PT33 Free Prescription PDF & Field Guide

Who uses it and when

An authorized practitioner assesses the patient and determines treatment. The dispensing establishment checks patient details, prescribed limits and supporting documents, then retains the prescription for inspection. PT33 is separate from PT27 and PT28 reporting.

What each field means

Select a number to read its explanation, or open the full-size image

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1. Issue date

   Enter the date the practitioner issues the prescription after assessment, rather than the PT27/PT28 reporting month.

2. Prescribing practitioner

   The practitioner's name, profession, licence or certification number and address must identify an authorized prescriber and be verifiable.

3. Patient details

   Name, age, nationality and Thai ID or passport number must match the actual patient.

4. Condition or symptoms

   The practitioner records findings from the consultation under their professional guidance. Do not copy an example as a diagnosis.

5. Prescribed amount

   The practitioner determines grams per day, treatment days and total quantity. The form limits each prescription to no more than 30 days.

6. Signatures and retention

   The form has signature lines for the recipient and prescriber. The dispensing establishment retains it for inspection; DTAM guidance specifies at least one year.

Fictional data example

Administrative example only: 06/08/2026, Sample patient (fictional), age 36, Thai nationality, document DEMO-ID. Practitioner details, clinical findings, quantities and signatures are intentionally left blank because they must come from an authorized practitioner after assessment.

For understanding fields only. This is not a submission document or a prescription.