Every medical prescription must include:
on the front
- physician's code
- health insurance company's code
- surname and name of the patient
- patient's birth ID number
- patient's address of residence
- code of diagnosis according to the ICD 10 SK
- code of medicine / medical device / dietetic food
- name of medicine (also the medicine's company name may be included), form of medicine, intensity of medicine, dose content / name of medical device / name of dietetic food
- number of packages
- dose, frequency of use and method of taking medicine
- date of issue of prescription
- physician's stamp
- physician's signature
- the text "Paid by patient" if paid by patient
on the reverse
- if prescription of the medicine is restricted, a note shall be added: "on the recommendation of a specialised physician"
- "Emergency treatment" shall be written in case of emergency treatment.
- "Non-contractual physician" shall be written if the physician is not a contracted healthcare provider
- Humane medicines containing class II narcotic and psychotropic substances must be prescribed using a separate form.