WO2005087506A1 - Prescription pad - Google Patents
Prescription pad Download PDFInfo
- Publication number
- WO2005087506A1 WO2005087506A1 PCT/US2005/008581 US2005008581W WO2005087506A1 WO 2005087506 A1 WO2005087506 A1 WO 2005087506A1 US 2005008581 W US2005008581 W US 2005008581W WO 2005087506 A1 WO2005087506 A1 WO 2005087506A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- zone
- patient
- entry
- form according
- prescription form
- Prior art date
Links
Classifications
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B42—BOOKBINDING; ALBUMS; FILES; SPECIAL PRINTED MATTER
- B42D—BOOKS; BOOK COVERS; LOOSE LEAVES; PRINTED MATTER CHARACTERISED BY IDENTIFICATION OR SECURITY FEATURES; PRINTED MATTER OF SPECIAL FORMAT OR STYLE NOT OTHERWISE PROVIDED FOR; DEVICES FOR USE THEREWITH AND NOT OTHERWISE PROVIDED FOR; MOVABLE-STRIP WRITING OR READING APPARATUS
- B42D15/00—Printed matter of special format or style not otherwise provided for
- B42D15/0053—Forms specially designed for commercial use, e.g. bills, receipts, offer or order sheets, coupons
Definitions
- Figure 1 shows a prescription form in accordance with the present invention which includes a sheet having a first zone for entry information identifying a patient for whom a pharmaceutical product is being prescribed, a second zone for entry of risk management assessment of the patient, a third zone for entry of the pharmaceutical product dosing instructions and a fourth zone for entry of a signature of a prescribing medical practitioner.
- the second zone includes indicia setting forth a criteria for use management assessment which may include questions regarding patient life status and pregnancy state of the patient.
- the second zone may further include indicia for enabling recordation of confirmed practitioner-patient discussions of risk management.
- Figure 2 is an alternative embodiment, of the present invention which includes a second sheet identical to the first sheet shown in Figure 1 disposed thereunder along with a transfer medium, shown in dashed line, for transferring impressions from the first sheet to the second sheet.
- Figure 3 is an embodiment of the present invention shown under that shown in Figure 2 but including the plurality of multi form sheets superimposed upon one another with each multi-form unit including identical sheets with each sheet having the zones set forth hereinabove in connection with the embodiment shown in Figure 1.
- Both the embodiment shown in Figure 2 and 3 may have adhesive bonding along one side of the form to produce a pad structure .
- Figure 4 shows yet another embodiment of the present invention which includes the form hereinabove noted and described in Figures 1-3 and further including an instruction sheet having indicia regarding questions to be asked by the practitioner of the patient.
- the instruction sheet is preferably separable from a remainder of the form as indicated by a dash line in Figure 4 representing perforations or the like.
Landscapes
- Medical Treatment And Welfare Office Work (AREA)
Abstract
Description
Claims
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US55240804P | 2004-03-10 | 2004-03-10 | |
US60/552,408 | 2004-03-10 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2005087506A1 true WO2005087506A1 (en) | 2005-09-22 |
Family
ID=34963984
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2005/008581 WO2005087506A1 (en) | 2004-03-10 | 2005-03-08 | Prescription pad |
Country Status (1)
Country | Link |
---|---|
WO (1) | WO2005087506A1 (en) |
Citations (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3625547A (en) * | 1969-05-09 | 1971-12-07 | William A Burke | Composite prescription form |
US4153277A (en) * | 1978-02-24 | 1979-05-08 | Wright Line Inc. | Record keeping system |
US4799712A (en) * | 1986-11-18 | 1989-01-24 | Physicians' Pharmaceutical Services, Inc. | Prescription sheet and medication distribution system |
US4932682A (en) * | 1988-10-20 | 1990-06-12 | Miller Lucinda G | Medication record |
US5799981A (en) * | 1995-05-12 | 1998-09-01 | Global Healthcomm, Inc. | Pharmaceutical marketing device and system |
US5803498A (en) * | 1995-05-12 | 1998-09-08 | Tung; James C. | Pharmaceutical marketing device and system |
US20020163178A1 (en) * | 2001-04-04 | 2002-11-07 | Williams Brian A. | Prescription paper for physicians |
-
2005
- 2005-03-08 WO PCT/US2005/008581 patent/WO2005087506A1/en active Application Filing
Patent Citations (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3625547A (en) * | 1969-05-09 | 1971-12-07 | William A Burke | Composite prescription form |
US4153277A (en) * | 1978-02-24 | 1979-05-08 | Wright Line Inc. | Record keeping system |
US4799712A (en) * | 1986-11-18 | 1989-01-24 | Physicians' Pharmaceutical Services, Inc. | Prescription sheet and medication distribution system |
US4932682A (en) * | 1988-10-20 | 1990-06-12 | Miller Lucinda G | Medication record |
US5799981A (en) * | 1995-05-12 | 1998-09-01 | Global Healthcomm, Inc. | Pharmaceutical marketing device and system |
US5803498A (en) * | 1995-05-12 | 1998-09-08 | Tung; James C. | Pharmaceutical marketing device and system |
US20020163178A1 (en) * | 2001-04-04 | 2002-11-07 | Williams Brian A. | Prescription paper for physicians |
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