Binh Thuan Medical Service

Dr.DONGS Polyclinic

Phan Thiet, Date... 15....../....12......./...2011..................

Name of the subscriber (patient):
ZIMINA SVETLANA
Date of brith:
17.11.1980 - Sex: Female.............
Address:
Room 218, Blue Ocean Resort, Phan Thiet, Viet Nam
Diagnosis :
Allegy to seafood
TREATMENT
Drugs :

1Soli-medon 40 mg
X
01
Bottles/ Ampules/ Tablets/ Packets/
Creame
Morning1bot.Afternoon.Evening
InjectionIM

Drinking/ To apply (.minutes before meal/minutes

after meal
2Cetirizin
10 mg
X
10
Bottles/ Ampules/ Tablets/
Packets/ Creame
Morning1 tab.Afternoon.Evening
1 tab
( 5
days)
Injection

Drinking/ To apply (30.minutes before meal/minutes

after meal)
3Dexamethason 0.5g
X
20
Bottles/ Ampules/ Tablets/ Packets/
Creame
Morning2 tabs.Afternoon
Evening 2 tabs
( 5
days)
Injection Drinking/ To apply (.minutes before meal/ 30minutes
after meal)

Surgery: ..........................................................................................................
Bandage change :
Instrutions :
- No alcohol for a week

Doctors Signature:

Add: 29A Nguyen inh Chieu- Ham Tien ward - Phan Thiet City - Binh Thuan
Province - VIET NAM
Tel/ Fax : (+84)62 3741213
Mobile :
(+84) 918210504 - Email :
dr.vohongdongbt@yahoo.com.vn