FPV Practice Exam 1-10
9542876
2/9/20XX
Rose Bontrager
Norman Keyes
Instill 4 drops into both ears 4 times a day for 7 days.
Neomycin 0.35%/Polymixin B 10000 u/mL/HC 1% Otic Solution
10 mL
1
2/8/20XX
Fougera
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00168-0256-10
Quantity: 10 mL
Days Supply: 7
AWP Cost/Unit: $1.02
Total Drug Cost: $10.20
Dispensing Fee: $2.00
Total Billed: $12.20
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00168-0256-10
Quantity: 10 mL
Days Supply: 7
AWP Cost/Unit: $1.02
Total Drug Cost: $10.20
Dispensing Fee: $2.00
Total Billed: $12.20
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 9542876
Dispensing Date: 2/9/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/9/20XX
Initials: RPh
Drug Manu: Fougera
Rx Documentation
Dispensing Date: 2/9/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/9/20XX
Initials: RPh
Drug Manu: Fougera