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Rx#
8394722
Written Date
3/2/20XX
 
Rx Expires
1 year
Name
Don Q. Wright
Original Prescription
DOB
6/9/XXXX
Age
69
Ht/Wt
174 lbs
Family Practice Physician Group
1315 W. 12th Street
Don Q. Wright
3/2/20XX
Calan SR 240 mg
Dispense #30
Sig: i po qd for heart
0
Carolyn Abman
DAW: generic authorized
Irma Grey
Address
902 Princeton Blvd.
Phone
785-555-3714
Product/Quantity/Refills/SIG
Prescribed
Calan SR
Strength
240 mg
 
Dispensed
Verapamil 240 mg Extended-Release Tablet
Pres Qty
20
 
Dis Qty
30
 
Day Supply
30
 
Refills
0
 
SIG
Take 1 tablet by mouth once daily for heart.
Pill Image & Dispensing Notes
DAW
0
Origin Code
4
 
Pill Image
Name
Carolyn Abman
Address
1315 W. 12th Street
Fax
316-555-3278
DEA
BA4132647
NPI
1269594188
Phone
316-555-3277
Dispensing
Notes