Chinese Herbal Formula Please circle: Granules / Bulk For bulk formulas number of bags: HERB GRAM AMOUNT Date Patient Name: Address: Telephone: DOB: **Orders will be filled when payment information.
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How to fill out the Chinese Medicine Prescription Fax Form - Ncnm online
Filling out the Chinese Medicine Prescription Fax Form - Ncnm online requires attention to detail to ensure accurate information is provided. This guide will walk you through each section of the form, offering clear instructions to make the process straightforward.
Follow the steps to complete the Chinese Medicine Prescription Fax Form - Ncnm
- Press the ‘Get Form’ button to retrieve the Chinese Medicine Prescription Fax Form - Ncnm, making it accessible for completion.
- Indicate your choice of granules or bulk by circling the appropriate option. If selecting bulk, specify the number of bags in the designated field.
- Fill in the gram amount of the herb required and list the specific herb names in the provided space.
- Enter the date when the form is being filled out to establish a timeline for the prescription.
- Provide the patient’s full name, address, and telephone number. This information is crucial for contact and verification purposes.
- Document the patient's date of birth to ensure accurate identification.
- Input the doctor's name, address, and telephone number to facilitate communication regarding the prescription.
- Complete the cooking instructions for bulk herbs, specifying the number of cups of water and boiling time as needed.
- Indicate the dosage or SIG information for the prescription. This should detail how the herbs should be taken.
- Note the number of refills allowed as applicable, understanding that prescriptions may expire three months from the original date.
- Provide any additional instructions for consumption, such as temperature (warm, hot, or cold) and timing relative to meals.
- Finally, sign in the designated area to validate the prescription before submission.
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