Pharmacy Prescription


	Pharmacy Prescription
	
	
	
	
	
	
		
			
			
				
				
				
				
				
			
			
			
				
					Michael
					Jackson
				
				
				
				
					
					
					
						US
						State
						City
						12345
						Streeet 123
					
					
					
						
							Taylor
							Elisabeth
						
					
				
			
		
	
	
		
		
		
			
			
				$HOME_COUNTRY
				Vienna
				Vienna
				1110
				Guglgasse 6
			
			
			
				
					Doug
					Ross
					Dr.
				
			
			
				
				Sisters of Mercy
				
				
					$HOME_COUNTRY
					Vienna
					Vienna
					1110
					Guglgasse 6
				
			
		
	
	
		
			
				
				Sacred Heart Hospital
				
				
					US
					IL
					Urbana
					62994
					114 S. Elizabeth Street
				
			
		
	
	
		
		
		
			
			
				$HOME_COUNTRY
				Vienna
				Vienna
				1110
				Guglgasse 6
			
			
			
				
					Doug
					Ross
					Dr.
				
			
			
				
				Sisters of Mercy
				
				
					$HOME_COUNTRY
					Vienna
					Vienna
					1110
					Guglgasse 6
				
			
		
	
	
		
			
				
				
			
			
				
				
					
					
				
				
					
					
						$HOME_COUNTRY
						Vienna
						Vienna
						1110
						Guglgasse 6
					
					
					
						
							Doug
							Ross
							Dr.
						
					
					
						
						Sisters of Mercy
						
						
							$HOME_COUNTRY
							Vienna
							Vienna
							1110
							Guglgasse 6
						
					
				
			
		
	
	
		
			
				
					
					
					
					
					
					Prescription for medication
					
						
							
								
									
									Branded Medication
									Package name
									Packag form
									LOT number
									Package capacity
									Ingredients
									Date from
									Date to
									Frequency
									Route code
									Approach site
									Dose quantity
									Rate quantity
									Reason
									Patient instructions
									Fulfillment instructions
									Dispense amount
									Substitution
								
							
							
								
									Insulin (human) 1mg/10ml, 5 injections package
									
									 
									 
									 
									 
										
											
												Insulin
												1mg/10ml
											
										
									
									2012-05-21
									2012-05-25
									1 times per d
									injection
									arm
									1mg
									1/d
									:
									max. 1/d
									1 OP
									1mg
									none
								
							
						
					
					
						
							
							
							
							
							
							
								
							
							
							
								
								
							
							
								
							
							
							
								
									
								
							
							
								
									
										
											
										
									
								
								
									
										
											
										
									
								
							
							
								
									
										
											
										
									
								
								
									
										
											
										
									
								
							
							
								
									
									
									
										
										
										Insulin (human)
										
										
											
												
												
												
												Insulin (human) 1mg/10ml, 5 injections package
												
												
											
										
										
											
												
												
											
											
												
												various

Branded Medication	Package name	Packag form	LOT number	Package capacity	Ingredients	Date from	Date to	Frequency	Route code	Approach site	Dose quantity	Rate quantity	Reason	Patient instructions	Fulfillment instructions	Dispense amount	Substitution
Insulin (human) 1mg/10ml, 5 injections package					Insulin 1mg/10ml	2012-05-21	2012-05-25	1 times per d	injection	arm	1mg	1/d	:	max. 1/d	1 OP	1mg	none