Patient details

Name: Williams, James DOB: 1/17/1958

MRN: 201610051560642 Gender: Male

ALLERGIES:
Allergies:
Allergen/Product Reaction
vancomycin Alopecia (MildToModerate)
Peanuts Chills (Mild)
Dust Anaphylaxis
sulfa drugs Unknown
OUTPATIENT MEDS:
Outpatient Medications:
* Patient Currently Takes Medications as of 09-Apr-2017 22:12 documented in Structured Notes
Type Medication Schedule Instructions Status Transmissio Start Date
n Status
Rx polyethylene 0 3 gram(s) Active None 02-Nov-2016
glycol 3350 orally 2 times
oral powder a day x 365
for days, As
reconstitutio Needed
n
Stop Date Quantity Refills Comment Submitted On Behalf Of
By
01-Nov-2018 730 1 Test SCM, AUT SCM, AUT
Comment Admin Admin
Reference # Substitution Modification
Permitted Type
13775 No None
Type Medication Schedule Instructions Status Transmissio Start Date
n Status
Hx oxyCODONE 2 1 tab(s) orally Active None 01-Nov-2016
5 mg oral every 6 hours
tablet
Stop Date Quantity Refills Comment Submitted On Behalf Of
By
01-Dec-2016 0 None Test SCM, AUT SCM, AUT
Admin Admin
Reference # Substitution Modification
Permitted Type
13774 Yes None
DX, ORDERS, RX:
Prescriptions List:
* Patient Currently Takes Medications as of 09-Apr-2017 22:12 documented in Structured Notes
Type Medication Schedule Instructions Status Transmissio Start Date
n Status
Rx polyethylene 0 3 gram(s) Active None 02-Nov-2016
glycol 3350 orally 2 times
oral powder a day x 365
for days, As
reconstitutio Needed

Printed by: Provider, Allscripts Print date: 5/5/2017 08:48:34 Page: 1 of 2

Patient details
Name: Williams, James DOB: 1/17/1958
MRN: 201610051560642 Gender: Male

n
Stop Date Quantity Refills Comment Submitted On Behalf Of
By
01-Nov-2018 730 1 Test SCM, AUT SCM, AUT
Comment Admin Admin
Reference # Substitution Modification
Permitted Type
13775 No None
Type Medication Schedule Instructions Status Transmissio Start Date
n Status
Hx oxyCODONE 2 1 tab(s) orally Active None 01-Nov-2016
5 mg oral every 6 hours
tablet
Stop Date Quantity Refills Comment Submitted On Behalf Of
By
01-Dec-2016 0 None Test SCM, AUT SCM, AUT
Admin Admin
Reference # Substitution Modification
Permitted Type
13774 Yes None
Electronic Signatures:
SCM, AUT Admin (Physician) (Signed 09-Apr-2017 22:16)
Authored: ALLERGIES, OUTPATIENT MEDS, DX, ORDERS, RX

Last Updated: 09-Apr-2017 22:16 by SCM, AUT Admin (Physician)

Printed by: Provider, Allscripts Print date: 5/5/2017 08:48:34 Page: 2 of 2