{"text":"TR L BT \nGartnavel General Hospital \nRef. No: \nImmediate Discharge and , \u2019 : \" Glasgow G12 OYN v, 089615 NHS - \nMedicine Prescrlptlon Form - Confidential Telephone: 0141 211 3000 S \n- Co NURSE TO COMPLETE \nName of GP.. . o \nWard:_: 1< Tel: Out Patient apPOINtMENt date......cuuuuesmeemrssrereremsessersssssnsmssassones \nSurgery\/Health Centre \u2014 : o ' f : . . \n\u2014{ Consultant:- - DlagnOSJS informed (circle) Patient | Relative \n5 : Circle support services set up: . \nDustnct. Nurse Home Help Health Visitor \n\u2019 Oncology referral Hospice: \nWeight \n- Post Codeq_\ufb02\ufb01f\ufb01_\u2014_ \nA ':\/,LI{ Unit no: LOL&ZJ&O! ...... \n- CH no: afa\u2018( .rff'\u201df \u2019 \nday care OR home care \n. Discharge address if- riot hom \n: Dlscharge date\\_\u2018_l.:)_'_.\/_...@ ....... \/..i?v._. ) - \n. . WARD .USE ONLY _ \nMed:catlon Rec. on Ward by \nChecked \u2018against kardex: \n- Issued by:... . \nReason for Admlsswn Diagnosis \nTreatment Investlgatlons,,Operatlons \n\/}\/t \u00a2 LacN \ufb02\/l-\ufb02TRTlOw \nCompllcatlon_s \no \nSignature of Recipient: i \nAll known drug sensitivities.\/ adverse reactions: \nTIMES FOR ADMINISTRATION \nPHARMACY USE ONLY \nNew|New| . ' . N \nDrug| Dose ) MEDICINE Form | Dose [am |md pm|pm [pm Other imes Course thmza[ Pharmacy Check D Professional Check Ij \nC 8 12| 2 10 length su\u2018;,ag}[e%\u2019 Dispensing Details \nC o-Cottir tndo\/fon o _\\um S| WV VL Syl \ne . . - : : \n_ B \nS - \n4. - \" \ni \n{ \n- oy : 1 \nMedicines Discontinued \nr . ' . g \ng jD_is;ien\u00e9Ed\u201cby- i \nPrescribers name: _[\/) (f\\\u2018:l_\/_\u2018\ufb02g\ufb02_.___u S[gnature \u20189 72 M \nDesignation:_.____. E_\/_E.._.__,__.___. \nPager number: _,_.\ufb01,_w_' \nChecked-by: - \nMedication Collected by: \nWhite copy - G.P.; Pink copy - Case Notes; Blue copy - Pharmacy; Yellow copy - Patient \nYou must use-a ballpoint pen and fully complete this for_nj or the prescription will not be di;p\u00e9n;ed 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