FPV Practice Exam 2-09
29448809
1/8/20XX
Sylvia Jones
James Warren
Take 1 tablet by mouth every 4 to 6 hours as needed for pain.
Hydrocodone/APAP 5 mg/500 mg Tablets
21
0
1/7/20XX
Qualitest
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00603-3881-28
Quantity: 21
Days Supply: 2
AWP Cost/Unit: $0.42
Total Drug Cost: $8.82
Dispensing Fee: $2.00
Total Billed: $10.82
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00603-3881-28
Quantity: 21
Days Supply: 2
AWP Cost/Unit: $0.42
Total Drug Cost: $8.82
Dispensing Fee: $2.00
Total Billed: $10.82
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 29448809
Dispensing Date: 1/8/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 1/8/20XX
Initials: RPh
Drug Manu: Qualitest
Rx Documentation
Dispensing Date: 1/8/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 1/8/20XX
Initials: RPh
Drug Manu: Qualitest