Data Entry Generate Label Patient Select Patient Click to Select *New Patient Bontrager, Stanley M.Bontrager, Coleen L.Bontrager, Julia M.Bontrager, David M.Bontrager, Joel N.Bontrager, Rose J.Bruno, Kyle O.Bruno, Elizabeth R.Bruno, Billy JoeDay, DanielDay, GloriaElder, RobertElder, Georgia L.Elder, Charles O.Elder, Laurie N.Elder, Mrs. HaroldGarcia, CarlosGarcia, AndreaGarcia, GabrielaGarcia, MaríaGarcia, JuanHanson, Richard T.Hanson, Lily M.Hanson, James R.Hanson, William B.Hanson, Mary JeanJohnson, ElmerJohnson, EvelynJones, William P.Jones, Sylvia F.Jones, Janet T.Khan, OmarKhan, FayrahKhan, PhoebeMiller, Edward M.Miller, Judy J.Miller, Jim S.Miller, Jill J.Moore, George S.Moore, Betty L.Moore, Wendy J.Moore, AnnaMorgan, John R.Morgan, MargaretMorgan, Hilda R.Mott, Edward G.Mott, Mary F.Mott, Jim O.Mott, Jill S.Mott, Tim D.Mott, JulieNguyen, VanNguyen, TrangNguyen, TranNguyen, AnhNguyen, DucNguyen, NgocNguyen, NhiRoberts, RobertaRoberts, RobertRoberts, RobbieRoberts, RobinSawyer, MarkSawyer, AliceSykes, Bob O.Sykes, Teresa C.Williams, AlexanderWilliams, BeverlyWilliams, WilliamWilliams, GinaWilliams, AudreyWong, ZhangWong, SunnyWong, LilyWong, LiWright, Don Q.Wright, Elizabeth A.Wright, Mary S. View All Patient Profiles Use Safety Caps?: Prescription Insurance: Cash - no third party insurance Third Party Insurance/Coupon Prescriber Select Prescriber Click to Select *New Prescriber Carolyn Abman, MDSamuel Bernstein, MDSherman F. Fleer, DDSHarold L. Green, MDSandra Jones, DONorman Keyes, MDCynthia McDonald, MDGeorge Platz, MDRoyal T. Shumway, MDJames T. Warren, MD View All Doctors Drug Pharmacy DAW Code Click to Select ---------------------------------------------- 0 - No Product Selection Indicated (generic authorized) 1 - Substitution Not Allowed by Prescriber ---------------------------------------------- 2 - Substitution Allowed-Patient Requested Product Dispensed 3 - Substitution Allowed-Pharmacist Selected Product Dispensed 4 - Substitution Allowed-Generic Drug Not in Stock 5 - Substitution Allowed-Brand Drug Dispensed as a Generic 6 - Override 7 - Substitution Not Allowed-Brand Drug Mandated by Law 8 - Substitution Allowed-Generic Drug Not Available in Marketplace 9 - Substitution Allowed By Prescriber but Plan Requests Brand Lexicomp Drug Info Link Drug Name Generic equivalent of: Brand name of: Manufacturer Cost Per Unit $ Unit Type each (units) mL gram milligram international unit NDC# DEA Schedule Not a Controlled Substance CII CIII CIV CV SIG Morning Quantity: Dosage Form: Midday Quantity: Dosage Form: Evening Quantity: Dosage Form: Bedtime Quantity: Dosage Form: Latin Terms & Common Abbreviations Qty & Refills Quantity Prescribed Quantity To Dispense Days Supply Refills Dates Date Rx Dispensed Date Rx Written Date Rx Expires Use By Delivery Status Waiting Pickup Delivery Date/Time Due: Documentation Pharmacist Initials: Technician Initials: Prescription Origin Code Click to Select 1 - Written 2 - Telephone 3 - Electronic 4 - Facsimile 5 - Pharmacy Transfer 5 - Pharmacy Serial Number Dispensing Fee Counseling Auxiliary Label #1 Controlled Substance Required Statement: Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 Medication Guide is Provided: Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 Take with Food: Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 Take on an Empty Stomach: Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 Do Not Crush or Chew: Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 Finish All Medication (e.g. antibiotics): Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 Shake Well: Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 Keep Refrigerated (storage): Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 Avoid Alcohol: Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 REMOVE AUXILIARY LABEL: Click to SelectAuxiliary Label #1Auxiliary Label #2Auxiliary Label #3Auxiliary Label #4 Open Aux 1 Load Aux 1 Auxiliary Label #2 Open Aux 2 Load Aux 2 Auxiliary Label #3 Open Aux 3 Load Aux 3 Auxiliary Label #4 Open Aux 4 Load Aux 4 Custom Patient Information Data Entry Generate Label University Pharmacy102 Main Street, ST, 76543 TEL: (987) 555-1212 RX: QTY: REFILLS: Prescriber: Date Rx Written: Date Filled: Discard After: RPh/CPhT: / Morning Midday Evening Bedtime Important Information Pharmacy Software SystemRx Documentation Pharmacy Rx#: Fill Date: RPh/CPhT: / Drug MFR: Safety Cap: DEA Schedule: Pharmacy Software SystemInsurance Information Rx Origin Code: Pharmacy DAW Code: Drug NDC#: Quantity: Days' Supply: AWP Cost/Unit: Total Drug Cost: Dispensing Fee: Total Billed: Billed To: Rx Bag Tag Delivery Status: Ready By: University PharmacyDrug Information Handout Generic Name: XXXX Pronounced: XXXX Brand Name: XXXX What is this drug used for? .....