of this drug to any person other than patient for whom ... · pjp/pjp fred,barnes j. rx# 1000218...

CAUTION/W

ARNING: Federal and/or State law prohibits the transfer

of this drug to any person other than patient for whom prescribed.

Forms & Labels5800 Corporate Drive, 4th Floor, Pittsburgh, PA 15237

TRX-081

3.5”

x 5

” Therm

al Pre

scrip

tion &

IV L

abel

fra

me

wo

rklt

c.c

om

/fo

rms

-la

be

ls

412

-49

2-9

841

form

s@

so

ftw

rite

rs.c

om

1.5” Core with 4.5” Max. OD

TRX-0813.5” x 5” Thermal Prescription & IV Label

STOCK # TYPE CORE LABELS/ROLL

LABELS/CTN

TRX-081 Direct Thermal 1.5” 500 5,000

Label Packaging:

CAUTION/W



HAPPY ACRES (HACRES)NS: EAST 1 Room: 102 B

PHONE: (412)492-9841

NEXIUM CAP 40MG10/12/16

30 CPDR

FRED,BARNES J.

NEXIUM CAP 40MG

Rx# 1000218Ro# BF200010

Take

Thi

s M

edic

ine

At L

east

1 H

our

Befo

re A

Mea

l.Sw

allo

w W

hole

. Do

Not

Che

w O

r Cr

ush.

Rea

d Th

e M

edic

atio

nG

uide

Tha

t Com

esW

ith

This

Med

icin

e.Reorder:BF200010

SWI FORMS DIVISION

PITTSBURGH, PA 152375800 CORPORATE DRIVE 4TH FLRDEA:DEA000000

04/29/13

1 of 1Gen: ESOMEPRAZOLE MAGNESIUM CAP DELAYED RELEASE 40 M

10/12/16FRED,BARNES J.

10/12/1630 CPDRHAPPY ACRES

Rx:1000218

Manuf: QUALITY

PJP/PJP

FRED,BARNES J.

Rx# 1000218 Rx# 1000218

NEXIUM CAP 40MG

NEXIUM CAP 40MGManuf: QUALITY

NEXIUM CAP 40MGFRED,BARNES J.

Reorder after: 11/26/2016CHARLES GORMAN, ONC

NON-

RETU

RNAB

LE

amethyst oblong NEXIUM 40 mg

Cycle

30 CPDR

CHARLES GORMAN, ONC10/12/16

LOT: ________________________EXP: ________________________BIN: DEFAULT ZONE: DEFAULT

30 CPDR49999-0307-15CHARLES GORMAN, ONC

SWI FORMS DIVISION DEA000000FRED,BARNES J.500 W BROADWAY PITTSBURGH, PA 15222NEXIUM CAP 40MG QUALITYTotal: 0CHARLES GORMAN, ONC220 WALNUT STREET PITTSBURGH, PA 15219PHONE: (412)221-2424 FAX: (___)___-____

10/12/16DOB: 04/22/30

DAW 0

AD1234563Disp: 30 PJP

MOP: CARE PrOpt: CARE

Take 1 Capsule By Mouth In the Morning. TFLBL341 for TRX-081. Call 412-492-9841 for samples.

Take 1 Capsule By Mouth In the Morning.TFLBL341 for TRX-081. Call 412-492-9841for samples.

CAUTION/W



DRUG NAME: CLONAZEPAM TAB 1MGMFG: TEVA USA

LOT: ________________________

USE BY: _____________________

CAUTION/W



HAPPY ACRESEAST 1 102 BCARE CARE PHONE: (412)492-4000

NEXIUM CAP 40MG 10/12/1630


Manuf: QUALITYNDC: 49999-0307-15

FRED,BARNES J.Rx:1000218NEXIUM CAP 40MG 30

HAPPY ACRES

Dr. C. GORMAN Rx# 1000218Ro# BF200010PJP/PJP

REFILL

BATCH ID: CycleRx# 1000218ZONE/BIN: DEFAULT/DEFAULT

DELIVERY ID:NEXIUM CAP 40MGNDC: 49999-0307-15PACKAGE TYPE: PHDEF

FRED,BARNES J. Rx# 1000218HAPPY ACRESNEXIUM CAP 40MGRP: PrilosecDr. C. GORMANMFG: QUALITY

DRUG NAME: NEXIUM CAP 40MGMFG: QUALITY

LOT: ________________________

EXP: ________________________

CARE/CARE10/12/16

RO:BF200010

FRED,BARNES J. SWI FORMS DIVISION


1 of 1RP: Prilosec

CAUTION/W




PHONE: (412)492-9841

NEXIUM CAP 40MG10/12/16

30 CPDR

FRED,BARNES J.

NEXIUM CAP 40MG

Rx# 1000218Ro# BF200010

Take

Thi

s M

edic

ine

At L

east

1 H

our

Befo

re A

Mea

l.Sw

allo

w W

hole

. Do

Not

Che

w O

r Cr

ush.

Rea

d Th

e M

edic

atio

nG

uide

Tha

t Com

esW

ith

This

Med

icin

e.Reorder:BF200010

SWI FORMS DIVISION


04/29/13




Rx:1000218

Manuf: QUALITY

PJP/PJP

FRED,BARNES J.

Rx# 1000218 Rx# 1000218

NEXIUM CAP 40MG

NEXIUM CAP 40MGManuf: QUALITY

NEXIUM CAP 40MGFRED,BARNES J.


NON-

RETU

RNAB

LE


Cycle

30 CPDR




SWI FORMS DIVISION DEA000000FRED,BARNES J.500 W BROADWAY PITTSBURGH, PA 15222NEXIUM CAP 40MG QUALITYTotal: 0CHARLES GORMAN, ONC220 WALNUT STREET PITTSBURGH, PA 15219PHONE: (412)221-2424 FAX: (___)___-____

10/12/16DOB: 04/22/30

DAW 0





CAUTION/W



Williams,Rita M.Happy Acres HACRES

MOP: FACIFill Type:

Refill 30 EA03/06/14PJP/PJPExp Date: 03/06/15

zyPREXA 7.5MG-TABSGen: Olanzapine Tab 7.5 MGwhite, round, LILLY 4116

Dr R SmithRx# 1000058

Refill on: 03/22/2014

30 EA00002-4116-30 LILLY

8AM,8PM

Williams,Rita M.HAPPY ACRES 03/06/14zyPREXA 7.5MG-TABS

Reorder# RW200020Rx# 1000058Forms Division3960 William FlynnAllison Park, PA 15101

Phone: (412)492-9841 Fax: (412)492-9851Toll Free:

Williams,Rita M. Rx# 100005807/08/32 Dr R SmithHappy AcreszyPREXA 7.5MG-TABS 30 EA00002-4116-30 LILLY 03/06/14Exp ________________ LOT# ________________

Williams,Rita M. Rx# 1000058zyPREXA 7.5MG-TABS 30 EA00002-4116-30 LILLY 03/06/14Dr R Smith AJ1234563480 W Water StPittsburgh, PA 15222

May

Cau

se D

row

sine

ss. A

lcoh

olM

ay M

ake

This

Wor

se. U

se C

are

Whe

n O

pera

ting

A Ve

hicl

e, V

esse

l,O

r D

ange

rous

Mac

hine

ry.

May

Cau

se D

izzi

ness

Do

Not

Tak

e O

ther

Med

icin

es W

ithou

tCh

ecki

ng W

ith Y

our

Doc

tor

Or

Phar

mac

ist.

Take

Or

Use

Thi

s M

edic

ine

Exac

tlyAs

Dir

ecte

d. D

o N

ot S

kip

Dos

es O

rD

isco

ntin

ue U

nles

s D

irec

ted

ByYo

ur D

octo

r. Scan

Rx

NS: EAST 1 Room/Bed: 108/W

Williams,Rita M.Happy AcresRX# 1000058

Zone:DEFAULT

Bin:DEFAULT

Take One Half Tablet After BreakfastMixed w Juice; Take One Tablet Before Bedtime.

NO REFILLS

Format #TFLBL416 for TRX-081 label.

CAUTION/W




MOP: FACIFill Type:


zyPREXA 7.5MG-TABSGen: Olanzapine Tab 7.5 MGwhite, round, LILLY 4116 Rx# 1000058

Refill on: 03/22/2014

30 EA00002-4116-30 LILLY

8AM,8PM


Reorder# RW200020Rx# 1000058Forms Division3960 William FlynnAllison Park, PA 15101

Phone: (412)492-9841 Fax: (412)492-9851Toll Free:

Williams,Rita M. Rx# 100005807/08/32Happy AcreszyPREXA 7.5MG-TABS 30 EA00002-4116-30 LILLY 03/06/14Exp ________________ LOT# ________________

Williams,Rita M. Rx# 1000058zyPREXA 7.5MG-TABS 30 EA00002-4116-30 LILLY 03/06/14

AJ1234563480 W Water StPittsburgh, PA 15222

May

Cau

se D

row

sine

ss. A

lcoh

olM

ay M

ake

This

Wor

se. U

se C

are

Whe

n O

pera

ting

A Ve

hicl

e, V

esse

l,O

r D

ange

rous

Mac

hine

ry.

May

Cau

se D

izzi

ness

Do

Not

Tak

e O

ther

Med

icin

es W

ithou

tCh

ecki

ng W

ith Y

our

Doc

tor

Or

Phar

mac

ist.

Take

Or

Use

Thi

s M

edic

ine

Exac

tlyAs

Dir

ecte

d. D

o N

ot S

kip

Dos

es O

rD

isco

ntin

ue U

nles

s D

irec

ted

ByYo

ur D

octo

r. Scan

Rx



Zone:DEFAULT

Bin:DEFAULT

CARD R Smith

CARD R Smith

CARD R Smith

Take One Half Tablet After BreakfastMixed w Juice; Take One Tablet Before Bedtime.

NO REFILLS

Format #TFLBL416-PREFIX for TRX-081 label.

CAUTION/W




PHONE: (412)492-9841

NexIUM Capsule DR 40MG10/12/16

30 CPDR

FRED,BARNES J.

NexIUM Capsule DR 40MG

Rx# 1000218Ro# BF200010

Take

Thi

s M

edic

ine

At L

east

1 H

our

Befo

re A

Mea

l.Sw

allo

w W

hole

. Do

Not

Che

w O

r Cr

ush.

Rea

d Th

e M

edic

atio

nG

uide

Tha

t Com

esW

ith

This

Med

icin

e.Reorder:BF200010

SWI FORMS DIVISION


04/29/13




Rx:1000218

Manuf: QUALITY

PJP/PJP

FRED,BARNES J.

Rx# 1000218 Rx# 1000218


NexIUM Capsule DR 40MGManuf: QUALITY

NexIUM Capsule DR 40MGFRED,BARNES J.


NON-

RETU

RNAB

LE


Cycle

30 CPDR




SWI FORMS DIVISION DEA000000FRED,BARNES J.500 W BROADWAY PITTSBURGH, PA 15222NexIUM Capsule DR 40MG QUALITYTotal: 0CHARLES GORMAN, ONC220 WALNUT STREET PITTSBURGH, PA 15219PHONE: (412)221-2424 FAX: (___)___-____

10/12/16DOB: 04/22/30

DAW 0





CAUTION/W




PHONE: (412)492-9841


30 CPDR

FRED,BARNES J.


Rx# 1000218Ro# BF200010

Take

Thi

s M

edic

ine

At L

east

1 H

our

Befo

re A

Mea

l.Sw

allo

w W

hole

. Do

Not

Che

w O

r Cr

ush.

Rea

d Th

e M

edic

atio

nG

uide

Tha

t Com

esW

ith

This

Med

icin

e.Reorder:BF200010

SWI FORMS DIVISION


04/29/13




Rx:1000218

Manuf: QUALITY

PJP/PJP

FRED,BARNES J.

Rx# 1000218 Rx# 1000218



NexIUM Capsule DR 40MGFRED,BARNES J.


NON-

RETU

RNAB

LE


Cycle

30 CPDR




SWI FORMS DIVISION DEA000000FRED,BARNES J.500 W BROADWAY PITTSBURGH, PA 15222NexIUM Capsule DR 40MG QUALITYTotal: 0CHARLES GORMAN, ONC220 WALNUT STREET PITTSBURGH, PA 15219PHONE: (412)221-2424 FAX: (___)___-____

10/12/16DOB: 04/22/30

DAW 0



Take 1 Capsule By Mouth In the Morning. TFLBL467-IC for TRX-081. Call 412-492-9841 for samples.

Take 1 Capsule By Mouth In the Morning.TFLBL467-IC for TRX-081. Call 412-492-9841 for samples.

CAUTION/W



BLAC

K BO

XW

ARN

ING

NO

N-R

ETU

RN

ABLE

Happy AcresNS: EAST 1 Room: 108 WPrOpt: CARE MOP: CARE FacPatID: False

GENERIC FOR: KLONOPINCLONAZEPAM TAB 1MG

04/12/1730 TABS

04/12/17Williams,Rita M.Happy AcresCLONAZEPAM TAB 1MG 30 TABS

Reorder:RW200088

CLONAZEPAM TAB 1MG QTY: 30GENERIC FOR: KLONOPIN

Rx# 1000250 Dr. R. Smith

04/12/17

Rx:1000250

Williams,Rita M.

New Rx Needed for Future Fills

CLONAZEPAM TAB 1MG QTY: 30

Williams,Rita M. NS: EAST 1 Room: 108 W

Williams,Rita M. NS: EAST 1 Room: 108 W

GENERIC FOR: KLONOPIN

04/12/17

Dr. R. SmithRx# 1000250


LOT: ________________________

USE BY: _____________________

Rx# 1000250Ro# RW200088

Dr. R. SmithPJP/PJP

Refill after: 04/08/2017NEW ORDER

DELIVERY ID:WEST

ZONE/BIN: DEFAULT/DEFAULTPACKAGE TYPE: BLISTER

Take One Tablet By Mouth Three Times Daily. TFLBL516 for TRX-081

SWI Forms Division

DEA# DEA000000

(412)555-0000Pittsburgh, PA 152374th Flr5800 Corproate Drive

CAUTION/W




MOP: FACIFill Type:


zyPREXA 7.5MG-TABSGen: Olanzapine Tab 7.5 MGwhite, round, LILLY 4116 Rx# 1000146

Refill on: 12/05/15

8:00 AM,.,8:00 PM


Reorder# RW200020Rx# 1000146SWI Forms Division5800 Corporate DrivePittsburgh, PA 15237

Phone: (412)492-9841 Fax: (412)492-9851Toll Free: (412)492-4000

Williams,Rita M. Rx# 100014607/08/32Happy AcreszyPREXA 7.5MG-TABS 30 EA00002-4116-30 LILLY 11/19/15Exp ________________ LOT# ________________

Williams,Rita M. Rx# 1000146zyPREXA 7.5MG-TABS 30 EA00002-4116-30 LILLY 11/19/15

AJ1234563480 W Water StCabin Creek, WV 25305

May

Cau

se D

row

sine

ss. A

lcoh

olM

ay M

ake

This

Wor

se. U

se C

are

Whe

n O

pera

ting

A Ve

hicl

e, V

esse

l,O

r D

ange

rous

Mac

hine

ry.

May

Cau

se D

izzi

ness

Do

Not

Tak

e O

ther

Med

icin

es W

ithou

tCh

ecki

ng W

ith Y

our

Doc

tor

Or

Phar

mac

ist.

Take

Or

Use

Thi

s M

edic

ine

Exac

tlyAs

Dir

ecte

d. D

o N

ot S

kip

Dos

es O

rD

isco

ntin

ue U

nles

s D

irec

ted

ByYo

ur D

octo

r.

Rea

d Th

e M

edic

atio

nG

uide

Tha

t Com

esW

ith

This

Med

icin

e.

Labe

l



Zone:DEFAULT

Bin:DEFAULT

CARD R Smith

#30Take One Half Tablet After Breakfast; Take One Tablet Before Bedtime.

30 EA00002-4116-30 LILLY

CARD R Smith

CARD R Smith

Format #TFLBL518 for TRX-081 label.

CAUTION/W




PHONE: (412)492-9841


30 CPDR

FRED,BARNES J.


Take

Thi

s M

edic

ine

At L

east

1 H

our

Befo

re A

Mea

l.Sw

allo

w W

hole

. Do

Not

Che

w O

r Cr

ush.

Rea

d Th

e M

edic

atio

nG

uide

Tha

t Com

esW

ith

This

Med

icin

e.

SWI FORMS DIVISION





Rx:1000218

Manuf: QUALITY49999-0307-15

PJP/PJP

FRED,BARNES J.

Rx# 1000218NexIUM Capsule DR 40MG


FRED,BARNES J.

Reorder after: 11/26/2016

CHARLES GORMAN, ONC

NON-

RETU

RNAB

LE

Cycle

LOT: ________________________USE BY: _____________________

30 CPDR

49999-0307-15

CHARLES GORMAN, ONC

SWI FORMS DIVISIONDEA000000

10/12/16


Disp: 30

Rx# 1000218

NexIUM Capsule DR 40MGRx# 100021830 CPDR

NexIUM Capsule DR 40MG QUALITY

FRED,BARNES J.500 W BROADWAYPITTSBURGH, PA 15222

SEE MD ORDERSFormat ID # TFLBL529 for TRX-081 label.

CAUTION/W



Do

Not

Use

Thi

s M

edic

ine

If Y

ou A

re P

regn

ant O

rPl

an T

o Be

com

e Pr

egna

nt

Cont

act Y

our

Doc

tor

IfYo

u D

evel

op U

nusu

al O

rPe

rsis

tent

Bru

isin

g O

rBl

eedi

ng.

Do

Not

Dri

nk A

lcoh

olic

Beve

rage

s W

hile

Taki

ng T

his

Med

icin

e.

Do

Not

Tak

e As

piri

n O

r O

ther

Med

icin

es (

Pres

crip

tion

Or

Non

pres

crip

tion)

With

out

Chec

king

With

You

r D

octo

r.

WILLIAMS,RITA M. RxNo: 1000154

HAPPY ACRES

ORIG DATE: 11/24/15Room: 108

DR. SMITH CARE 01/14/16

RX:1000154

WARFARIN TAB 4MG

HACRESCARE

Take One Tablet By Mouth Once Daily

WARFARIN TAB 4MG63629-4748-01 ZONE: DEFAULT

WILLIAMS,RITA M.WARFARIN TAB 4MGGENERIC FOR: COUMADIN

WILLIAMS,RITA M.

Room: 108REFILL DATE: 01/14/16 HACRESGENERIC FOR: COUMADINWARFARIN TAB 4MG

BIN: DEFAULT

LABEL: 1 of 114 REFILLS: 0

Take One Tablet By Mouth Once Daily

RX# 1000154

63629-4748-01

EARLIEST REFILL DATE: 01/14/2016

Format ID # TFLBL539 for TRX-081 label.

CAUTION/W



Facility ID: HACRESNS: East Wing First Floor Room: 102PrOpt: CARE MOP: CARE

5800 Corporate Drive 4th FlrPittsburgh, PA 15237

(412)492-9841

NEXIUM CAP 40MG QTYD: 30

10/12/16Fred,Barnes J.Happy AcresNEXIUM CAP 40MG 30 CPDR

Reorder:BF200010

PJP

Rx# 1000218 R

QTYREM: 0QTYW/D: 14/86DISP: 10/12/16

WRITTEN: 10/12/16

Rx:1000218 R

Fred,Barnes J.

dx:____________________________

Fred,Barnes J. FACILITY ID: HACRES NS: EAST 1 Room: 102 B

MO

RN

ING

NO

ON

EVEN

ING

P.R

.N.

BED

TIM

E

THIS

IS T

HE

SAM

E M

EDIC

ATI

ON

YOU

HA

VE B

EEN

GET

TIN

G.

CO

LOR

, SIZ

E, O

R S

HA

PEM

AY

APP

EAR

DIF

FER

ENT.

Dr. C. Gorman(412)221-2424

Exp: 10/11/17

amethyst, oblong, NEXIUM 40 mg

NEXIUM CAP 40MG

NDC: 49999-0307-15

Sub for: Esomeprazole Magnesium Cap Delayed Release 40 MG (Base Eq)

Disp: 10/12/16

Rx# 1000218 RStart: 10/12/16

PJP

Fred,Barnes J.Happy AcresPittsburgh, PA 15222

FACILITY ID: HACRES

Sub for: Esomeprazole Magnesium Cap


Take 1 Capsule By Mouth In the Morning.TFLBL561 for TRX-081. Call

8AM

SWI Forms Division

CAUTION/W



SWI FORMS DIVISIONMa

y Mak

e You

Dro

wsy O

r Dizz

y. Do

Not

Drink

Alco

hol W

ith T

his M

edici

ne. U

seCa

re W

hen O

pera

ting A

Veh

icle,

Vess

el,Or

Othe

r Mac

hines

.

If You

Are

Pre

gnan

t Or C

onsid

ering

Beco

ming

Pre

gnan

t You

Sho

uld D

iscus

sTh

e Use

Of T

his M

edici

ne W

ith Y

our

Docto

r Or P

harm

acist

.

War

ning:

Brea

stfee

ding I

sNo

t Rec

omme

nded

Whil

eUs

ing T

his M

edici

ne. C

onsu

ltYo

ur D

octor

Or P

harm

acist

.

WILLIAMS,RITA M. C4

CLONAZEPAM TAB 1MG

HACRES EAST 1 108 W

CLONAZEPAM TAB 1MGSUB FOR: KLONOPIN

NDC: 00093-0833-01 MFG: TEVA USA

HAPPY ACRES 04/12/17

04/12/1760

Next Fill Requires New Rx

WILLIAMS,RITA M.

CLONAZEPAM TAB 1MG

RO:RW200088 Rx:1000250

Rx# 1000250PJP/PJPDr. R. SMITH

DISCARD ON 4/11/2018 OR SOONER IF OTHERWISE INDICATED.

CLONAZEPAM TAB 1MG

TEVA USA 00093-0833-01

LOT:

00093-0833-01 TEVA USA

EXP:PHDEF ZONE: DEFAULT BIN: DEFAULT

NEW

5800 CORPORATE DRIVE 4TH FLOORPITTSBURGH, PA 15237PH: (412)555-0000 DEA000000

* BLA

CK

BO

X W

AR

NIN

G *

WIL

LIAM

S,R

ITA

M.

CLO

NAZ

EPAM

TAB

1M

GD

r. R

. SM

ITH

#

60R

x 10

0025

0

Take One Tablet By Mouth Once Daily. TFLBL606 for TRX-081.

Rx

1000

250

Dr.

R. S

MIT

H

#60

CLO

NAZ

EPAM

TAB

1M

GW

ILLI

AMS,

RIT

A M

.

CAUTION/W




LOT: ________________________

USE BY: _____________________

CAUTION/W



CAUTION/W



PHONE: (412)492-9841

clonazePAM Tablet 1MG04/12/1760 TABS

WILLIAMS,RITA M.

clonazePAM Tablet 1MG

Rx# 1000250PJP/PJP

FORMS & LABELS

PITTSBURGH, PA 152375500 CORPORATE DRIVE 4TH FLR

1 of 1Generic For: KLONOPIN

04/12/1760 TABSHAPPY ACRES

Rx:C1000250

NEW ORDER

Rx# 1000250

clonazePAM Tablet 1MGManuf: TEVA USA

* BLA

CK B

OX W

ARNI

NG *

NON-

RETU

RNAB

LE

green round TEVA 833

RONALD SMITH, CARD DEA:AJ1234563

, _____-____

(412)555-9991RONALD SMITH, CARD480 W MAIN ST GREENTREE, PA 15505PHONE: (412)555-9999 FAX: (___)___-____

Written:04/12/17 Fill:04/12/17DOB: 07/08/32

Use By:4/12/2018Manuf: TEVA USANDC: 00093-0833-01

RONALD SMITH, CARD

Total: 90

Rx# 1000250WILLIAMS,RITA M.

AJ1234563 EXP: ________________________LOT: ________________________00093-0833-01

Disp: 60 Day Supply:10 DAW: 0


WILLIAMS,RITA M.60 TABS04/12/17

clonazePAM Tablet 1MGTake One Tablet By Mouth Twice Daily. Format #TFLBL654 for SoftWriters TRX-081 label.

00093-0833-01

NPI81765

PHDE

F

HAPPY ACRES (HACRES)NS: EAST 1 Room: 108 WWILLIAMS,RITA M.

Take One Tablet By Mouth Twice Daily. Format #TFLBL654 for SoftWriters TRX-081 label.

CAUTION/W



PHONE: (412)492-9841

clonazePAM Tablet 1MG04/12/1760 TABS

WILLIAMS,RITA M.


Rx# 1000250PJP/PJP

FORMS & LABELS

PITTSBURGH, PA 152375500 CORPORATE DRIVE 4TH FLR

1 of 1Generic For: KLONOPIN


Rx:C1000250

NEW ORDER

Rx# 1000250


* BLA

CK B

OX W

ARNI

NG *

NON-

RETU

RNAB

LE

green round TEVA 833

Refills: 0

RONALD SMITH, CARD DEA:AJ1234563

, _____-____

(412)555-9991RONALD SMITH, CARD480 W MAIN ST GREENTREE, PA 15505PHONE: (412)555-9999 FAX: (___)___-____

Written:04/12/17 Fill:04/12/17DOB: 07/08/32

Use By:4/12/2018Manuf: TEVA USANDC: 00093-0833-01

RONALD SMITH, CARD

Total: 90

Rx# 1000250WILLIAMS,RITA M.

AJ1234563 EXP: ________________________LOT: ________________________00093-0833-01

Disp: 60 Day Supply:10 DAW: 0


WILLIAMS,RITA M.60 TABS04/12/17

clonazePAM Tablet 1MGTake One Tablet By Mouth Twice Daily. Format #TFLBL654-R for SoftWriters TRX-081 label.

00093-0833-01

NPI81765

PHDE

F

HAPPY ACRES (HACRES)NS: EAST 1 Room: 108 WWILLIAMS,RITA M.

Take One Tablet By Mouth Twice Daily. Format #TFLBL654-R for SoftWriters TRX-081 label.

CAUTION/W




LOT: ________________________

USE BY: _____________________

CAUTION/W



CAUTION/W



Take One Tablet By Mouth Once Daily. Format # TFLBL692 for TRX-081 Label.

CAUTION/W



PHONE: (412)492-9841

06/02/2014 TABS

WILLIAMS,RITA M.


YOUR PHARMACY NAME

PITTSBURGH, PA 152375800 CORPORATE DRIVE 4TH FLOORDEA:DEA000000

1 of 1

06/02/20WILLIAMS,RITA M.


Rx:C1000280

Manuf: TEVA USA00093-0833-01

PJP/PJP

NEW ORDER

Rx# C1000280clonazePAM Tablet 1MG


WILLIAMS,RITA M.

Reorder after: 06/01/2020New Rx Needed For Future FillsRONALD SMITH, CARD

* BLA

CK B

OX W

ARNI

NG *

NON-

RETU

RNAB

LE

C-IV

STAT

LOT: ________________________USE BY: _____________________

14 TABS

00093-0833-01

RONALD SMITH, CARD

YOUR PHARMACY NAMEDEA000000

06/02/20Disp: 14

clonazePAM Tablet 1MGRx# C100028014 TABS

clonazePAM Tablet 1MG TEVA USA

WILLIAMS,RITA M.500 W BROADWAYPITTSBURGH, PA 15222

SEE MD ORDERS

WILLIAMS,RITA M.HAPPY ACRES (HACRES)NS: EAST 1 Room: 108 WMOP: FACI PrOpt: FACGEN

Rx# C1000280clonazePAM Tablet 1MGGen For: KLONOPIN

CAUTION/W



HAPPY ACRES (HACRES)NS: EAST 1 Room: 108 W

PHONE: (412)492-9841

CLONAZEPAM TAB 1MG06/02/2014 TABS

WILLIAMS,RITA M.

CLONAZEPAM TAB 1MG

YOUR PHARMACY NAME

PITTSBURGH, PA 152375800 CORPORATE DRIVE 4TH FLDEA:DEA000000

1 of 1Gen For: KLONOPIN

06/02/20WILLIAMS,RITA M.


Rx:C1000280

Manuf: TEVA USA00093-0833-01

PJP/PJP

NEW ORDER

WILLIAMS,RITA M.

Rx# C1000280CLONAZEPAM TAB 1MG

CLONAZEPAM TAB 1MGManuf: TEVA USA

WILLIAMS,RITA M.

Reorder after: 06/01/2020New Rx Needed For Future FillsRONALD SMITH, CARD

* BLA

CK B

OX W

ARNI

NG *

NON-

RETU

RNAB

LE

WEST1234567890

C-IV

STAT

LOT: ________________________USE BY: _____________________

14 TABS

00093-0833-01

RONALD SMITH, CARD

YOUR PHARMACY NAMEDEA000000

06/02/20

MOP: FACI PrOpt: FACGEN

Disp: 14

Rx# C1000280

CLONAZEPAM TAB 1MGRx# C100028014 TABS

CLONAZEPAM TAB 1MG TEVA USA

WILLIAMS,RITA M.500 W BROADWAYPITTSBURGH, PA 15222

SEE MD ORDERS

CAUTION/W




LOT: ________________________

USE BY: _____________________

CAUTION/W



CAUTION/W



Visit the Customer Engagement Zone to download our catalog and view formats.

For samples & pricing: 412.492.9841 [email protected]

SoftWriters Forms & Labels

5800 Corporate Drive, 4th Floor

Pittsburgh, PA 15237

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of this drug to any person other than patient for whom ... · pjp/pjp fred,barnes j. rx# 1000218...

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