Patient : Rx Profile

Patient

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Drug

info

Created By/On:Devel# 11/26/2015 | 5:23:47 AM

Maintained By/On: Jayden Smith 02/12/2018 | 5:06:479 AM

Name: Maria Rodriguez
DOB: 10/07/1976
Patient Type: Compliance Packaging , Care Facility Patient

Rx Profile

Rx	Pharm	Status	Fill	Product	Date Written	Date Filled	Discontinue Date	Refills Auth	Refills Remain	QTY Prescd	QTY Disp	QTY Rem	Prescriber	Pat Pay
51235830-000	0	New	0	D 1000 Capsule 1000 UNIT	04/13/2018	04/13/2018	04/13/2018	5	5	10.000	10.000	50	Hernandez Maria	5.00
51235796-000	0	Pending Fill	1	Aspirin Adult Low Strength 81 MG Tablet DR	07/21/2017	11/01/2017	11/01/2017	5	5	10.000	5.000	50	Smith James	5.00
51235628-000	0	QA	0	Atorvastatin Calcium	04/13/2018	04/13/2018	04/13/2018	5	5	6.000	4.000	50	Rodriguez Maria	5.00
51235830-000	0	Inactive	1	Boniva Tablet 150 MG	04/13/2018	04/13/2018	04/13/2018	5	5	6.000	6.000	50	Smith Mary	5.00
51235830-000	0	New	0	Zantac Tablet 150 MG	04/13/2018	04/13/2018	04/13/2018	5	5	10.000	10.000	50	Hernandez Maria	5.00

Status Audit

Number of Rx's Completed: 10
Total Dollar Amt. of Rx's: $6,535.12
Date Last Filed: 04/01/2007
Date Patient Added: 05/21/2007

Number of Rx Completed: 10
Total Dollar Amount of Rx's: $2.12
Date Last Filled: 04/01/2007

Fill #	Pharm	Filled	Product Name	Manuf.	Rem.	Fill QTY	Pres. QTY	Billed	Pat. Pay	Next Fill Date	% Util	First Allowed Date	Sig	Inactivated Date	Sold Date	Relationship	Primary Plan	Primary Pd	Secondary Plan	Secondary Pd	Tertiary Plan	Tertiary Pd
0	0	04/16/2018	D 1000 Capsule 1000 Unit	Mason Vita	5	10.000	10.000	4.21	5.00	04/21/2018	100		One				Prim	-7.71
0	0	11/22/2017	Atorvastatin Calcium	BMS-PC	0	5.000	5.000		164.55	12/11/2017	100		Take One Tablet Daily	01/27/2017			Prim	-7.71
0	0	04/16/2018	Zantac Tablet 150 MG	Mason Vita	5	10.000	10.000	4.21	5.00	04/21/2018	100		One				Prim	-7.71

Workflow Queue	Created On	Created By	Information
Label	07/22/2016 07:45:52 AM	Maria, Hernandez
Dispensing	11/29/2017 02:25:30 AM	James, Smith
Refill	01/12/2017 11:34:12 AM	James, Garcia

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Name	Date of Birth	Address	City	State	ZIP	Phone	CF	Status
Smith James	10/07/1978	88 Center Rd	Bedford	OH	44146	715-361-4850		Active
Rodriguez Maria	10/07/1976	2349 Spinnaker Lane	Joliet	LA	60432	724-376-4350		Active
Smith James	10/07/1978	1566 Elm Drive	Cambridge	NY	12816	532-247-7219		Active