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IMPORTANT: Compounded prescription orders must be patient-specific. In accordance with Poison Act 1952, kindly fill in the prescription form completely. Thank you.
| Doctor's Name : | MMC No : |
Please compound the following medication(s):
| Date : | Patient's Name : |
| Patient's IC No : | Patient's Address : |
| No. | Medication Name and Strength | Directions for use | Qty per UOM | Bottle Qty |
|---|
Remarks :
Free Courier / Delivery when order total
>RM 300 West Malaysia
>RM 600 East Malaysia
Please note this list is non-exhaustive and only includes the prescribed dosage and combinations.
For items not listed, please contact Aalsum Pharmas for more information (aalsumpharmas@gmail.com).