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Use the attached provided prescriiption template. For each assignment you will complete 3 prescriiptions. They will all be submitted as one document (1 prescriiption per page) and uploaded to the Assignment Drop Box.
ALL sections must be completed as follows:
Create an address, phone, fax, DEA number, and UPIN for yourself (you will use these for all the prescriiption writing assignments). A DEA number will have two letters followed by 7 numbers – MG 0706911; a UPIN will have 10 numbers – 1518088780
Enter a date
For each patient you will be given the name, DOB and gender. You will need to calculate age and create an address for each patient.
Write in the name of the prescriiption, dose, and whether it is a capsule, chewable tablet, tablet, oral suspension, topical ointment or cream, etc. FOR EXAMPLE:
Amoxicillin 200 mg/5 ml suspension
Write out the instructions for use. FOR EXAMPLE:
Sig: Take 5 ml PO q. 6 hours x 10 days
Write in the amount to dispense. This is based on the dose, frequency, and days of therapy. FOR EXAMPLE, USING THE ABOVE MEDICATION:
Dispense: 200 ml
Indicate if refills are authorized, and if so, how many.
Sign your name (you may type your name in this space if you do not have the capability to insert your signature).
Write in the diagnosis code.
Ht. & Wt.
1 – Rx #1
62” 110 #
Prescribe an SSRI
Acute Low Back Pain/strain
Prescribe a centrally acting muscle relaxant
69” 160 #
Prescribe a selective alpha1 antagonist
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