INTERNATIONAL HEALTH CENTRE LIMITED NOTE: (i) The Treatment Sheet is to be used only NAME:

TENTH STREET 2ND AVENUE, EASTLEIGH, NAIROBI for the prescribing and recording of medication. REG NO:
P.O.BOX 41238-00100 (ii) ALL prescriptions must be rewritten weekly SEX: AGE: WARD:
TEL: 0796529181-0796529182 not later than Monday mid-day. CONSULTANT:

IN-PATIENT TREATMENT SHEET

DRUG ALLERGIES:
ONCE ONLY PRESCRIPTIONS, STAT DOSES, PRE-MED ETC. A.M P.M A.M P.M A.M P.M A.M P.M A.M P.M A.M P.M

DATE DRUG DOSE ROUTE TIME SIGN

1
2
3
4
5
6
REGULAR PRESCRIPTIONS
DATE DRUG DOSE ROUTE TIME SIGN A.M P.M A.M P.M A.M P.M A.M P.M A.M P.M A.M P.M
1
2
3
4
5
6
7
8
9
10
Doctor’s Name: Sign: