Original Prescription
at 9:19, eRx #: 8688
ELECTRONIC PRESCRIPTION
Elizabeth A. Wright
902 Princeton Blvd.
Date: 5/30/20XX
Prednisolone 1% Oph. Susp.
Dispense 15 mL
Sig: 1 gtt OS Q6H
Refills: 1
Dr. Carolyn Abman
1315 W. 12th Street
BA4132647
DAW:
Prescription Origin Code: 3
Pharmacist Notes:
Dispensing Documentation
Rx #: 369551
Dispensing Date: 7/10/20XX
Patient: Elizabeth A. Wright
Doctor: Carolyn Abman
DEA: BA4132647
NDC: 61314-0637-15
RPh Initials: OPN
Drug: Prednisolone Acetate 1% Ophthalmic Suspension
Manufacturer: Falcon
DAW Code: 0
SIG: Instill,1,drop,OS,Q6H
Fill Type: Refill
Fill Number: 2
Last Fill Date: 5/30/20XX
Refills Remaining: 0
Quantity: 15
Day Supply: 30
Drug Unit Cost: $2.84
Dispensing Fee: $1.75
Total Cost: $44.35
Signature Log
Signature:
Don Wright
Rx Number:
369551
Fill Date Date:
7/10/20XX
Pick-up Date:
7/11/20XX
RPh Counseling:
Decline