Prescription from Peking University Sixth Hospital
Ordinary
Name: Zhao Jicat Gender: Female Age: 17 Outpatient Number: Cost Type: Self paid
Department: Psychiatry Date of Visit: June 30, 2025 Designated Medical Institution Code: 08000000
Diagnosis: | Rp Name/Specifications/unit price quantity usage frequency usage ②) Lamotrigine dispersible tablets 2boxes 100mg/time qid po (50mgx30table/box)122.00元 ① Sulpiride Tablets 2bottles 0.6g/time qid po (0.10gx100table/botlle)31.41元 Physician：Liang Jun |
Audit/deployment signature (seal):
Tips: (1) Please take the medication according to the doctor's advice. (2) Please check the medication at the window. (3) The prescription is valid for three days (including the same day). (4) The medication cannot be returned or exchanged
Cost category: Cost category: ① (A) no self-payment ② (B) self-payment ③ (C) full self-payment ④ children ⑤ work-related injury Printing time: June 30, 2025 14:50:29
