Max Patrick (DOB 2/08/1971) comes into your office for his routine 6 month follow-up visit for stable, well-controlled hypertension. He needs a prescription refill for carvedilol which he has been tak ing for two years without problems. He takes 12.5 mg twice a day. The drug is supplied in 25 ...
Provider Name: __P.Carson, FNP _____________________
Superhero Family Practice, INC
1234 Kryptonite Way
Superhero City, Superhero State 12301
(800) 123-4567
Patient Name: Max Patrick______Date: __07/26/2020__________
Address: 9056 _Eagle Park Road, Atlanta, GA 30302_____________ DOB:2/08/1971___________
License: RN230125 NPI: 18322176__________ DEA ( Controlled Substances Only): ______________
Carvedilol 25 mg tablets
Sig: take ½ tablet by mouth twice daily
Disp #90
1 Refill
DISPENSE AS WRITTEN (DAW) Generic Substitution Permitted
P.Carson, FNP
Signature of Provider Signature of Provider
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