Our Lady of Fatima University

College of Pharmacy
Rx No.: _4_ Quantity: __10mL__
Name of Patient: Abby Sanchez Age: 22_____
Address: __Caloocan City_________ Birthday: _05-09-1999__

Menthol and Eucalyptus

Inhalant
Formulation:
Menthol ………………………………….….0.2g
Eucalyptus ………..............................1mL
Light Magnesium Carbonate……….0.7g

Indication: ______Relief Cough_________

Signa: Inhale the vapor. Repeat 4 times if required
Name of Pharmacist: Sarmiento, Ray Anthony M.
Date of Preparation: _____07-08-2019_____
Beyond-use-date: ______07-22-2019_______

Our Lady of Fatima University

College of Pharmacy
PDC 415
Rx No.: _4_ Quantity: __10mL__
Name of Patient: Abby Sanchez Age: 22_____
Address: __Caloocan City_________ Birthday: _05-09-1999__

Menthol and Eucalyptus

Inhalant
Formulation:
Menthol ………………………………….….0.2g
Eucalyptus ………..............................1mL
Light Magnesium Carbonate……….0.7g

Indication: ______Relief Cough_________

Signa: Inhale the vapor. Repeat 4 times if required
Name of Pharmacist: Sarmiento, Ray Anthony M.
Date of Preparation: _____07-08-2019_____
Beyond-use-date: ______07-22-2019_______