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Rx#
302114
Written Date
10/13/2025
Patient Information
 
Rx Expires
10/13/2026
Name
Mary Jean Hanson
Original Prescription
DOB
8/24/2024
Age
1
Ht/Wt
at 1:07, eRx #: 8396343
ELECTRONIC PRESCRIPTION
Mary Jean Hanson
1205 Edgewood Lane
Date: 10/13/2025
Imodium A-D Oral Liquid
Dispense 240 mL
Sig: 7.5 mL po with first loose stool, MR x 3
Refills: 0
Dr. Harold L. Green
2-G Medical Arts Building
AG1294230
DAW: brand only
Address
1205 Edgewood Lane
Phone
(785) 555-3521
Product/Quantity/Refills/SIG
Prescribed
Imodium A-D Oral Liquid
Strength
1 mg/7.5 mL
 
Dispensed
Imodium A-D Oral Liquid
Pres Qty
240 mL
 
Dis Qty
240 mL
 
Day Supply
30
 
Refills
0
 
SIG
Take 7.5 mL by mouth with first loose stool, repeat after each subsequent loose stool, not to exceed 3 doses/day.
Pill Image & Dispensing Notes
RPh Note:
DAW
1
Origin Code
3
 
Pill Image
Prescriber Information
Name
Harold L. Green
Address
2-G Medical Arts Building
Fax
(785) 555-7718
DEA
AG1294230
NPI
5946269224
Phone
(785) 555-7718
DUR ALERT
 
There is a PROFILE ALERT for Mary Jean Hanson taking Imodium A-D Oral Liquid
 

Alert Concern: Pharmacist Action: Proposed Change: