Original Prescription
Dr. Samuel Bernstein
3-C Medical Arts Building
Margaret Morgan
1824 New York Street
4/20/20XX
Buspar 10 mg Tablet
Dispense 60
Sig: i po BID for anxiety
2
Samuel Bernstein
DAW:
substitution permitted
Prescription Origin Code: 1
Pharmacist Notes:
Dispensing Documentation
Rx #: 198459
Dispensing Date: 7/15/20XX
Patient: Margaret Morgan
Doctor: Samuel Bernstein
DEA: AB1294824
NDC: 00093-0054-01
RPh Initials: RTG
Drug: Buspirone HCl 10 mg Tablet
Manufacturer: Teva
DAW Code: 0
SIG: T,1,TAB,PO,BID,for anxiety
Fill Type: Refill
Fill Number: 3
Last Fill Date: 6/10/20XX
Refills Remaining: 0
Quantity: 60
Day Supply: 30
Drug Unit Cost: $1.35
Dispensing Fee: $1.75
Total Cost: $82.75
Signature Log
Signature:
John Morgan
Rx Number:
198459
Fill Date Date:
7/15/20XX
Pick-up Date:
7/18/20XX
RPh Counseling:
Decline