice of a medical professional and is not responsible for any adverse effects or consequences resulting from the use of the information provided.