CLICK on error (1 error per prescription) for Completion Code |
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Rx# |
3701298 |
Written Date |
2/1/20XX |
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Rx Expires |
1 year |
Name |
Janet T. Jones |
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Original Prescription |
DOB |
9/21/XXXX |
Age |
20 |
Ht/Wt |
70 inches, 205 lbs |
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Address |
2032 Missouri Street |
Phone |
785-555-8126 |
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Product/Quantity/Refills/SIG |
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Prescribed |
Zovirax Tab |
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Strength |
400 mg |
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Dispensed |
Acyclovir 400 mg Tablet |
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Pres Qty |
30 |
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Dis Qty |
30 |
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Day Supply |
10 |
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Refills |
0 |
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SIG |
Take 1 tablet by mouth three times a day for 10 days for lip sore. |
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Pill Image & Dispensing Notes |
DAW |
0 |
Origin Code |
4 |
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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 |
Patient expressed concern over recurrent Herpes Simplex infections. |