(V2) Product Verification Queue

ELECTRONIC PRESCRIPTION

Date: 10/13/2025 at 02:37 AM

Patient: Elizabeth A. Wright

Address: 902 Princeton Blvd.

Drug: Ambien 5 mg Tablet

Dispense: 20

SIG: i po HS prn insomnia

Refills: 2

DAW: substitution permitted

Prescriber: Carolyn Abman

Address: 1315 W. 12th Street

DEA#: BA4132647


`Rx#`	2869492	`Written Date`	10/13/2025

`Name`	Elizabeth A. Wright
`DOB`	1/9/1957		`Age`	68
`Address`	902 Princeton Blvd.		`Phone`	(785) 555-1312
`Allergies`	Penicillin, Aspirin, Sulfa, Macrolides (hives, throat swelling, difficulty breathing)

`Prescriber`	Carolyn Abman		`Practice`	Family Practice Physician Group
`Address`	1315 W. 12th Street		`Fax`	(316) 555-3278
`DEA`	BA4132647	`NPI`	1269594188	`Phone`	(316) 555-3277

`Dispensed`	Zolpidem 5 mg Tablet
`NDC #`	00781-5317-01		`Mfg`	Sandoz
`Pres Qty`	20	`Dis Qty`	20	`Day Supply`	20
`Refills`	1	`DAW`	0	`Origin Code`	3

`Instructions`	Take 1 tablet by mouth at bedime as needed for sleep.

`Dispensing Notes`

Product Verification

Bag Tag

Counting Verification

Patient Name: Elizabeth A. Wright
Address: 902 Princeton Blvd.

Stock Bottle

00781-5317-01

NDC: 00781-5317-01

Lot #: 794563
Exp Date: 10/12/2026

Pharmacist Action