Tanisha Johnson X Name: Original Entry or Dr. Chen Lee Doctor: ______Transferred from page___ Pharmacy: Greenleaf Prescription Number: N347 Medication and Strength: Phenobarbital 32.4mg Prescription Date: March 3, yr Directions: Take 2 tablets by mouth once daily in evening Amount Amount Amount Date Time Route Signature on Hand Used Left Dowd 3/3/yr Linda White/Sam 9am Amount left ____ transferred to page ______ Signature ____________________________ Signature ____________________________ 5| Page
Name: Tanisha Johnson X Original Entry or Doctor: Dr. Chen Lee ______Transferred from page___ Pharmacy: Greenleaf Prescription Number: N347 Medication and Strength: Phenobarbital 32.4mg Prescription Date: March 3, yr Directions: Take 2 tablets by mouth once daily in evening Date Time Route Amount on Hand Amount Used Amount Left Signature 3/3/yr 9am Linda White/Sam Dowd Amount left ____ transferred to page ______ Signature ____________________________ Signature ____________________________ 5| Page