Chronic diseases have a gradual onset, slow progress, derange the living organism in their own peculiar manner, if not treated. These cases need a series of medicines in order to restore the health and general wellbeing of the patient. Hence second prescription is utmost important in chronic diseases hence, practical knowledge related to it must be obtained by every homeopathic physician. The MONARCH is a tool used to evaluate the likelihood of causal attribution of homeopathic treatment to clinical outcome. Objective: To understand the clinical utility, effect and frequency of different varieties of second prescription along with the use of MONARCH tool. Design: This is a case series study of chronic diseases to understand the utility, effect and frequency of second prescription using MONARCH tool for evaluation of cases. Materials and methods: 45 cases with chronic diseases were studied from OPD over a period of 6 months, the response of the patient to first prescription was analysed and second prescription was made, evaluation of outcome and treatment was done using MONARCH and the utilityand frequency of each type of second prescription was studied.Result:There was improvement in 41 cases out of 45 cases with MONARCH score above 6 and repetition of the same medicine [115 times], was observed to be the most frequently type followed by placebo, [ 88 times] and change of potency [29 times], change of remedy [14 times], complimentary remedy [7 times] and intercurrent remedy [3 times] respectively.