E-Prescription Request

This online request applies only to medicines that have already been prescribed to you in the past by a clinic at FN Nitra and that you take regularly on a long-term basis.
The prescription can also be issued by a doctor of the same specialization at FN Nitra, even if they were not the original prescriber.
Please fill in all fields accurately – incomplete or incorrect information will prevent your request from being processed.
We will process your request within 5 business days at the latest.
Information about the issued prescription can be found in your health insurance company’s mobile app or online branch; the pharmacy where you pick up your medicine can also confirm this for you.

Clinic

Name of the clinic where the medication was prescribed

First and last name of the doctor prescribing the medication

Patient Information

Patient's first and last name

Patient's birth number

Mobile number

Email address

Health insurance company

Mobile Number insurance

Medication

Check more medications only if you want to repeatedly prescribe an e-prescription for several different medications. The medications must be prescribed by the same doctor at the same clinic.

Name of medication

Medication strength

active ingredient in g, mg, etc.

Number of packages