Original Prescription
Dr. Royal T. Shumway
1724 Rainbow
Edward M. Miller
432 Locust
11/10/20XX
Lovenox 40 mg Injection
Dispense 10 syringes
Sig: Inject 40 mg SC BID x5 days
0
Royal T. Shumway
DAW:
dispense as written
Prescription Origin Code: 1
Pharmacist Notes: counseled patient on correct administration technique
Dispensing Documentation
Rx #: 874112
Dispensing Date: 11/10/20XX
Patient: Edward M. Miller
Doctor: Royal T. Shumway
DEA: AS1291234
NDC: 00075-0620-40
RPh Initials: RRC
Drug: Lovenox 40 mg/0.4 mL Injection Syringe
Manufacturer: Sanfoi-Aventis
DAW Code: 1
SIG: Inject,40 mg (0.4 mL),SC,BID,for 5 days
Fill Type: New
Fill Number: 1
Last Fill Date: 11/10/20XX
Refills Remaining: 0
Quantity: 10
Day Supply: 5
Drug Unit Cost: $99.23
Dispensing Fee: $1.75
Total Cost: $994.05
Signature Log
Signature:
Judy Miller
Rx Number:
874112
Fill Date Date:
11/10/20XX
Pick-up Date:
11/10/20XX
RPh Counseling:
Accept