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Original Prescription
at 9:15, eRx #:52191
ELECTRONIC PRESCRIPTION
Coleen L. Bontrager
421 E. 21st Street
Date: 3/5/20XX
Anucort-HC 25 mg Rectal Suppository
Dispense 2 week supply
Sig: 1 PR BID X 2 WEEKS FOR HEMORRHOIDS
Refills: 0
Dr.
DAW: substitution permitted
Pharmacist Notes:
Patient Profile
Name: Bontrager, Coleen L.
Address: 421 E. 21st Street
Age: 32
Gender: F
Chronic Illness: Breastfeeding
Allergies:
OTC Drugs:
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:  Stanley M. Bontrager
Member ID:  193644507
Person Code:  00 Stanley M., 01 Coleen L, 02 Julia M., 03 David M., 04 Joel N., 05 Rose J.
RxBIN:  849224
RxPCN:  ODMUCZ
RxGROUP:  4FLS546N