Page 24 - A guide to dosage form 1_full v3

You are required to write on the prescription of all the necessary preparation, as below. You are
also required to put your signature and date of dispensing on the prescription above the
physician’s signature, with a caption [‘Prepared by’: Your name (Pharmacist)].

SCHOOL OF PHARMACEUTICAL SCIENCES
UNIVERSITI SAINS MALAYSIA
11800 USM, PENANG, MALAYSIA
Tel: 04-6532211 Fax: 04-6570017
NAME: John Epkin DATE: 25 February 2018
ADDRESS: 5, Halaman Bukit Gambir, Penang AGE: 8 yo SEX: M

Novobiocin Mixture BPC 1973  250mg/10mL

Sig. 250 mg b.d 5/7  10 mL x 2 x 5 = 100 mL Mitte q.s

Refill 0 1 2 3

100 mL Prepared by,
Novobiocin calcium 516 mg/ 5.16 g Amirah
dose
Compound tragacanth powder 3% w/v 3 g (25/2/18)
Syrup BP 20% v/v 20 mL
Apple Green 1% v/v 1 mL
Freshly boiled and cooled water q.s ad 100 mL

S.L Tang MD

(A preservative is an option. If no preservative is included in the preparation, a short shelf life of 2
weeks should be indicated in the label, and freshly boiled and cooled water should be used (or also
known as distilled water))

Following this step, you will now have to prepare a worksheet for your preparation. The
worksheet should be filled in as complete as possible. At the bottommost of the worksheet, do not
forget to put down your signature and date of preparation, as this will serve as a record for
extemporaneous preparation. According to the law, this worksheet will have to be retained for 2 years
following preparation.

In the next page, you will be briefed on the worksheet and how to fill in. An example will also
be provided so that you will have a clearer picture. An empty worksheet can be found at the end of
this guidebook for your perusal.

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