(V2) Product Verification Queue

ELECTRONIC PRESCRIPTION

Date: 10/12/2025 at 02:20 PM

Patient: Carlos Garcia

Address: 632 N. Hampton Avenue

Drug: Amitriptyline 10 mg Tablet

Dispense: 15

SIG: i po HS for sleep

Refills: 1

DAW:

Prescriber: Norman Keyes

Address: 4-G Medical Arts Building

DEA#: AK4132647


`Rx#`	5556445	`Written Date`	10/12/2025

`Name`	Carlos Garcia
`DOB`	4/30/1986		`Age`	39
`Address`	632 N. Hampton Avenue		`Phone`	(316) 555-0732
`Allergies`

`Prescriber`	Norman Keyes		`Practice`	Uptown Family Practice
`Address`	4-G Medical Arts Building		`Fax`	(785) 555-3239
`DEA`	AK4132647	`NPI`	3816380925	`Phone`	(785) 555-3238

`Dispensed`	Amitriptyline 10 mg Tablet
`NDC #`	16729-0171-01		`Mfg`	Accord
`Pres Qty`	15	`Dis Qty`	15	`Day Supply`	15
`Refills`	1	`DAW`	0	`Origin Code`	3

`Instructions`	Take 1 tablet by mouth at bedtime for sleep.

`Dispensing Notes`

Product Verification

Bag Tag

Counting Verification

Patient Name: Carlos Garcia
Address: 632 N. Hampton Avenue

Stock Bottle

16729-0175-01

NDC: 16729-0175-01

Lot #: 307839
Exp Date: 10/21/2026

Pharmacist Action