Pharmacy Audit Prescriptions

Original Prescription

Family Health Associates - Doctors James Warren and Norman Keyes

3-G Medical Arts Building

Hilda R. Morgan

1824 New York Street

6/12/20XX

Novolog 100 units/mL FlexPen

Dispense 2 boxes

Sig: Inject SC UD

3

James T. Warren	

AW1351977

DAW: dispense as written

Prescription Origin Code: 4

Pharmacist Notes: called doctor who said patient was to inject up to 60 units per day SC depending on carb counting and insulin sensitivity

Molly Deeds

Prescription Origin Code: 4

Pharmacist Notes: called doctor who said patient was to inject up to 60 units per day SC depending on carb counting and insulin sensitivity

Dispensing Documentation

Rx #: 903322

Dispensing Date: 6/12/20XX

Patient: Hilda R. Morgan

Doctor: James T. Warren

DEA: AW1351977

NDC: 00169-6339-10

RPh Initials: TED

Drug: Novolog FlexPen 100 units/mL Injection

Manufacturer: Novo Nordisk

DAW Code: 1

SIG: Inject up to 60 units per day,SC,UD,depending on carb counting and insulin sensitivity

Fill Type: New

Fill Number: 1

Last Fill Date: 6/12/20XX

Refills Remaining: 3

Quantity: 30

Day Supply: 30

Drug Unit Cost: $20.46

Dispensing Fee: $1.75

Total Cost: $615.55

Signature Log

Signature:

John Morgan

Rx Number:

903322

Fill Date Date:

6/12/20XX

Pick-up Date:

6/12/20XX

RPh Counseling:

Decline