Prescription Allergy to Seafood

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Binh Thuan Medical Service
Dr.DONG’S Polyclinic

Phan Thiet, Date... 28....../....11......./...2011..................
Name of the subscriber (patient):
ALEXANDROVA OLGA
Date of brith:
06.03.1973.- Sex: Female.............
Address:
Room 4403, Sealion Resort, Phan Thiet, Viet Nam
Diagnosis :
Allegy to seafood
TREATMENT
Drugs :
1…Soli-medon 40 mg ……………
X
01
Bottles/ Ampules/ Tablets/ Packets/
Creame
Morning……1bot…………….Afternoon……………….……Evening…
Injection……IM………

Drinking/ To apply (………….minutes before meal/…………minutes

after meal
2…Cetirizin
10 mg …
X
10
…… Bottles/ Ampules/ Tablets/
Packets/ Creame
Morning……1 tab…………………….Afternoon…………….…Evening
1 tab
( 5
days)…
Injection……………

Drinking/ To apply (……30…….minutes before meal/………minutes

after meal)
3…Prednisolon.5 mg …………
X
20
…… Bottles/ Ampules/ Tablets/ Packets/
Creame
Morning……2 tabs…………………….Afternoon……2tabs……… Evening 2
… ( 5
days)
Injection…………… Drinking/ To apply (………….minutes before meal/… 30………minutes
after meal)
4…Genfrederm …………
X
01
…… Bottles/ Ampules/ Tablets/ Packets/
Creame
Morning……1 time…………………….Afternoon…………1time…………… Evening 1time
Injection…………… Drinking/ To apply (………….minutes before meal/… 30………minutes
after meal)

Surgery: ..........................................................................................................
Bandage change :
Instrutions :
- No alcohol for a week

Doctors’ Signature:

Add: 29A Nguyen Ñinh Chieu- Ham Tien ward - Phan Thiet City - Binh Thuan
Province - VIET NAM
Tel/ Fax : (+84)62 3741213
Mobile :
(+84) 918210504 - Email :
[email protected]

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