(V2) Product Verification Queue

ELECTRONIC PRESCRIPTION

Date: 04/01/2026 at 05:44 PM

Patient: Sylvia F. Jones

Address: 2032 Missouri Street

Drug: Fluoxetine 20 mg Tablet

Dispense: 14

SIG: i po QD on days 15-28 of cycle for PMDD

Refills: 5

DAW:

Prescriber: Sandra Jones

Address: 2300 Clinton Parkway Ct.

DEA#: BJ1234563


`Rx#`	3342213	`Written Date`	04/01/2026

`Name`	Sylvia F. Jones
`DOB`	2/25/1988		`Age`	38
`Address`	2032 Missouri Street		`Phone`	(316) 555-3931
`Allergies`

`Prescriber`	Sandra Jones		`Practice`	Women Health Care Clinic
`Address`	2300 Clinton Parkway Ct.		`Fax`	(785) 555-8615
`DEA`	BJ1234563	`NPI`	9683386307	`Phone`	(785) 555-8614

`Dispensed`	Fluoxetine 20 mg Tablet
`NDC #`	62332-0243-30		`Mfg`	Alembic
`Pres Qty`	14	`Dis Qty`	14	`Day Supply`	14
`Refills`	5	`DAW`	0	`Origin Code`	3

`Instructions`	Take 1 tablet by mouth in the morning on days 15 to 28 of cycle for PMDD.

`Dispensing Notes`

Product Verification

Bag Tag

Counting Verification

Patient Name: Sylvia F. Jones
Address: 2032 Missouri Street

Stock Bottle

62332-0243-30

NDC: 62332-0243-30

Lot #: 343599
Exp Date: 9/15/2027

Pharmacist Action