LOY'S PHARMACY, INC. LOY'S PHARMACY, INC.

BRANCH ________ BRANCH ________

ILIGAN CITY ILIGAN CITY
PARTIAL FILLING PRESCRIPTION PARTIAL FILLING PRESCRIPTION

GEN.NAME: LOT# GEN.NAME: LOT#

BRAND NAME: E/D: BRAND NAME: E/D:
DOSAGE: # DOSAGE: #
DOCTOR: Lic# DOCTOR: Lic#
Patient Name: Age: Patient Name: Age:
Qty served: Bal: RPh: Qty served: Bal: RPh:

LOY'S PHARMACY, INC. LOY'S PHARMACY, INC.

BRANCH ________ BRANCH ________
ILIGAN CITY ILIGAN CITY
PARTIAL FILLING PRESCRIPTION PARTIAL FILLING PRESCRIPTION

GEN.NAME: LOT# GEN.NAME: LOT#

BRAND NAME: E/D: BRAND NAME: E/D:
DOSAGE: # DOSAGE: #
DOCTOR: Lic# DOCTOR: Lic#
Patient Name: Age: Patient Name: Age:
Qty served: Bal: RPh: Qty served: Bal: RPh:

LOY'S PHARMACY, INC. LOY'S PHARMACY, INC.

BRANCH ________ BRANCH ________
ILIGAN CITY ILIGAN CITY
PARTIAL FILLING PRESCRIPTION PARTIAL FILLING PRESCRIPTION

GEN.NAME: LOT# GEN.NAME: LOT#

BRAND NAME: E/D: BRAND NAME: E/D:
DOSAGE: # DOSAGE: #
DOCTOR: Lic# DOCTOR: Lic#
Patient Name: Age: Patient Name: Age:
Qty served: Bal: RPh: Qty served: Bal: RPh: