CLICK on error (1 error per prescription) for Completion Code |
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Rx# |
6974474 |
Written Date |
2/17/20XX |
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Rx Expires |
1 year |
Name |
John R. Morgan |
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Original Prescription |
DOB |
6/6/XXXX |
Age |
66 |
Ht/Wt |
73 inches, 214 lbs |
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Address |
1824 New York Street |
Phone |
785-555-4102 |
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Product/Quantity/Refills/SIG |
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Prescribed |
Norvasc Tab |
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Strength |
5 mg |
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Dispensed |
Amlodipine 5 mg Tablet |
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Pres Qty |
30 |
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Dis Qty |
30 |
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Day Supply |
30 |
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Refills |
5 |
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SIG |
Take 1 tablet by mouth once daily. |
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Pill Image & Dispensing Notes |
DAW |
0 |
Origin Code |
3 |
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Pill Image |
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Name |
James T. Warren |
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Address |
3-G Medical Arts Building |
Fax |
785-555-5567 |
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DEA |
AW1351977 |
NPI |
6379131958 |
Phone |
785-555-5566 |
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Dispensing Notes |