1º VIA - FARMÁCIA

2º VIA - PACIENTE

RECEITUÁRIO DE CONTROLE ESPECIAL

NOME
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CRMV UF FONE
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ENDEREÇO UF
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CIDADE
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PACIENTE
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ENDEREÇO
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PRESCRIÇÃO
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COMPRADOR FORNECEDOR
NOME____________________________
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RG_______________EMISSOR________
ENDEREÇO________________________
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CIDADE___________________________ _________________ ___ /___ /___
TELEFONE_________________________ FARMACÊUTICO DATA

CABO DE SANTO AGOSTINHO/PE pethousecabo@hotmail.com

Rua Sebastião Barreto, 5, Santo inácio - (81)98713-0308
Cabo de Santo Agostinho/PE @pethousecabooficial