FPV Practice Exam 1-07
78220057
4/5/20XX
Margaret Morgan
Carolyn Abman
Take 1 tablet by mouth 4 times a day.
Lisinopril/HCTZ 20 mg/12.5 mg Tablet
30
3
4/5/20XX
Lupin
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 68180-0519-01
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $1.21
Total Drug Cost: $36.30
Dispensing Fee: $2.00
Total Billed: $38.30
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 68180-0519-01
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $1.21
Total Drug Cost: $36.30
Dispensing Fee: $2.00
Total Billed: $38.30
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 78220075
Dispensing Date: 4/5/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 4/5/20XX
Initials: RPh
Drug Manu: Lupin
Rx Documentation
Dispensing Date: 4/5/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 4/5/20XX
Initials: RPh
Drug Manu: Lupin