FPV Practice Exam 1-08
94585138
1/16/20XX
Mary Mott
James Warren
Take 1 tablet by mouth once daily at bedtime.
Haloperidol 0.5 mg Tablet
30
2
1/16/20XX
Geneva
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00781-1396-01
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $0.25
Total Drug Cost: $7.50
Dispensing Fee: $2.00
Total Billed: $9.50
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00781-1396-01
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $0.25
Total Drug Cost: $7.50
Dispensing Fee: $2.00
Total Billed: $9.50
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 94585138
Dispensing Date: 1/16/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 1/16/20XX
Initials: RPh
Drug Manu: Haloperidol
Rx Documentation
Dispensing Date: 1/16/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 1/16/20XX
Initials: RPh
Drug Manu: Haloperidol