xmlns:atom="http://www.w3.org/2005/Atom" xmlns:atom="http://www.w3.org/2005/Atom"
Surname(s)
First name(s) (written out in full, i.e. no initials)
Date of Birth
Issue date
Surname(s)
First name(s) (written out in full, i.e. no initials)
Professional qualification
Details for direct contact (email and telephone or fax, the latter both with international prefix)
Work address (including the name of the relevant Member State)
Signature (written or digital, depending on the medium chosen for issuing the prescription)
‘Common name’ as defined by Article 1 of Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use
The brand name if:
the prescribed product is a biological medicinal product, as defined in point 3.2.1.1.(b) of Annex I (Part I) to Directive 2001/83; or
the prescribing health professional deems it medically necessary; in that case the prescription shall shortly state the reasons justifying the use of the brand name
Pharmaceutical formulation (tablet, solution, etc.)
Quantity
Strength, as defined in Article 1 of Directive 2001/83/EC
Dosage regimen