Case File
efta-efta01201947DOJ Data Set 9OtherDS9 Document EFTA01201947
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01201947
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
EA
Patient Nam
Address
/ 5
NLIIVIRER
City
//
/ , t"- ` 1
/
,
Prescri ,er Sig ture X
/
/ , ,.41,115 PRE
CRIPTION WILL BE FILLED GENE
S
REFILLS
ACIST
TES ter,.....
\
,
Preferred Language
-,
-,
4c3(tion errots Pleate set
\
Dispense As Written
/
[repeated 3 times]
/ / 7.
te
,
4,, s , \
`\
,
preficriptio:rF
4
;
\
,
MAXIMUM DAILY DOSE ,\\
(controlled substances only)
SS PRESCRIBER WRITES 'claw' IN THE BOX BELOW
Illikiliii111111119111111
\
" -
EFTA01201947
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