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Rx#
9123044
Written Date
2/26/20XX
 
Rx Expires
1 year
Name
Bob O. Sykes
Original Prescription
DOB
7/5/XXXX
Age
75
Ht/Wt
162 lbs
at 23:36, eRx #: 4669
ELECTRONIC PRESCRIPTION
Bob O. Sykes
832 Missouri Street
Date: 2/26/20XX
Lanoxin 125 mcg Tablet
Dispense 30
Sig: i po qAM
Refills: 6
Dr. Sam Jones
DAW: brand only
Address
832 Missouri Street
Phone
785-555-6403
Product/Quantity/Refills/SIG
Prescribed
Lanoxin Tab
Strength
125 mcg
 
Dispensed
Lanoxin 0.125 mg Tablet
Pres Qty
30
 
Dis Qty
30
 
Day Supply
30
 
Refills
6
 
SIG
Take 1 tablet by mouth once daily every morning.
Pill Image & Dispensing Notes
DAW
1
Origin Code
3
 
Pill Image
Name
Sandra Jones
Address
2300 Clinton Parkway Ct.
Fax
785-555-4199
DEA
BJ1234563
NPI
999999999
Phone
785-555-4195
Dispensing
Notes