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Rx#
6974474
Written Date
2/17/20XX
 
Rx Expires
1 year
Name
John R. Morgan
Original Prescription
DOB
6/6/XXXX
Age
66
Ht/Wt
73 inches, 214 lbs
at 1:15, eRx #: 8008
ELECTRONIC PRESCRIPTION
John R. Morgan
Address:
Date: 2/17/20XX
Norvasc 5 mg
Dispense: 1 month supply
Sig: i po qd
Refills: 5
Dr. James T. Warren
3-G Medical Arts Building
DEA:
DAW: substitution permitted
Address
1824 New York Street
Phone
785-555-4102
Product/Quantity/Refills/SIG
Prescribed
Norvasc Tab
Strength
5 mg
 
Dispensed
Amlodipine 5 mg Tablet
Pres Qty
30
 
Dis Qty
30
 
Day Supply
30
 
Refills
5
 
SIG
Take 1 tablet by mouth once daily.
Pill Image & Dispensing Notes
DAW
0
Origin Code
3
 
Pill Image
Name
James T. Warren
Address
3-G Medical Arts Building
Fax
785-555-5567
DEA
AW1351977
NPI
6379131958
Phone
785-555-5566
Dispensing
Notes