📞 123-456-7890, 444-666-8899
🏠 Street address here
🕐 Days: Mon–Fri
⏰ 05:00 PM - 08:30 PM
Prescription
📞 123-456-7890, 444-666-8899
🏠 City, State, ZIP
🕐 Days: Mon–Fri
⏰ 05:00 PM - 08:30 PM
Dr. John Smith
Immunologist
MBBS, MCPS, FCPS (Immunology)
[Hospital/Department Name]
Treatment
Date: _____________
Signature: __________________________