1| Page David Cook X Name: Original Entry or Dr. Black Doctor: ______Transferred from page___ Pharmacy: Greenleaf Prescription Number: N671 Medication and Strength: Phenobarbital 32.4mg Prescription Date: Feb. 17, yr Directions: Take 3 tablets by mouth once daily in evening Amount Amount Amount Date Time Route Signature on Hand Used Left Dowd Linda White /Sam 2/17/yr 9am 42 2/17/yr Jenna Sherman 42 39 8pm mouth three 2/18/yr Jenna Sherman 8pm mouth 39 three 36 2/19/yr Amanda Smith 36 33 8pm mouth three 2/20/yr Amanda Smith 8pm mouth 33 three 30 2/21/yr Amanda Smith 30 27 8pm mouth three 2/22/yr Jenna Sherman 8pm mouth 27 three 24 2/23/yr Jenna Sherman 24 21 8pm mouth three 2/24/yr Amanda Smith 8pm mouth 21 three 18 2/25/yr Amanda Smith 18 15 8pm mouth three 2/26/yr Amanda Smith 8pm mouth 15 three 12 2/27/yr Jenna Sherman 8pm mouth 12 three 9 2/28/yr Jenna Sherman 8pm mouth 9 three 6 3/1/yr Amanda Smith 8pm mouth 6 three 3 3 Amanda Smith 3/2/yr 8pm mouth three 0 Amount left _0__ transferred to page __2___ Smith__ Signature _________Amanda Signature ____________Jenna Sherman___ 2| Page
1| Page Name: David Cook X Original Entry or Doctor: Dr. Black ______Transferred from page___ Pharmacy: Greenleaf Prescription Number: N671 Medication and Strength: Phenobarbital 32.4mg Prescription Date: Feb. 17, yr Directions: Take 3 tablets by mouth once daily in evening Date Time Route Amount on Hand Amount Used Amount Left Signature 2/17/yr 9am 42 Linda White /Sam Dowd 2/17/yr 8pm mouth 42 three 39 Jenna Sherman 2/18/yr 8pm mouth 39 three 36 Jenna Sherman 2/19/yr 8pm mouth 36 three 33 Amanda Smith 2/20/yr 8pm mouth 33 three 30 Amanda Smith 2/21/yr 8pm mouth 30 three 27 Amanda Smith 2/22/yr 8pm mouth 27 three 24 Jenna Sherman 2/23/yr 8pm mouth 24 three 21 Jenna Sherman 2/24/yr 8pm mouth 21 three 18 Amanda Smith 2/25/yr 8pm mouth 18 three 15 Amanda Smith 2/26/yr 8pm mouth 15 three 12 Amanda Smith 2/27/yr 8pm mouth 12 three 9 Jenna Sherman 2/28/yr 8pm mouth 9 three 6 Jenna Sherman 3/1/yr 8pm mouth 6 three 3 Amanda Smith 3/2/yr 8pm mouth 3 three 0 Amanda Smith Amount left _0__ transferred to page __2___ Signature _________Amanda Smith__ Signature ____________Jenna Sherman___ 2| Page