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Pharmskills Online - Electronic Third-Party Insurance Prescriptions

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Original Prescription
at 10:51, eRx #:11470
ELECTRONIC PRESCRIPTION
Robert Elder
940 Popular
Date: 2/4/20XX
HCTZ 12.5 mg Capsule
Dispense 30
Sig: 1,PO,QAM
Refills: 2
Dr.
DAW: substitution permitted
Pharmacist Notes:
Patient Profile
Name: Elder, Robert
Address: 940 Popular
Age: 47
Gender: M
Chronic Illness: Hypertension
Allergies:
OTC Drugs: Chlortrimeton, MOM
Doctor Information
Name:
Practice:
Address:
DEA Number:
DAW Codes
DAW 0 - NO DISPENSE AS WRITTEN
(substitution allowed or no generic on market)
 
DAW 1 - PHYSICIAN writes DISPENSE AS WRITTEN
 
DAW 2 - PATIENT REQUESTED BRAND
 
DAW 3 - PHARMACIST SELECTED BRAND
 
DAW 4 - GENERIC NOT IN STOCK
 
DAW 5 - BRAND DISPENSED, PRICED AS GENERIC
 
DAW 6 - OVERRIDE
 
DAW 7 - SUBSTITUTION NOT ALLOWED BY LAW
 
DAW 8 - GENERIC NOT AVAILABLE
 
DAW 9 - OTHER
Insurance Card
United Blue Expressmark
Prescription Drug Card
Member Name:  Robert Elder
Member ID:  174285396
Person Code:  00 Robert, 01 Georgia L., 02 Charles O., 03 Laurie N.
RxBIN:  643125
RxPCN:  GLDPLS
RxGROUP:  OPSS2955