<DrName>
<DrAddress>
Phone: <DrPhone>
Prescriber number :<DrPrescriberNo>	
		
Name (first and last)	<Partner first and last name>
	
AND		
Address	<PtAddress>	

Medication name and dose	Azithromycin 500mg, 2 tablets	
	Take 2 tablets orally as a stat dose.
Private Prescription	
Signature		
Date	<TodaysDate>