Use of this site and material contained on its pages is for EDUCATIONAL USE ONLY.
 
Check out our new version by clicking HERE
 
Prescription Intake
 
Patient Select Patient
 

 
 
View All Patient Profiles
 

 
Use Safety Caps?:

 
Prescription Insurance:

 
Prescriber Select Prescriber
 

 
View All Doctors
Validate DEA #
Drug Pharmacy DAW Code
 

Drug Name

Manufacturer

 
Cost Per Unit  $
Unit Type  

 
NDC#

 
DEA Schedule   
SIG
Latin Terms & Common Abbreviations
Qty & Refills Quantity Prescribed   

 
Quantity To Dispense   

 
Days Supply   

 
Refills   
Dates Date Rx Dispensed   

 
Date Rx Written   

 
Date Rx Expires   

 
Use By   

 
Delivery Status   

 
Date/Time Due:   
Documentation Pharmacist Initials:   

 
Prescription Origin Code   

 
Serial Number   

 
Dispensing Fee   
Counseling Auxiliary Label #1   
      
 Controlled Substance Required Statement:

Medication Guide is Provided:

Take with Food:

Take on an Empty Stomach:

Do Not Crush or Chew:

Finish All Medication (e.g. antibiotics):

Shake Well:

Keep Refrigerated (storage):

Avoid Alcohol:

 
REMOVE AUXILIARY LABEL:

 
 Open Aux 1      Load Aux 1
Auxiliary Label #2   
      
 Open Aux 2      Load Aux 2
Auxiliary Label #3   
      
 Open Aux 3      Load Aux 3
Auxiliary Label #4   
      
 Open Aux 4      Load Aux 4
 
Custom Patient Information