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Patient Full Name Ahmed Ali Ahmed Doctor Name Khalid Samir

Age 18 Clinic / Hospital Name ABC

Mobile Number 07712345678 Perscription Number 780

Healthcare ID 7 Date 2022/05/01

# Medecine Scientific Name Dosage Medecine Commercial Name Period TIMES x COUNT
1 AAA 4 OIO 3 4

DOCTORS USE INSTRUCTIONS : 1- bal bla bla


bla bla bla 2-

Signature :

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