Original Prescription
Family Health Associates - Doctors James Warren and Norman Keyes
3-G Medical Arts Building
Mary F. Mott
906 Harvard
1/22/20XX
Risperdal 2 mg Tablet
Dispense 1 month
Sig: i po QD
6
James T. Warren
DAW:
substitution permitted
Prescription Origin Code: 1
Pharmacist Notes:
Dispensing Documentation
Rx #: 598779
Dispensing Date: 7/20/20XX
Patient: Mary F. Mott
Doctor: James T. Warren
DEA: AW1351977
NDC: 68382-0115-14
RPh Initials: VNB
Drug: Risperidone 2 mg Tablet
Manufacturer: Zygenerics
DAW Code: 0
SIG: T,1,TAB,PO,QD
Fill Type: Refill
Fill Number: 6
Last Fill Date: 6/18/20XX
Refills Remaining: 1
Quantity: 30
Day Supply: 30
Drug Unit Cost: $7.60
Dispensing Fee: $1.75
Total Cost: $229.75
Signature Log
Signature:
Mary Mott
Rx Number:
598779
Fill Date Date:
7/20/20XX
Pick-up Date:
7/23/20XX
RPh Counseling:
Decline