Prescription Form Template

What should I include in a prescription form?

When creating a prescription form or customizing our template, make sure you include the patient’s name, date of birth, and any other information that might serve as an identifier. Next, add the medication, its strength, the amount that the patient should take, how it should be taken, how frequently, how much of it should the pharmacy give, and the number of refills. On 123FormBuilder, you can add a form field for each of these items, so you’ll be able to fill in a prescription without leaving any important details out. And once the form is completed, you can print the prescription and give it to your patient or send the prescription to the pharmacy by email. 

Is this prescription form template HIPAA-compliant?

If you want to build HIPAA-compliant prescription forms, contact us and we’ll activate our HIPAA suite on your forms. Learn more about our HIPAA-complaint forms and how clinics in the US use 123FormBuilder to collect and manage PHI.

What is a medical prescription form?

A medical prescription form is a form used by health institutions to provide patients and drug stores with an easy, seamless, paper-free way of enabling patients to get prescription medicine.

What do you include in a prescription form?

A prescription form should always include patient information (including their contact details), information about the prescription options, as well as how the prescription will be delivered.