Si Jin Bao

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Prescription Description
Web Printing
  1. Patient name & address as provided by patient or guardian
  2. Date the provider requested prescription
  3. Quantity of remaining refills and expiration date
  4. Name of prescribed Concentrated Decoction

5. Dosage instructions
6. Name and address of prescribing physician
7. Invoice number
8. Office use only
9. Off Label Use

  1. The name and address of the patient as provided by the patient/guardian on the order placed.
  2. The date that the prescribing physician submitted the prescription for patient.
  3. The number of refills left in the prescription before it expires.  Each prescription comes with 8 refills in any 90 day period.
  4. The name of the Concentrated Decoction prescribed by physician.
  5. Dosage instructions as provided by physician.
  6. The name and address of the prescribing physician is provided here.
  7. The invoice number of the order placed by the patient.
  8. The Herbacy Prescription number, for in-office use only.
  9. If the dosage instructions differ from the suggested Si Jin Bao dosage amount, OLU (Off Label Use) will be signified.  Physician accepts full responsibility of all OLU prescriptions.