Nom et Prenom :	Age :	Poids :	Date de consultation :

	Medicament	Forme	Dose	Quantite
1	--- Select --- ----- BetaLactamines ----- Amoxicilline Clamoxyle Oxacilline Orapen Ospen Augmentin ----- Cephalosporines ----- Cefacidal Keforal zinnat Claforan Rocephine Fortum Oroken Omnicef ----- Aminosides ----- Gentamycine Amikacine Tobramycine ----- Macrolides ----- zeclar Zomax Erybesan Josacine Rovamycine Spiramycine Fucidine ----- Synergistines ----- Pyostacine ----- Sulfamides ----- Bactrim ----- Glycopeptides ----- Vancomycine Targocid Imipeneme ----- Tetracyclines ----- Doxyline ----- Anti-Parasitaires ------ Flagyl Fluvermal Combantrin Vermox ----- Anti-Viraux ----- Aciclovir ----- Anti-Fongique ----- Fongenal ketoderm Mycocide ----- Anti-Septiques ----- Hexamidine Eosine_Aqueuse ----- Anti-pyretiques ----- Doliprane ----- AINS ----- Algifene Nifluril ----- Dermatologiques ----- Ascalol Poullox Oxyplastine Mitosyl Locapred Locoid Efficort Diprosone Dermoval Clotasol Diprolene ----- Emollient ------ Xeroderm Vaseline_salicylee Dexeryl ----- Anti-Allergiques ------ Tifen Polaramine Histagan Primalan Loratadine Deslor zyrtec ----- Corticoides ----- Prednisone Solupred Celestene Prurax ----- Anti-Spasmodiques ----- Debridat Duspatalin Spasfon-Lyoc Bedelix ----- Anti diarrhéiques ----- Smecta Tiorfan Ultra-Levure ----- Anti-Reflux ----- Gaviscon ----- Anti-emetiques ----- Vomiteb ----- Laxatifs ----- Forlax Lactulose Huile_de_Paraffine Glycerine NormaCol MicroLax_Bebe ----- Anti-Secretoires ----- Ranitidine Omeprazol ------ mdts Hemato ----- Ferrum SeloFer Femacur TardyFeron Zanitra Cobamine Desferal Dicynone ------ mdts en Pneumo ----- Budecort PulmiCort SymbiCort Seretide Singulair ----- Anti-Epileptiques ----- Gardenal Tegretol Depakine zarontine Keppra Lamictal ----- ORL ----- Otipax Polydexa otofa Otocine Beconsae Nasonex Sterimar ----- Ophtalmologiques ----- Naabak Levophta Crombak VitaBact Dacroserum Rifamycine_chibret Chibroxine Ciloxan Maxidrol Rifamycine Fucithalamic ----- Vitamines ----- Appeti_Kid Solvityl Vitaform BabyGaz	--- Select --- Comprime Gelules Granules Poudre Sirop Sachets Gouttes Ampoule Huile Suspension_buvable Suppositoires Pommade Capsule lavement Ovules Creme Collyre Bain Solution Lotion Patch -

Posologie :

	Medicament	Forme	Dose	Quantite
2	--- Select --- ----- BetaLactamines ----- Amoxicilline Clamoxyle Oxacilline Orapen Ospen Augmentin ----- Cephalosporines ----- Cefacidal Keforal zinnat Claforan Rocephine Fortum Oroken Omnicef ----- Aminosides ----- Gentamycine Amikacine Tobramycine ----- Macrolides ----- zeclar Zomax Erybesan Josacine Rovamycine Spiramycine Fucidine ----- Synergistines ----- Pyostacine ----- Sulfamides ----- Bactrim ----- Glycopeptides ----- Vancomycine Targocid Imipeneme ----- Tetracyclines ----- Doxyline ----- Anti-Parasitaires ------ Flagyl Fluvermal Combantrin Vermox ----- Anti-Viraux ----- Aciclovir ----- Anti-Fongique ----- Fongenal ketoderm Mycocide ----- Anti-Septiques ----- Hexamidine Eosine_Aqueuse ----- Anti-pyretiques ----- Doliprane ----- AINS ----- Algifene Nifluril ----- Dermatologiques ----- Ascalol Poullox Oxyplastine Mitosyl Locapred Locoid Efficort Diprosone Dermoval Clotasol Diprolene ----- Emollient ------ Xeroderm Vaseline_salicylee Dexeryl ----- Anti-Allergiques ------ Tifen Polaramine Histagan Primalan Loratadine Deslor zyrtec ----- Corticoides ----- Prednisone Solupred Celestene Prurax ----- Anti-Spasmodiques ----- Debridat Duspatalin Spasfon-Lyoc Bedelix ----- Anti diarrhéiques ----- Smecta Tiorfan Ultra-Levure ----- Anti-Reflux ----- Gaviscon ----- Anti-emetiques ----- Vomiteb ----- Laxatifs ----- Forlax Lactulose Huile_de_Paraffine Glycerine NormaCol MicroLax_Bebe ----- Anti-Secretoires ----- Ranitidine Omeprazol ------ mdts Hemato ----- Ferrum SeloFer Femacur TardyFeron Zanitra Cobamine Desferal Dicynone ------ mdts en Pneumo ----- Budecort PulmiCort SymbiCort Seretide Singulair ----- Anti-Epileptiques ----- Gardenal Tegretol Depakine zarontine Keppra Lamictal ----- ORL ----- Otipax Polydexa otofa Otocine Beconsae Nasonex Sterimar ----- Ophtalmologiques ----- Naabak Levophta Crombak VitaBact Dacroserum Rifamycine_chibret Chibroxine Ciloxan Maxidrol Rifamycine Fucithalamic ----- Vitamines ----- Appeti_Kid Solvityl Vitaform BabyGaz	--- Select --- Comprime Gelules Granules Poudre Sirop Sachets Gouttes Ampoule Huile Suspension_buvable Suppositoires Pommade Capsule lavement Ovules Creme Collyre Bain Solution Lotion Patch -

Posologie :

	Medicament	Forme	Dose	Quantite
3	--- Select --- ----- BetaLactamines ----- Amoxicilline Clamoxyle Oxacilline Orapen Ospen Augmentin ----- Cephalosporines ----- Cefacidal Keforal zinnat Claforan Rocephine Fortum Oroken Omnicef ----- Aminosides ----- Gentamycine Amikacine Tobramycine ----- Macrolides ----- zeclar Zomax Erybesan Josacine Rovamycine Spiramycine Fucidine ----- Synergistines ----- Pyostacine ----- Sulfamides ----- Bactrim ----- Glycopeptides ----- Vancomycine Targocid Imipeneme ----- Tetracyclines ----- Doxyline ----- Anti-Parasitaires ------ Flagyl Fluvermal Combantrin Vermox ----- Anti-Viraux ----- Aciclovir ----- Anti-Fongique ----- Fongenal ketoderm Mycocide ----- Anti-Septiques ----- Hexamidine Eosine_Aqueuse ----- Anti-pyretiques ----- Doliprane ----- AINS ----- Algifene Nifluril ----- Dermatologiques ----- Ascalol Poullox Oxyplastine Mitosyl Locapred Locoid Efficort Diprosone Dermoval Clotasol Diprolene ----- Emollient ------ Xeroderm Vaseline_salicylee Dexeryl ----- Anti-Allergiques ------ Tifen Polaramine Histagan Primalan Loratadine Deslor zyrtec ----- Corticoides ----- Prednisone Solupred Celestene Prurax ----- Anti-Spasmodiques ----- Debridat Duspatalin Spasfon-Lyoc Bedelix ----- Anti diarrhéiques ----- Smecta Tiorfan Ultra-Levure ----- Anti-Reflux ----- Gaviscon ----- Anti-emetiques ----- Vomiteb ----- Laxatifs ----- Forlax Lactulose Huile_de_Paraffine Glycerine NormaCol MicroLax_Bebe ----- Anti-Secretoires ----- Ranitidine Omeprazol ------ mdts Hemato ----- Ferrum SeloFer Femacur TardyFeron Zanitra Cobamine Desferal Dicynone ------ mdts en Pneumo ----- Budecort PulmiCort SymbiCort Seretide Singulair ----- Anti-Epileptiques ----- Gardenal Tegretol Depakine zarontine Keppra Lamictal ----- ORL ----- Otipax Polydexa otofa Otocine Beconsae Nasonex Sterimar ----- Ophtalmologiques ----- Naabak Levophta Crombak VitaBact Dacroserum Rifamycine_chibret Chibroxine Ciloxan Maxidrol Rifamycine Fucithalamic ----- Vitamines ----- Appeti_Kid Solvityl Vitaform BabyGaz	--- Select --- Comprime Gelules Granules Poudre Sirop Sachets Gouttes Ampoule Huile Suspension_buvable Suppositoires Pommade Capsule lavement Ovules Creme Collyre Bain Solution Lotion Patch -

Posologie :

	Medicament	Forme	Dose	Quantite
4	--- Select --- ----- BetaLactamines ----- Amoxicilline Clamoxyle Oxacilline Orapen Ospen Augmentin ----- Cephalosporines ----- Cefacidal Keforal zinnat Claforan Rocephine Fortum Oroken Omnicef ----- Aminosides ----- Gentamycine Amikacine Tobramycine ----- Macrolides ----- zeclar Zomax Erybesan Josacine Rovamycine Spiramycine Fucidine ----- Synergistines ----- Pyostacine ----- Sulfamides ----- Bactrim ----- Glycopeptides ----- Vancomycine Targocid Imipeneme ----- Tetracyclines ----- Doxyline ----- Anti-Parasitaires ------ Flagyl Fluvermal Combantrin Vermox ----- Anti-Viraux ----- Aciclovir ----- Anti-Fongique ----- Fongenal ketoderm Mycocide ----- Anti-Septiques ----- Hexamidine Eosine_Aqueuse ----- Anti-pyretiques ----- Doliprane ----- AINS ----- Algifene Nifluril ----- Dermatologiques ----- Ascalol Poullox Oxyplastine Mitosyl Locapred Locoid Efficort Diprosone Dermoval Clotasol Diprolene ----- Emollient ------ Xeroderm Vaseline_salicylee Dexeryl ----- Anti-Allergiques ------ Tifen Polaramine Histagan Primalan Loratadine Deslor zyrtec ----- Corticoides ----- Prednisone Solupred Celestene Prurax ----- Anti-Spasmodiques ----- Debridat Duspatalin Spasfon-Lyoc Bedelix ----- Anti diarrhéiques ----- Smecta Tiorfan Ultra-Levure ----- Anti-Reflux ----- Gaviscon ----- Anti-emetiques ----- Vomiteb ----- Laxatifs ----- Forlax Lactulose Huile_de_Paraffine Glycerine NormaCol MicroLax_Bebe ----- Anti-Secretoires ----- Ranitidine Omeprazol ------ mdts Hemato ----- Ferrum SeloFer Femacur TardyFeron Zanitra Cobamine Desferal Dicynone ------ mdts en Pneumo ----- Budecort PulmiCort SymbiCort Seretide Singulair ----- Anti-Epileptiques ----- Gardenal Tegretol Depakine zarontine Keppra Lamictal ----- ORL ----- Otipax Polydexa otofa Otocine Beconsae Nasonex Sterimar ----- Ophtalmologiques ----- Naabak Levophta Crombak VitaBact Dacroserum Rifamycine_chibret Chibroxine Ciloxan Maxidrol Rifamycine Fucithalamic ----- Vitamines ----- Appeti_Kid Solvityl Vitaform BabyGaz	--- Select --- Comprime Gelules Granules Poudre Sirop Sachets Gouttes Ampoule Huile Suspension_buvable Suppositoires Pommade Capsule lavement Ovules Creme Collyre Bain Solution Lotion Patch -

Posologie :