Original Prescription
Julie Mott
906 Harvard
7/10/20XX
Amoxicillin 400 mg/5 mL Suspension
Dispense 10 days
Sig: take 800 mg PO BID x10 days
0
Harold L. Green
2-G Medical Arts Building
Nancy Corbiss
Prescription Origin Code: 2
Pharmacist Notes:
Dispensing Documentation
Rx #: 236559
Dispensing Date: 7/10/20XX
Patient: Julie Mott
Doctor: Harold L. Green
DEA: AG1294230
NDC: 00093-4161-73
RPh Initials: MFC
Drug: Amoxicillin 400 mg/5 mL Oral Suspension
Manufacturer: Teva
DAW Code: 0
SIG: T,2,TSP,(10 mL),PO,BID,X10D
Fill Type: New
Fill Number: 1
Last Fill Date: 7/10/20XX
Refills Remaining: 0
Quantity: 200
Day Supply: 10
Drug Unit Cost: $0.10
Dispensing Fee: $1.75
Total Cost: $21.75
Signature Log
Signature:
Mary Mott
Rx Number:
236559
Fill Date Date:
7/10/20XX
Pick-up Date:
7/10/20XX
RPh Counseling:
Accept