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Synopsis Assessing the quality of patient care and setting standards through performance review should become part of everyday clinical practice. Medical audit overseas the observance of standards of medical treatment of all levels of health care delivery system. Prescription surveys are components of the medical audit which provide a relatively unbiased picture of prescribing habits and also identifies aberrant or suboptimal prescribing. Few such surveys have been undertaken mostly at tertiary care hospitals on sample sizes of 200-250 prescriptions. But this survey encompasses screening of over a hundred thousand OPD prescriptions of secondary level government hospital. With such a huge sample size it has been possible to investigate disease morbidity, drug utilization, core prescribing indicators in pediatric, adult and geriatric patients collectively, and also study the trends in prescribing. Results indicate that there is considerable scope for improving prescribing practices through prescriber education and public awareness on issues like gender bias and health.