Original Prescription
at 9:13, eRx #: 6978
ELECTRONIC PRESCRIPTION
Roberta Roberts
5050 Plaza Hill Road
Date: 2/4/20XX
Penlac 8% Nail Lacquer
Dispense 1 bottle
Sig: Apply once daily to affected nails
Refills: 1
Dr. Carolyn Abman
1315 W. 12th Street
BA4132647
DAW: substitution permitted
Prescription Origin Code: 3
Pharmacist Notes: patient requested Penlac brand to be dispensed
Dispensing Documentation
Rx #: 748873
Dispensing Date: 3/16/20XX
Patient: Roberta Roberts
Doctor: Carolyn Abman
DEA: BA4132647
NDC: 00066-8008-02
RPh Initials: TTL
Drug: Penlac Nail Lacquer 8% Topical Solution
Manufacturer: Aventis
DAW Code: 1
SIG: A,TOP,affected nail,QD
Fill Type: Refill
Fill Number: 2
Last Fill Date: 2/4/20XX
Refills Remaining: 0
Quantity: 6.6
Day Supply: 30
Drug Unit Cost: $52.89
Dispensing Fee: $1.75
Total Cost: $350.82
Signature Log
Signature:
Robert Roberts
Rx Number:
748873
Fill Date Date:
3/16/20XX
Pick-up Date:
3/18/20XX
RPh Counseling:
Decline