Patient : Rx Profile

Patient

Prescriber

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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 Rx	Pharm Pharm	Status Status	Fill Fill	Product Product	Date Written Date Written	Date Filled Date Filled	Discontinue Date Discontinue Date	Refills Auth Refills Auth	Refills Remain Refills Remain	QTY Prescd QTY Prescd	QTY Disp QTY Disp	QTY Rem QTY Rem	Prescriber Prescriber	Pat Pay 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	Maria Rodriguez	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 Filled: 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 Name	Date of Birth Date of Birth	Address Address	City City	State State	ZIP ZIP	Phone Phone	CF CF	Status Status
Annie Wiedman	10/07/1978	88 Center Rd	Bedford	OH	44146	715-361-4850		Active
Maria Rodriguez	12/03/1976	2349 Spinnaker Lane	Joliet	LA	60432	724-376-4350		Active
Scott Adams	08/19/1979	1919 County Line Road	Tampa	FL	33634	727-729-9038		Active
Smith James	04/11/1978	1566 Elm Drive	Cambridge	NY	12816	532-247-7219		Active
Teresa Andresen	11/28/1987	1227 Perine Street	Alexandria	VA	22304	703-823-4297		Active