Medical doctors, psychologists, social workers, pharmacists, politicians and other related professionals

What would a good prescription or management plan look like?

How should a prescription look?

Details of physician/medical doctor


Details of resident/patient




Eyeglass prescription


Here are further guidelines.

    Exercise Recommendations
    Nutrition Recommendations
    Counseling Recommendations
    Exercise Recommendations
    Nutrition Recommendations
    Counseling Recommendations
    Diagnostic tests
    Interventional cardiology, gastroenterology, dialysis, Ophthalmology, Obstetrics & Gynecology, etc.
    Rare surgery
Would you like to add anything?
Can you make me wiser? How?
Can you make us wiser? How?
Have an interesting case?

Retain receipts/copies of all your emails.
Retain receipts of all postal mail.
Anyone found blocking communication at any level will face consequences. Prescription

Prescription medication, a drug available only by a medical prescription
Medical prescription, a plan of care written by a physician or other health care professional
Eyeglass prescription, written by an ophthalmologist or an optometrist/physician.
Please provide information about your Patient.

Patient Name

Patient DOB

Prescriber Information (required)

Prescriber Name

Prescriber Phone

Prescriber Fax


Is patient being discharged from hospital or institution on these medications?

Contact Person for This Request Prior Authorization Request Drug #1

Medication Name & Strength Drug #1

Dosage Form #1

If Available Quantity #1

Directions for Use Drug #1

Including Length of Treatment

Diagnosis or ICD-10 Code Drug #1