Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the form in an editable format.
2. Begin by entering the patient’s details. This includes the full name, year of birth, and identification number.
3. Fill out the prescription section. Include the medication name, pharmaceutical form, route of administration, dose per unit, and the number of units per package.
4. Indicate the duration of the treatment by specifying the total number of units required.
5. Record the prescription's order number and the expected date of dispensing.
6. Complete the prescriber details, including full name, registration number, specialty, and signature.
7. If applicable, specify any substitutions, the reason for substitution, and any warnings for the pharmacist.
8. Fill in the pharmacy details, mentioning the tax identification number and any other identification data.
9. Review all entries for accuracy before finalizing.
10. Once completed, save your changes, and you can choose to download, print, or share the form as needed.

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