FPV Practice Exam 1-09






75566921
2/14/20XX
Sylvia Jones
James Warren
Take 1 or 2 tablets by mouth every 6 hours as needed for
headache.
Hydrocodone/APAP 5 mg/325 mg Tablet
30
0
2/14/20XX
Mallinckrodt
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00406-0365-01
Quantity: 30
Days Supply: 3
AWP Cost/Unit: $0.54
Total Drug Cost: $16.20
Dispensing Fee: $2.00
Total Billed: $18.20
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00406-0365-01
Quantity: 30
Days Supply: 3
AWP Cost/Unit: $0.54
Total Drug Cost: $16.20
Dispensing Fee: $2.00
Total Billed: $18.20
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 75566921
Dispensing Date: 2/14/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/14/20XX
Initials: RPh
Drug Manu: Mallinckrodt
Rx Documentation
Dispensing Date: 2/14/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/14/20XX
Initials: RPh
Drug Manu: Mallinckrodt