CLICK on error (1 error per prescription) for Completion Code |
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Rx# |
5136998 |
Written Date |
2/19/20XX |
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Rx Expires |
3 months |
Name |
Stanley M. Bontrager |
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Original Prescription |
DOB |
3/3/XXXX |
Age |
33 |
Ht/Wt |
74 inches, 226 lbs |
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Address |
421 East 21st Street |
Phone |
785-555-9023 |
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Product/Quantity/Refills/SIG |
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Prescribed |
Percocet Tab |
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Strength |
5 mg/325 mg |
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Dispensed |
Oxycodone 5 mg Tablet |
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Pres Qty |
15 |
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Dis Qty |
15 |
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Day Supply |
2 |
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Refills |
0 |
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SIG |
Take 1 tablet by mouth every 4 to 6 hours as needed for pain. |
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Pill Image & Dispensing Notes |
DAW |
0 |
Origin Code |
3 |
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Pill Image |
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Name |
Sherman F. Fleer |
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Address |
2831 Sunset |
Fax |
316-555-6848 |
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DEA |
AF1299468 |
NPI |
3096652801 |
Phone |
316-555-6847 |
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Dispensing Notes |
Patient recovering from dental tooth extraction. |