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Pharmskills Online - (V1) Data Entry Verification - View Detail

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Rx#
5136998
Written Date
2/19/20XX
 
Rx Expires
3 months
Name
Stanley M. Bontrager
Original Prescription
DOB
3/3/XXXX
Age
33
Ht/Wt
74 inches, 226 lbs
Fleer Dental Clinic
2831 Sunset
Stanley M. Bontrager
421 East 21st Street
2/19/20XX
Percocet 5/325 Tablet
Dispense 15  
Sig: i po q4-6h prn pain
0
Sherman F. Fleer, DDS
AF1299468
DAW:
generic okay
Address
421 East 21st Street
Phone
785-555-9023
Product/Quantity/Refills/SIG
Prescribed
Percocet Tab
Strength
5 mg/325 mg
 
Dispensed
Roxicet 5 mg/325 mg Tablet
Pres Qty
15
 
Dis Qty
15
 
Day Supply
2
 
Refills
0
 
SIG
Take 1 tablet by mouth every 4 to 6 hours as needed for pain.
Pill Image & Dispensing Notes
DAW
0
Origin Code
2
 
Pill Image
Name
Sherman F. Fleer
Address
2831 Sunset
Fax
785-555-2145
DEA
AF1299468
NPI
9999999999
Phone
785-555-2144
Dispensing
Notes
Patient recovering from dental tooth extraction.