Original Prescription
Family Health Associates - Doctors James Warren and Norman Keyes
3-G Medical Arts Building
Edward M. Miller
432 Locust
5/4/20XX
Percocet 5
Dispense 28
Sig: i po q6h prn severe pain
Cancelled - BML - 5/4/20XX
0
Norman Keyes
AK4132647
DAW:
substitution permitted
Prescription Origin Code: 1
Pharmacist Notes:
Dispensing Documentation
Rx #: 445634
Dispensing Date: 5/4/20XX
Patient: Edward M. Miller
Doctor: Norman Keyes
DEA: AW1351977
NDC: 53746-0203-01
RPh Initials: BML
Drug: Oxycodone/APAP 5 mg/325 mg Tablet
Manufacturer: Amneal
DAW Code: 0
SIG: T,1,PO,Q6H,PRN,severe pain
Fill Type: New
Fill Number: 1
Last Fill Date: 5/4/20XX
Refills Remaining: 0
Quantity: 28
Day Supply: 7
Drug Unit Cost: $0.51
Dispensing Fee: $1.75
Total Cost: $16.03
Signature Log
Signature:
Edward Miller
Rx Number:
445634
Fill Date Date:
5/4/20XX
Pick-up Date:
5/4/20XX
RPh Counseling:
Accept