John Smith, MD

Family and General Medicine

1600 Creekside Dr., Suite 0000

Folsom, CA 95630

voice (916) 983-0000

fax (916) 983-0000

This is a Family Prescription for

Torres, Christyne dob 07/01/1959 45 & 5/12 y/o 12-28-04

000-0000 000-0000

PatientName1: Torres, Christyne dob 07/01/1959

Griseofulvin microsize 500 mg 1 times per day, orally, qs 6 weeks

PatientName2: Ian Torres

Griseofulvin microsize 250 mg 1 times per day, orally, qs 6 weeks

PatientName3: John Torres

Griseofulvin 175 mg 1 times per day, orally, qs 6 weeks

PatientName4: Sally Torres

Griseofulvin 250 mg 1 times per day, orally, qs 6 weeks

PatientName5: Bill Adams

Griseofulvin 50 mg 1 times per day, orally, qs 6 weeks

John Smith, MD

C34200 AC 9034800 CoreMedicalConcepts.com Sec. Code 5801287aer