Run Date 09/03/17 The Burke Rehab. Hosp.

PHA **LIVE** Page 1

Run Time 1513 PHA Profile

Patient ALLEN,MICHAEL Responsible Doctor VAIDYA, SUDHIR M.D.

Account Number W00001219047 Location B1NN Unit Number M000209019
Age/Sex 48/M Room 135 Registered Date 08/14/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 7.99 in 172.7 cm Body Surface Area 2.33 m2

Weight 272 lb 1.6 oz 123.422 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/14/17-2150 ALLERGY VERIFICATION CALL COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: C3-C6 ALDF, DM
Secondary Diagnosis:

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 12 UNIT (0.12 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/14/17-2100 Stop Date 09/13/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01536811

History
08/14/17 1945 - POM ORDER by RSHARMA
08/14/17 2051 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/14/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/14/17-2200 Stop Date 09/13/17 2159
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01536812

History
08/14/17 1945 - POM ORDER by RSHARMA
08/14/17 2052 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/14/17 - 2200

LTN005OP2 - LATANOPROST 0.005% OP SOLN 2.5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions please place 1 drop into both eyes daily. thank you
Admin Route OPHTHALMIC
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $285.00
Rx Number 01539751

History
08/24/17 1631 - POM ORDER by RSHARMA
08/24/17 1639 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Dose Instructions please apply to groin areas
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/21/17-2100 Stop Date 09/18/17 1259
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $28.41
Rx Number 01538712

History
08/21/17 1713 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538698
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/21/17 - 1700
Last Actual Administration Time: 08/21/17 - 1655
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/21/17 - 1709
New Order Start: 08/21/17 - 2100
New Order Stop: 09/18/17 - 1259
08/21/17 1714 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SMOHAMED Eff: 08/21/17 1713
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/21/17 - 1700
Last Actual Administration Time: 08/21/17 - 1655
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/21/17 - 1709
New Order Start: 08/21/17 - 2100
New Order Stop: 09/18/17 - 1259
08/21/17 1714 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 2100
08/21/17 1715 - CREDIT by MHAIMOWITZ
ITEMS: 1
08/27/17 1247 - DEBIT by AADEGBAMIG
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
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ALLEN,MICHAEL W00001219047 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions please apply to buttock and inner thigh areas
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/06/17 2059
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01540637

History
08/28/17 1223 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540007
08/28/17 1236 - VERIFIED by YLEE
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
08/28/17 1237 - CREDIT by YLEE
ITEMS: 1
08/30/17 0938 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/06/17-2059 SOFT STOP: 0
08/30/17 1046 - DEBIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
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ALLEN,MICHAEL W00001219047 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/14/17-1945 Stop Date 09/13/17 1944
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01536802

History
08/14/17 1944 - POM ORDER by RSHARMA
08/14/17 2048 - VERIFIED by EBALILO
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 08/14/17-1945 Stop Date 09/13/17 1944
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536804

History
08/14/17 1945 - POM ORDER by RSHARMA
08/14/17 2049 - VERIFIED by EBALILO
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
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ALLEN,MICHAEL W00001219047 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/15/17-0900 Stop Date 09/14/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $14.75
Rx Number 01536803

History
08/14/17 1944 - POM ORDER by RSHARMA
08/14/17 2049 - VERIFIED by EBALILO
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

For: 08/28/17 - 0900

For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
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ALLEN,MICHAEL W00001219047 (Continued)

DOCU283E4 - DOCUSATE SODIUM 283 MG/5ML (ENEMEEZ) ENEMA

Dose 283 MG (1 ENEMA)

Admin Route RECTALLY
Frequency NIGHTLY (SCH)
Start Date 08/15/17-2100 Stop Date 09/14/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 22 Total Costs $0.00 Total Charges $0.00
Rx Number 01536890

History
08/15/17 1108 - ENTER by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
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ALLEN,MICHAEL W00001219047 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/14/17-2100 Stop Date 09/13/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 23 Total Costs $0.00 Total Charges $1704.60
Rx Number 01536810

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.32
MG/KG/DAY is below the Low Daily Dose.

History
08/14/17 1945 - POM ORDER by RSHARMA
08/14/17 2050 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 2100
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
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ALLEN,MICHAEL W00001219047 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/14/17-1945 Stop Date 09/13/17 1944
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536805

History
08/14/17 1945 - POM ORDER by RSHARMA
08/14/17 2049 - VERIFIED by EBALILO
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
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ALLEN,MICHAEL W00001219047 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/14/17-1945 Stop Date 09/13/17 1944
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536806

History
08/14/17 1945 - POM ORDER by RSHARMA
08/14/17 2049 - VERIFIED by EBALILO
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
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ALLEN,MICHAEL W00001219047 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/14/17-1945 Stop Date 09/13/17 1944
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 01536807

History
08/14/17 1944 - POM ORDER by RSHARMA
08/14/17 2049 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/14/17 - 1945
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
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ALLEN,MICHAEL W00001219047 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/15/17-0800 Stop Date 09/14/17 0759
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 22 Total Costs $0.00 Total Charges $417.60
Rx Number 01536808

History
08/14/17 1945 - POM ORDER by RSHARMA
08/14/17 2050 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/17 - 0800
For: 08/16/17 - 0800
For: 08/17/17 - 0800
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0800
For: 08/19/17 - 0800
For: 08/20/17 - 0800
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0800
For: 08/22/17 - 0800
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0800
For: 08/24/17 - 0800
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
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ALLEN,MICHAEL W00001219047 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1200 Stop Date 10/01/17 1159
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 6 Total Costs $ Total Charges $
Rx Number 01541858

History
09/01/17 0850 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01536809
09/01/17 1015 - VERIFIED by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1200

LTN005OP2 - LATANOPROST 0.005% OP SOLN 2.5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions please place 1 drop into both eyes daily. thank you
Admin Route OPHTHALMIC
Frequency 1630 (ONE)
Start Date 08/24/17-1630 Stop Date 08/24/17 1631 DC: 08/24/17-1631
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01539750

Discontinued Comments Reached Stop Date

History
08/24/17 1631 - POM ORDER by RSHARMA
08/24/17 1639 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 1630
08/24/17 1639 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 1631
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/24/17 1644 - CREDIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Dose Instructions please apply to groin areas
Admin Route TOPICALLY
Frequency 3 TIMES A DAY (SCH)
Start Date 08/19/17-1300 Stop Date 08/21/17 1629 DC: 08/21/17-1629
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $28.41
Rx Number 01538300

History
08/19/17 1026 - POM ORDER by HAZIZI
08/19/17 1028 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 1300
08/21/17 1631 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/19/17-1300 STOP: 09/18/17 1259 SOFT STOP: 0
TO:
START: 08/19/17-1300 STOP: 08/21/17-1629 SOFT STOP:
08/21/17 1631 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1629
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/21/17 1631 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424906
08/21/17 1634 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 08/21/17 1631
Discontinue by SMOHAMED Eff: 08/21/17 1631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Dose Instructions please apply to groin areas
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/21/17-1700 Stop Date 08/21/17 1709 DC: 08/21/17-1709
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538698

History
08/21/17 1631 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538300
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/21/17 - 1300
Last Actual Administration Time: 08/21/17 - 0851
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/21/17 - 1629
New Order Start: 08/21/17 - 1700
New Order Stop: 09/18/17 - 1259
08/21/17 1632 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SMOHAMED Eff: 08/21/17 1631
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/21/17 - 1300
Last Actual Administration Time: 08/21/17 - 0851
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/21/17 - 1629
New Order Start: 08/21/17 - 1700
New Order Stop: 09/18/17 - 1259
08/21/17 1632 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 1700
08/21/17 1633 - CREDIT by MHAIMOWITZ
ITEMS: 1
08/21/17 1713 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/21/17-1700 STOP: 09/18/17 1259 SOFT STOP:
TO:
START: 08/21/17-1700 STOP: 08/21/17-1709 SOFT STOP:
08/21/17 1713 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1709
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/21/17 1713 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424932
08/21/17 1714 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 08/21/17 1713
Discontinue by SMOHAMED Eff: 08/21/17 1713

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions please apply to buttock and inner thigh areas
Admin Route TOPICALLY
Frequency 3 TIMES A DAY (SCH)
Start Date 08/19/17-1300 Stop Date 08/21/17 1630 DC: 08/21/17-1630
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01538299

History
08/19/17 1026 - POM ORDER by HAZIZI
08/19/17 1028 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 1300
08/21/17 1631 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/19/17-1300 STOP: 08/26/17 1259 SOFT STOP: 0
TO:
START: 08/19/17-1300 STOP: 08/21/17-1630 SOFT STOP:
08/21/17 1631 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1630
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/21/17 1631 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424907
08/21/17 1634 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 08/21/17 1631
Discontinue by SMOHAMED Eff: 08/21/17 1631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions please apply to buttock and inner thigh areas
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/21/17-1700 Stop Date 08/21/17 1712 DC: 08/21/17-1712
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538699

History
08/21/17 1631 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538299
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/21/17 - 1300
Last Actual Administration Time: 08/21/17 - 0854
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/21/17 - 1630
New Order Start: 08/21/17 - 1700
New Order Stop: 08/26/17 - 1259
08/21/17 1633 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SMOHAMED Eff: 08/21/17 1631
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/21/17 - 1300
Last Actual Administration Time: 08/21/17 - 0854
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/21/17 - 1630
New Order Start: 08/21/17 - 1700
New Order Stop: 08/26/17 - 1259
08/21/17 1633 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 1700
08/21/17 1634 - CREDIT by MHAIMOWITZ
ITEMS: 1
08/21/17 1713 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/21/17-1700 STOP: 08/26/17 1259 SOFT STOP:
TO:
START: 08/21/17-1700 STOP: 08/21/17-1712 SOFT STOP:
08/21/17 1713 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1712
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

Allergies/Duplicates/Interactions differ from order entry

Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/21/17 1713 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424933
08/21/17 1714 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 08/21/17 1713
Discontinue by SMOHAMED Eff: 08/21/17 1713
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions please apply to buttock and inner thigh areas
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/21/17-2100 Stop Date 08/26/17 1259 DC: 08/23/17-1504
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538713

History
08/21/17 1713 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538699
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/21/17 - 1700
Last Actual Administration Time: 08/21/17 - 1655
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/21/17 - 1712
New Order Start: 08/21/17 - 2100
New Order Stop: 08/26/17 - 1259
08/21/17 1714 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SMOHAMED Eff: 08/21/17 1713
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/21/17 - 1700
Last Actual Administration Time: 08/21/17 - 1655
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/21/17 - 1712
New Order Start: 08/21/17 - 2100
New Order Stop: 08/26/17 - 1259
08/21/17 1714 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 2100
08/21/17 1715 - CREDIT by MHAIMOWITZ
ITEMS: 1
08/23/17 1504 - DISCONTINUE by EALEXEEV Eff: 08/23/17 1504
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/23/17 1504 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01425485
08/23/17 1525 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EALEXEEV Eff: 08/23/17 1504
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions please apply to buttock and inner thigh areas
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/23/17-2100 Stop Date 08/27/17 2059 DC: 08/25/17-0831
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539337

History
08/23/17 1504 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01538713
08/23/17 1525 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/23/17-2100 STOP: 08/27/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/23/17-2100 STOP: 08/27/17-2059 SOFT STOP: 0
DISPENSE: 0
08/23/17 1525 - VERIFIED by MHAIMOWITZ
08/25/17 0831 - DISCONTINUE by EALEXEEV Eff: 08/25/17 0831
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/25/17 0831 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426034
08/25/17 1246 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/25/17 0831
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions please apply to buttock and inner thigh areas
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-0900 Stop Date 08/29/17 0859 DC: 08/28/17-1222
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540007

History
08/25/17 0831 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539337
08/25/17 1246 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-0900 STOP: 08/29/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/25/17-0900 STOP: 08/29/17-0859 SOFT STOP: 0
DISPENSE: 0
08/25/17 1246 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by DCYRIAC Eff: 08/25/17 0921
08/25/17 1246 - VERIFIED by AMOLINARI
08/28/17 1223 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1222
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1223 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426783
08/28/17 1236 - REVIEW PROVIDER ACTIVITY by YLEE
Discontinue by EALEXEEV Eff: 08/28/17 1223
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

CFTR2V - CEFTRIAXONE SOD 2 GM VIAL - 2 GM

in NS.9100 - SODIUM CHLORIDE 0.9% IV SOLN 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency DAILY@0700 (SCH)
Start Date 08/15/17-0700 Stop Date 08/17/17 0729 DC: 08/17/17-0729
Ordering Doctor SHARMA,RAMAN MD PGY-3
Clinical Indication COMPLICATED UTI
Last Bag 3
Total Dispensed 3 Total Costs $0.00 Total Charges $111.90
Rx Number 01536813

Discontinued Comments Reached Stop Date

History
08/14/17 2108 - ENTER by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/15/17 - 0700
08/15/17 1005 - FILL by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 0700
08/16/17 0949 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 0700
08/17/17 0729 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 0729
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/14/17-2000 Stop Date 09/13/17 1959 DC: 08/15/17-1022
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536801

History
08/14/17 1944 - POM ORDER by RSHARMA
08/14/17 2048 - VERIFIED by EBALILO
08/15/17 1025 - DISCONTINUE by SMOHAMED Eff: 08/15/17 1022
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/15/17 1107 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/15/17 1025
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 08/15/17-1200 Stop Date 09/14/17 1159 DC: 09/01/17-0849
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 34 Total Costs $0.00 Total Charges $3.40
Rx Number 01536809

History
08/14/17 1944 - POM ORDER by RSHARMA
08/14/17 2050 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 08/15/17 - 1200
For: 08/16/17 - 1200
For: 08/17/17 - 1200
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 1200
For: 08/19/17 - 1200
For: 08/20/17 - 1200
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 1200
For: 08/22/17 - 1200
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1200
For: 08/24/17 - 1200
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1200
For: 08/26/17 - 1200
For: 08/27/17 - 1200
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1200
For: 08/29/17 - 1200
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1200
For: 08/31/17 - 1200
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1200
For: 09/05/17 - 1200
09/01/17 0850 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 0849
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

Items Auto Credited: 10 Doses Auto Credited: 5

For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
For: 09/04/17 - 1200
For: 09/05/17 - 1200
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 0850 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427888
09/01/17 1015 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 09/01/17 0850

CFTR2V - CEFTRIAXONE SOD 2 GM VIAL - 2 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency DAILY@0700 (SCH)
Start Date 08/15/17-0700 Stop Date 08/17/17 0729 CAN: 08/14/17-2103
Ordering Doctor SHARMA,RAMAN MD PGY-3
Clinical Indication COMPLICATED UTI
Last Bag 1
Total Dispensed Total Costs $ Total Charges $
Rx Number U01423096

History
08/14/17 1945 - POM ORDER by RSHARMA
08/14/17 2103 - CANCEL by EBALILO
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED DILUENT TO NS 0.9% PER MD
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

ALLEN,MICHAEL W00001219047 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Enemez qhs

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/15/17-2100 Stop Date 09/14/17 2059 CAN: 08/15/17-1107
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01423176

History
08/15/17 1026 - POM ORDER by SMOHAMED
08/15/17 1107 - CANCEL by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO NF ENTRY
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient AMATO,DONNA Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219007 Location B1WE Unit Number M000208204
Age/Sex 60/F Room 156 Registered Date 08/09/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 5.98 in 167.6 cm Body Surface Area 2.01 m2

Weight 203 lb 6.4 oz 92.261 kg
Hem-Onc No

Drug Allergies Penicillins

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/28/17-1538 PT ALLERGIC TO MED ORDERED ACTIVE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/09/17-1845 Stop Date 09/08/17 1844
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535512

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1844 - VERIFIED by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Dose Instructions PRN Pain
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/09/17-1845 Stop Date 09/08/17 1844
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01535515

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1844 - VERIFIED by AMACCA
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

CLCX200C - CELECOXIB 200 MG CAP

Dose 200 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/09/17-2100 Stop Date 09/08/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 55 Total Costs $0.00 Total Charges $1377.50
Rx Number 01535520

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1846 - VERIFIED by AMACCA
Items Dispensed: 9 Doses Dispensed: 9
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

For: 08/24/17 - 0900

For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

CPH500C - CEPHALEXIN MONOHYDRATE 500 MG CAP

Dose 500 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 6 HOURS (SCH)
Start Date 08/28/17-1800 Stop Date 09/07/17 1759
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication CELLULITIS
Total Dispensed 35 Total Costs $0.00 Total Charges $12.72
Rx Number 01540753

History
08/28/17 1518 - POM ORDER by NBALCETIS
08/28/17 1530 - VERIFIED by MHAIMOWITZ
Items Dispensed: 15 Doses Dispensed: 15
For: 08/28/17 - 1800
For: 08/29/17 - 0000
For: 08/29/17 - 0600
For: 08/29/17 - 1200
For: 08/29/17 - 1800
For: 08/30/17 - 0000
For: 08/30/17 - 0600
For: 08/30/17 - 1200
For: 08/30/17 - 1800
For: 08/31/17 - 0000
For: 08/31/17 - 0600
For: 08/31/17 - 1200
For: 08/31/17 - 1800
For: 09/01/17 - 0000
For: 09/01/17 - 0600
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 09/01/17 - 1200
For: 09/01/17 - 1800
For: 09/02/17 - 0000
For: 09/02/17 - 0600
For: 09/02/17 - 1200
For: 09/02/17 - 1800
For: 09/03/17 - 0000
For: 09/03/17 - 0600
For: 09/03/17 - 1200
For: 09/03/17 - 1800
For: 09/04/17 - 0000
For: 09/04/17 - 0600
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 09/04/17 - 1200
For: 09/04/17 - 1800
For: 09/05/17 - 0000
For: 09/05/17 - 0600
For: 09/05/17 - 1200
For: 09/05/17 - 1800
For: 09/06/17 - 0000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

For: 09/06/17 - 0600

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/09/17-1845 Stop Date 09/08/17 1844
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01535513

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1844 - VERIFIED by AMACCA
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/09/17-1845 Stop Date 09/08/17 1844
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535514

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1844 - VERIFIED by AMACCA
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/09/17-2100 Stop Date 09/08/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 28 Total Costs $0.00 Total Charges $2130.75
Rx Number 01535550

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.43
MG/KG/DAY is below the Low Daily Dose.

History
08/09/17 1933 - POM ORDER by YCHO
08/10/17 0736 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by EMUNDACKAL Eff: 08/09/17 2116
08/10/17 0736 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/09/17 - 2100
For: 08/10/17 - 2100
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

For: 08/26/17 - 2100

For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/10/17-0900 Stop Date 09/09/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $6.25
Rx Number 01535517

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1845 - VERIFIED by AMACCA
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 09/04/17 - 0900
For: 09/05/17 - 0900

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/09/17-1845 Stop Date 09/08/17 1844
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535510

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1844 - VERIFIED by AMACCA
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 50 Total Costs $0.00 Total Charges $4.00
Rx Number 01539667

History
08/24/17 1515 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01535518
08/24/17 1535 - VERIFIED by MHAIMOWITZ
Items Dispensed: 14 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency BEFORE BREAKFAST (SCH)
Start Date 08/10/17-0800 Stop Date 09/09/17 0759
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 27 Total Costs $0.00 Total Charges $22.00
Rx Number 01535516

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1845 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/10/17 - 0800
For: 08/11/17 - 0800
For: 08/12/17 - 0800
For: 08/13/17 - 0800
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0800
For: 08/15/17 - 0800
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0800
For: 08/17/17 - 0800
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0800
For: 08/19/17 - 0800
For: 08/20/17 - 0800
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0800
For: 08/22/17 - 0800
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0800
For: 08/24/17 - 0800
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0817 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/01/17-1000 Stop Date 09/08/17 0959
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01541853

History
09/01/17 0953 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540564
09/01/17 1013 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1000 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1000 STOP: 09/08/17-0959 SOFT STOP: 0
09/01/17 1013 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/10/17-0900 Stop Date 09/11/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01535522

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1846 - VERIFIED by AMACCA
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 09/04/17 - 0900
For: 09/05/17 - 0900

RAMI2.5C2 - RAMIPRIL 2.5 MG CAP

Dose 2.5 MG (1 CAPSULE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $29.40
Rx Number 01540823

History
08/28/17 1720 - POM ORDER by NBALCETIS
08/28/17 1727 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions Constipation
374mg=2 tablets
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/09/17-1845 Stop Date 09/08/17 1844
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 4 Total Costs $0.00 Total Charges $0.20
Rx Number 01535511

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1844 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 1845
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 4 GM (4 GEL APPLICATIONS)

Dose Instructions R knee
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 07/20/17-2100 Stop Date 07/23/17 2059 DC: 07/23/17-2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $108.60
Rx Number 01530255

Discontinued Comments Reached Stop Date

History
07/20/17 1735 - POM ORDER by NBALCETIS
07/20/17 1738 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/20/17 - 2100
07/23/17 2100 - DISCONTINUE by PHABKGJOB Eff: 07/23/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 4 GM (4 GEL APPLICATIONS)

Dose Instructions BL knees
L lateral knee
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/02/17-2100 Stop Date 09/01/17 2059 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $108.60
Rx Number 01533626

Discontinued Comments DC'd by Discharge

History
08/02/17 1141 - POM ORDER by NBALCETIS
08/02/17 1145 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/02/17 - 2100
08/04/17 2349 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 4 GM (4 GEL APPLICATIONS)

Dose Instructions BL knees
L lateral knee
Admin Route TOPICALLY
Frequency 1139 (ONE)
Start Date 08/02/17-1139 Stop Date 08/02/17 1140 DC: 08/02/17-1140
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01533625

Discontinued Comments Reached Stop Date

History
08/02/17 1141 - POM ORDER by NBALCETIS
08/02/17 1144 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/02/17 - 1139
08/02/17 1145 - DISCONTINUE by PHABKGJOB Eff: 08/02/17 1140
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/02/17 1145 - CREDIT by EBALILO
ITEMS: 1

MMT17NA - MOMETASONE FUROATE NAS SUSP 50 MCG/ACT 17 GM INH

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Admin Route NASAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/01/17-1700 Stop Date 07/08/17 1659 DC: 07/05/17-1937
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $394.08
Rx Number 01525291

History
07/01/17 1242 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/01/17 - 1700
07/05/17 1938 - DISCONTINUE by RNOVITCH Eff: 07/05/17 1937
EDIT DOCTOR: NOVITCH, RICHARD MD.
07/06/17 1151 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RNOVITCH Eff: 07/05/17 1938
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

NPB15O - NEOMYCIN/POLYMYX/BACITR OINT 15 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions Groin area
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 07/05/17-0900 Stop Date 07/12/17 0859 DC: 07/05/17-1741
Ordering Doctor IVANOV,YURIY MD PGY-3
Clinical Indication OTHER
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01525959

History
07/04/17 2058 - POM ORDER by YIVANOV
07/05/17 0741 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/05/17 - 0900
07/05/17 0748 - CREDIT by AMOLINARI
ITEMS: 1
07/05/17 1608 - DEBIT by EBALILO
ITEMS: 1
07/05/17 1741 - DISCONTINUE by RNOVITCH Eff: 07/05/17 1741
EDIT DOCTOR: NOVITCH, RICHARD MD.
07/05/17 1752 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 07/05/17 1741
07/05/17 1911 - CREDIT by EBALILO
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 07/01/17-2100 Stop Date 07/31/17 2059 DC: 07/28/17-0850
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $56.82
Rx Number 01525292

History
07/01/17 1242 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/01/17 - 2100
07/22/17 1329 - DEBIT by AADEGBAMIG
ITEMS: 1
07/28/17 0851 - DISCONTINUE by NBALCETIS Eff: 07/28/17 0850
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01418765
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 07/28/17 0851
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $28.41
Rx Number 01532338

Discontinued Comments DC'd by Discharge

History
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525292
07/28/17 1009 - EDIT by AADEGBAMIG
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/28/17-0900 STOP: 08/27/17 SOFT STOP:
TO:
START: 07/28/17-0900 STOP: 08/27/17-0859 SOFT STOP:
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by EDENARO Eff: 07/28/17 0853
07/28/17 1010 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/28/17 - 0900
07/28/17 1011 - CREDIT by AADEGBAMIG
ITEMS: 1
07/31/17 0746 - DEBIT by AMOLINARI
ITEMS: 1
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/01/17-1245 Stop Date 07/31/17 1244 DC: 07/28/17-0850
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01525287

History
07/01/17 1242 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
07/28/17 0851 - DISCONTINUE by NBALCETIS Eff: 07/28/17 0850
For: 07/28/17 - 2100
For: 07/29/17 - 2100
For: 07/30/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01418767
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 07/28/17 0851
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532340

Discontinued Comments DC'd by Discharge

History
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525287
07/28/17 1009 - EDIT by AADEGBAMIG
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/28/17-0900 STOP: 08/27/17 SOFT STOP:
TO:
START: 07/28/17-0900 STOP: 08/27/17-0859 SOFT STOP:
07/28/17 1011 - VERIFIED by AADEGBAMIG
08/04/17 2349 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 07/05/17-2100 Stop Date 07/12/17 2059 DC: 07/10/17-1038
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 2 Total Costs $0.00 Total Charges $108.18
Rx Number 01526214

History
07/05/17 1741 - POM ORDER by RNOVITCH
07/05/17 1752 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/05/17 - 2100
07/10/17 0742 - DEBIT by AMOLINARI
ITEMS: 1
07/10/17 1038 - DISCONTINUE by NBALCETIS Eff: 07/10/17 1038
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/10/17 1038 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01413869
07/11/17 0852 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 07/10/17 1038
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 07/10/17-2100 Stop Date 07/17/17 2059 DC: 07/17/17-0949
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01527235

History
07/10/17 1038 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01526214
07/10/17 1043 - EDIT by AADEGBAMIG
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/10/17-2100 STOP: 07/17/17 SOFT STOP:
TO:
START: 07/10/17-2100 STOP: 07/17/17-2059 SOFT STOP:
07/10/17 1043 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/10/17 - 2100
07/10/17 1044 - CREDIT by AADEGBAMIG
ITEMS: 1
07/17/17 0949 - DISCONTINUE by NBALCETIS Eff: 07/17/17 0949
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/17/17 0949 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01415777
07/17/17 1144 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 07/17/17 0949
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 07/17/17-2100 Stop Date 07/24/17 2059 DC: 07/21/17-0923
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01529199

History
07/17/17 0949 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01527235
07/17/17 1144 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/17/17-2100 STOP: 07/24/17 SOFT STOP:
DISPENSE: 1
TO:
START: 07/17/17-2100 STOP: 07/24/17-2059 SOFT STOP: 0
DISPENSE: 0
07/17/17 1144 - VERIFIED by AMOLINARI
07/21/17 0924 - DISCONTINUE by NBALCETIS Eff: 07/21/17 0923
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/21/17 0924 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01416822
07/21/17 0951 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 07/21/17 0924
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 07/21/17-2100 Stop Date 07/28/17 2059 DC: 07/27/17-1021
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530304

History
07/21/17 0924 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01529199
07/21/17 0949 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/21/17-2100 STOP: 07/28/17 SOFT STOP:
DISPENSE: 1
TO:
START: 07/21/17-2100 STOP: 07/28/17-2059 SOFT STOP: 0
DISPENSE: 0
07/21/17 0949 - VERIFIED by AMOLINARI
07/27/17 1021 - DISCONTINUE by NBALCETIS Eff: 07/27/17 1021
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/27/17 1021 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01418542
07/27/17 1032 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 07/27/17 1021
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 07/27/17-2100 Stop Date 08/03/17 2059 DC: 08/03/17-2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01532086

Discontinued Comments Reached Stop Date

History
07/27/17 1021 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01530304
07/27/17 1033 - EDIT by AMACCA
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/27/17-2100 STOP: 08/03/17 SOFT STOP:
TO:
START: 07/27/17-2100 STOP: 08/03/17-2059 SOFT STOP:
07/27/17 1033 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/27/17 - 2100
07/27/17 1033 - CREDIT by AMACCA
ITEMS: 1
07/31/17 0747 - DEBIT by AMOLINARI
ITEMS: 1
08/03/17 2100 - DISCONTINUE by PHABKGJOB Eff: 08/03/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/21/17-2100 Stop Date 08/28/17 2059 DC: 08/25/17-1105
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01538778

History
08/21/17 1855 - POM ORDER by HMOHAMED
08/21/17 1959 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 2100
08/25/17 1105 - DISCONTINUE by NBALCETIS Eff: 08/25/17 1105
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/25/17 1105 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01426155
08/25/17 1234 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/25/17 1105
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/25/17-2100 Stop Date 09/01/17 2059 DC: 09/01/17-2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01539973

Discontinued Comments Reached Stop Date

History
08/25/17 1105 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538778
08/25/17 1234 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-2100 STOP: 09/01/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/25/17-2100 STOP: 09/01/17-2059 SOFT STOP: 0
DISPENSE: 0
08/25/17 1234 - VERIFIED by AMOLINARI
08/30/17 0736 - DEBIT by AMOLINARI
ITEMS: 1
09/01/17 2059 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Dose Instructions PRN Pain
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 07/01/17-1245 Stop Date 07/31/17 1244 DC: 07/28/17-0850
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01525289

History
07/01/17 1242 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
07/03/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0851 - DISCONTINUE by NBALCETIS Eff: 07/28/17 0850
For: 07/28/17 - 2100
For: 07/29/17 - 2100
For: 07/30/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01418761
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 07/28/17 0851
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Dose Instructions PRN Pain
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01532334

Discontinued Comments DC'd by Discharge

History
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525289
07/28/17 1008 - EDIT by AADEGBAMIG
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/28/17-0900 STOP: 08/27/17 SOFT STOP:
TO:
START: 07/28/17-0900 STOP: 08/27/17-0859 SOFT STOP:
07/28/17 1010 - VERIFIED by AADEGBAMIG
07/31/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/18/17-0900 Stop Date 08/17/17 0859 DC: 07/21/17-1727
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $51.92
Rx Number 01529476

History
07/17/17 1732 - POM ORDER by NBALCETIS
07/17/17 1734 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 07/18/17 - 0900
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/21/17 1728 - DISCONTINUE by NBALCETIS Eff: 07/21/17 1727
Items Auto Credited: 4 Doses Auto Credited: 4
For: 07/22/17 - 0900
For: 07/23/17 - 0900
For: 07/24/17 - 0900
For: 07/25/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/21/17 1728 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01417035
07/24/17 1215 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 07/21/17 1728
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency 1731 (ONE)
Start Date 07/17/17-1731 Stop Date 07/17/17 1732 DC: 07/17/17-1732
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $12.98
Rx Number 01529477

Discontinued Comments Reached Stop Date

History
07/17/17 1732 - POM ORDER by NBALCETIS
07/17/17 1734 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/17/17 - 1731
07/17/17 1734 - DISCONTINUE by PHABKGJOB Eff: 07/17/17 1732
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/22/17-0900 Stop Date 08/21/17 0859 DC: 07/22/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530524

History
07/21/17 1728 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01529476
07/21/17 1731 - DISCONTINUE by AADEGBAMIG Eff: 07/22/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/21/17 1731 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/22/17-0900 Stop Date 08/21/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $8.82
Rx Number 01530523

Discontinued Comments DC'd by Discharge

History
07/21/17 1731 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 07/22/17 - 0900
For: 07/23/17 - 0900
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

TO:
DC COMMENTS:
DC'd by Discharge

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 08/29/17 0900 DC: 08/29/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540821

Discontinued Comments dc

History
08/28/17 1714 - POM ORDER by NBALCETIS
08/28/17 1720 - DISCONTINUE by NBALCETIS Eff: 08/29/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
DC COMMENTS:
dc
08/28/17 1720 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/29/17-0900 STOP: 09/28/17 0859 SOFT STOP: 0
DISPENSE: 3
DC COMMENTS:
TO:
START: 08/29/17-0900 STOP: 08/29/17-0900 SOFT STOP:
DISPENSE: 0
DC COMMENTS:
dc
08/28/17 1720 - VERIFIED by SYSTEM
Verified in order to DC
08/28/17 1727 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by NBALCETIS Eff: 08/28/17 1720
Edit by SYSTEM Eff: 08/28/17 1720
Discontinue by NBALCETIS Eff: 08/28/17 1720
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 08/29/17 0900 DC: 08/29/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540822

Discontinued Comments dc

History
08/28/17 1715 - POM ORDER by NBALCETIS
08/28/17 1720 - DISCONTINUE by NBALCETIS Eff: 08/29/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
DC COMMENTS:
dc
08/28/17 1720 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/29/17-0900 STOP: 09/28/17 0859 SOFT STOP: 0
DISPENSE: 3
DC COMMENTS:
TO:
START: 08/29/17-0900 STOP: 08/29/17-0900 SOFT STOP:
DISPENSE: 0
DC COMMENTS:
dc
08/28/17 1720 - VERIFIED by SYSTEM
Verified in order to DC
08/28/17 1727 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by NBALCETIS Eff: 08/28/17 1720
Edit by SYSTEM Eff: 08/28/17 1720
Discontinue by NBALCETIS Eff: 08/28/17 1720
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/01/17-2100 Stop Date 07/31/17 2059 DC: 07/28/17-0850
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $10.25
Rx Number 01525288

History
07/01/17 1242 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
07/03/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/05/17 - 0900
For: 07/05/17 - 2100
For: 07/06/17 - 0900
For: 07/06/17 - 2100
07/05/17 0828 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/07/17 - 0900
For: 07/07/17 - 2100
For: 07/08/17 - 0900
For: 07/08/17 - 2100
For: 07/09/17 - 0900
For: 07/09/17 - 2100
07/07/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/10/17 - 0900
For: 07/10/17 - 2100
For: 07/11/17 - 0900
For: 07/11/17 - 2100
07/10/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/12/17 - 0900
For: 07/12/17 - 2100
For: 07/13/17 - 0900
For: 07/13/17 - 2100
07/12/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/14/17 - 0900
For: 07/14/17 - 2100
For: 07/15/17 - 0900
For: 07/15/17 - 2100
For: 07/16/17 - 0900
For: 07/16/17 - 2100
07/14/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/17/17 - 0900
For: 07/17/17 - 2100
For: 07/18/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

For: 07/18/17 - 2100

07/17/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/19/17 - 0900
For: 07/19/17 - 2100
For: 07/20/17 - 0900
For: 07/20/17 - 2100
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 2100
For: 07/22/17 - 0900
For: 07/22/17 - 2100
For: 07/23/17 - 0900
For: 07/23/17 - 2100
07/21/17 0811 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 2100
For: 07/25/17 - 0900
For: 07/25/17 - 2100
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 2100
For: 07/27/17 - 0900
For: 07/27/17 - 2100
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
For: 07/30/17 - 2100
07/28/17 0810 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 0900
07/28/17 0851 - DISCONTINUE by NBALCETIS Eff: 07/28/17 0850
For: 07/28/17 - 2100
For: 07/29/17 - 2100
For: 07/30/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01418762
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 07/28/17 0851
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.50
Rx Number 01532335

Discontinued Comments DC'd by Discharge

History
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525288
07/28/17 1008 - EDIT by AADEGBAMIG
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/28/17-0900 STOP: 08/27/17 SOFT STOP:
TO:
START: 07/28/17-0900 STOP: 08/27/17-0859 SOFT STOP:
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by EDENARO Eff: 07/28/17 0853
07/28/17 1010 - VERIFIED by AADEGBAMIG
07/31/17 0826 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

DC COMMENTS:
DC'd by Discharge

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/01/17-1245 Stop Date 07/31/17 1244 DC: 07/28/17-0850
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01525285

History
07/01/17 1241 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
07/03/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0851 - DISCONTINUE by NBALCETIS Eff: 07/28/17 0850
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01418763
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 07/28/17 0851
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532336

Discontinued Comments DC'd by Discharge

History
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525285
07/28/17 1009 - EDIT by AADEGBAMIG
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/28/17-0900 STOP: 08/27/17 SOFT STOP:
TO:
START: 07/28/17-0900 STOP: 08/27/17-0859 SOFT STOP:
07/28/17 1010 - VERIFIED by AADEGBAMIG
07/31/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/01/17-2100 Stop Date 07/31/17 2059 DC: 07/28/17-0850
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 106 Total Costs $0.00 Total Charges $10.60
Rx Number 01525290

History
07/01/17 1242 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 7
For: 07/01/17 - 2100
For: 07/02/17 - 0900
For: 07/02/17 - 2100
For: 07/03/17 - 0900
For: 07/03/17 - 2100
For: 07/04/17 - 0900
For: 07/04/17 - 2100
07/03/17 0810 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 07/05/17 - 0900
For: 07/05/17 - 2100
For: 07/06/17 - 0900
For: 07/06/17 - 2100
07/05/17 0828 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 07/07/17 - 0900
For: 07/07/17 - 2100
For: 07/08/17 - 0900
For: 07/08/17 - 2100
For: 07/09/17 - 0900
For: 07/09/17 - 2100
07/07/17 0823 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 07/10/17 - 0900
For: 07/10/17 - 2100
For: 07/11/17 - 0900
For: 07/11/17 - 2100
07/10/17 0832 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 07/12/17 - 0900
For: 07/12/17 - 2100
For: 07/13/17 - 0900
For: 07/13/17 - 2100
07/12/17 0834 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 07/14/17 - 0900
For: 07/14/17 - 2100
For: 07/15/17 - 0900
For: 07/15/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

For: 07/16/17 - 0900

For: 07/16/17 - 2100
07/14/17 0813 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 07/17/17 - 0900
For: 07/17/17 - 2100
For: 07/18/17 - 0900
For: 07/18/17 - 2100
07/17/17 0814 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 07/19/17 - 0900
For: 07/19/17 - 2100
For: 07/20/17 - 0900
For: 07/20/17 - 2100
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 2100
For: 07/22/17 - 0900
For: 07/22/17 - 2100
For: 07/23/17 - 0900
For: 07/23/17 - 2100
07/21/17 0811 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 2100
For: 07/25/17 - 0900
For: 07/25/17 - 2100
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 2100
For: 07/27/17 - 0900
For: 07/27/17 - 2100
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
For: 07/30/17 - 2100
07/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 07/31/17 - 0900
07/28/17 0851 - DISCONTINUE by NBALCETIS Eff: 07/28/17 0850
Items Auto Credited: 14 Doses Auto Credited: 7
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
For: 07/30/17 - 2100
For: 07/31/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

07/28/17 0851 - POM COPY AND EDIT by NBALCETIS

TO: Rx #U01418764
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 07/28/17 0851
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 30 Total Costs $0.00 Total Charges $3.00
Rx Number 01532337

Discontinued Comments DC'd by Discharge

History
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525290
07/28/17 1009 - EDIT by AADEGBAMIG
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/28/17-0900 STOP: 08/27/17 SOFT STOP:
TO:
START: 07/28/17-0900 STOP: 08/27/17-0859 SOFT STOP:
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by EDENARO Eff: 07/28/17 0853
07/28/17 1010 - VERIFIED by AADEGBAMIG
Items Dispensed: 20 Doses Dispensed: 10
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
For: 07/30/17 - 2100
For: 07/31/17 - 0900
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 2100
07/31/17 0826 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

For: 08/08/17 - 0900

For: 08/08/17 - 2100
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
Items Auto Credited: 18 Doses Auto Credited: 9
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/09/17-2100 Stop Date 09/08/17 2059 DC: 08/24/17-1515
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 60 Total Costs $0.00 Total Charges $5.80
Rx Number 01535518

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1845 - VERIFIED by AMACCA
Items Dispensed: 18 Doses Dispensed: 9
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/23/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

For: 08/23/17 - 2100

For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/24/17 1515 - DISCONTINUE by NBALCETIS Eff: 08/24/17 1515
Items Auto Credited: 14 Doses Auto Credited: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/24/17 1515 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425835
08/24/17 1535 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by NBALCETIS Eff: 08/24/17 1515
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

MULT-481 - MULTIVITAMINS W-MINERALS (ICAPS PLUS) TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/02/17-0900 Stop Date 08/01/17 0859 DC: 07/31/17-0925
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 30 Total Costs $0.00 Total Charges $14.40
Rx Number 01525295

History
07/01/17 1256 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 07/02/17 - 0900
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0828 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0811 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0810 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 0900
07/31/17 0926 - DISCONTINUE by NBALCETIS Eff: 07/31/17 0925
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/31/17 0926 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01419335
07/31/17 1104 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 07/31/17 0926
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

MULT-481 - MULTIVITAMINS W-MINERALS (ICAPS PLUS) TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/30/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $1.92
Rx Number 01532870

Discontinued Comments DC'd by Discharge

History
07/31/17 0926 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525295
07/31/17 1102 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/01/17 1154 - EDIT by AMACCA
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/01/17-0900 STOP: 08/30/17 SOFT STOP:
TO:
START: 08/01/17-0900 STOP: 08/30/17-0859 SOFT STOP:
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/04/17 2349 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/04/17-2100 Stop Date 08/11/17 2059 DC: 08/04/17-2100
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534148

Discontinued Comments DC'd by Discharge

History
08/04/17 1039 - POM ORDER by NBALCETIS
08/04/17 1123 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/04/17 2349 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2100
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 1037 (ONE)
Start Date 08/04/17-1037 Stop Date 08/04/17 1038 DC: 08/04/17-1038
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 1 Total Costs $0.00 Total Charges $8.03
Rx Number 01534149

Discontinued Comments Reached Stop Date

History
08/04/17 1039 - POM ORDER by NBALCETIS
08/04/17 1123 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/04/17 - 1037
08/04/17 1123 - DISCONTINUE by PHABKGJOB Eff: 08/04/17 1038
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 07/02/17-0800 Stop Date 08/01/17 0759 DC: 07/31/17-0925
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 30 Total Costs $0.00 Total Charges $25.52
Rx Number 01525293

History
07/01/17 1242 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 07/02/17 - 0800
For: 07/03/17 - 0800
For: 07/04/17 - 0800
07/03/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0800
For: 07/06/17 - 0800
07/05/17 0828 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0800
For: 07/08/17 - 0800
For: 07/09/17 - 0800
07/07/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0800
For: 07/11/17 - 0800
07/10/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0800
For: 07/13/17 - 0800
07/12/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0800
For: 07/15/17 - 0800
For: 07/16/17 - 0800
07/14/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0800
For: 07/18/17 - 0800
07/17/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0800
For: 07/20/17 - 0800
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0800
For: 07/22/17 - 0800
For: 07/23/17 - 0800
07/21/17 0811 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 07/24/17 - 0800
For: 07/25/17 - 0800
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0800
For: 07/27/17 - 0800
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0800
For: 07/29/17 - 0800
For: 07/30/17 - 0800
07/28/17 0810 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 0800
07/31/17 0926 - DISCONTINUE by NBALCETIS Eff: 07/31/17 0925
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/31/17 0926 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01419336
07/31/17 1104 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 07/31/17 0926
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/01/17-0800 Stop Date 08/30/17 0759 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $3.52
Rx Number 01532871

Discontinued Comments DC'd by Discharge

History
07/31/17 0926 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525293
07/31/17 1103 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/01/17-0800 STOP: 08/30/17 SOFT STOP:
TO:
START: 08/01/17-0800 STOP: 08/30/17-0759 SOFT STOP: 0
07/31/17 1103 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0800
For: 08/02/17 - 0800
For: 08/03/17 - 0800
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0800
For: 08/05/17 - 0800
For: 08/06/17 - 0800
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0800
For: 08/08/17 - 0800
08/04/17 2349 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0800
For: 08/06/17 - 0800
For: 08/07/17 - 0800
For: 08/08/17 - 0800
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/04/17-1645 Stop Date 08/04/17 1646 DC: 08/04/17-1646
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534387

Discontinued Comments Reached Stop Date

History
08/04/17 1645 - POM ORDER by NBALCETIS
08/04/17 1646 - VERIFIED by AADEGBAMIG
08/04/17 1646 - DISCONTINUE by PHABKGJOB Eff: 08/04/17 1646
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/09/17-1845 Stop Date 08/16/17 1844 DC: 08/16/17-1104
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $6.50
Rx Number 01535521

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1846 - VERIFIED by AMACCA
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 1104 - DISCONTINUE by RNOVITCH Eff: 08/16/17 1104
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/16/17 1104 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01423456
08/16/17 1133 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RNOVITCH Eff: 08/16/17 1104
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/16/17-1115 Stop Date 08/23/17 1114 DC: 08/22/17-1118
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $6.25
Rx Number 01537158

History
08/16/17 1104 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01535521
08/16/17 1133 - EDIT by AMOLINARI
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/16/17-1115 STOP: 08/23/17 SOFT STOP:
TO:
START: 08/16/17-1115 STOP: 08/23/17-1114 SOFT STOP: 0
08/16/17 1133 - VERIFIED by AMOLINARI
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/22/17 1119 - DISCONTINUE by NBALCETIS Eff: 08/22/17 1118
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/22/17 1119 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425138
08/22/17 1127 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/22/17 1119
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/22/17-1130 Stop Date 08/29/17 1129 DC: 08/28/17-1025
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $5.50
Rx Number 01538942

History
08/22/17 1119 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01537158
08/22/17 1127 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/22/17-1130 STOP: 08/29/17 SOFT STOP:
TO:
START: 08/22/17-1130 STOP: 08/29/17-1129 SOFT STOP: 0
08/22/17 1127 - VERIFIED by AMOLINARI
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 1026 - DISCONTINUE by NBALCETIS Eff: 08/28/17 1025
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/28/17 1026 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01426739
08/28/17 1047 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by NBALCETIS Eff: 08/28/17 1026
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/28/17-1030 Stop Date 09/04/17 1029 DC: 09/01/17-0953
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01540564

History
08/28/17 1026 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538942
08/28/17 1047 - VERIFIED by JDIMARCO
08/29/17 1427 - EDIT by AMACCA
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1030 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-1030 STOP: 09/04/17-1029 SOFT STOP:
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0953 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0953
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0953 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427908
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0953
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/11/17-0900 Stop Date 07/13/17 0859 DC: 07/13/17-0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $2.70
Rx Number 01527322

Discontinued Comments Reached Stop Date

History
07/10/17 1516 - POM ORDER by NBALCETIS
07/10/17 1517 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 07/11/17 - 0900
For: 07/12/17 - 0900
07/13/17 0859 - DISCONTINUE by PHABKGJOB Eff: 07/13/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 1515 (ONE)
Start Date 07/10/17-1515 Stop Date 07/10/17 1516 DC: 07/10/17-1516
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $1.35
Rx Number 01527321

Discontinued Comments Reached Stop Date

History
07/10/17 1516 - POM ORDER by NBALCETIS
07/10/17 1517 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 07/10/17 - 1515
07/10/17 1517 - DISCONTINUE by PHABKGJOB Eff: 07/10/17 1516
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/18/17-0900 Stop Date 08/17/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 18 Total Costs $0.00 Total Charges $24.30
Rx Number 01529479

Discontinued Comments DC'd by Discharge

History
07/17/17 1739 - POM ORDER by NBALCETIS
07/17/17 1742 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 07/18/17 - 0900
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700

Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 40 MEQ (2 TABLET, CONTROLLED-RELEASES)

Admin Route ORAL
Frequency 1738 (ONE)
Start Date 07/17/17-1738 Stop Date 07/17/17 1739 DC: 07/17/17-1739
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $2.70
Rx Number 01529480

Discontinued Comments Reached Stop Date

History
07/17/17 1739 - POM ORDER by NBALCETIS
07/17/17 1743 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 07/17/17 - 1738
07/17/17 1743 - DISCONTINUE by PHABKGJOB Eff: 07/17/17 1739
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/25/17-0900 Stop Date 08/01/17 0859 DC: 07/25/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530854

History
07/24/17 1211 - POM ORDER by NBALCETIS
07/24/17 1215 - DISCONTINUE by AADEGBAMIG Eff: 07/25/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/24/17 1215 - VERIFIED by SYSTEM
Verified in order to DC

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 1210 (ONE)
Start Date 07/24/17-1210 Stop Date 07/24/17 1211 DC: 07/24/17-1211
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $1.35
Rx Number 01530853

Discontinued Comments Reached Stop Date

History
07/24/17 1211 - POM ORDER by NBALCETIS
07/24/17 1215 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/24/17 - 1210
07/24/17 1215 - DISCONTINUE by PHABKGJOB Eff: 07/24/17 1211
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/10/17-0900 Stop Date 09/09/17 0859 DC: 08/29/17-1802
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $27.00
Rx Number 01535519

Discontinued Comments dc

History
08/09/17 1841 - POM ORDER by HMOHAMED
08/09/17 1845 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/10/17 - 0900
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

08/29/17 1803 - DISCONTINUE by NBALCETIS Eff: 08/29/17 1802

Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/30/17 0736 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/29/17 1803
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions Constipation
374mg=2 tablets
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/01/17-2100 Stop Date 07/31/17 2059 DC: 07/28/17-0850
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 54 Total Costs $0.00 Total Charges $3.40
Rx Number 01525286

History
07/01/17 1242 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 07/01/17 - 2100
For: 07/02/17 - 2100
For: 07/03/17 - 2100
For: 07/04/17 - 2100
07/03/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/05/17 - 2100
For: 07/06/17 - 2100
07/05/17 0828 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 07/07/17 - 2100
For: 07/08/17 - 2100
For: 07/09/17 - 2100
07/07/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/10/17 - 2100
For: 07/11/17 - 2100
07/10/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/12/17 - 2100
For: 07/13/17 - 2100
07/12/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 07/14/17 - 2100
For: 07/15/17 - 2100
For: 07/16/17 - 2100
07/14/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/17/17 - 2100
For: 07/18/17 - 2100
07/17/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/19/17 - 2100
For: 07/20/17 - 2100
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 07/21/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

For: 07/22/17 - 2100

For: 07/23/17 - 2100
07/21/17 0811 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/26/17 - 2100
For: 07/27/17 - 2100
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 07/28/17 - 2100
For: 07/29/17 - 2100
For: 07/30/17 - 2100
07/28/17 0851 - DISCONTINUE by NBALCETIS Eff: 07/28/17 0850
Items Auto Credited: 6 Doses Auto Credited: 3
For: 07/28/17 - 2100
For: 07/29/17 - 2100
For: 07/30/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01418766
07/28/17 1010 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 07/28/17 0851
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions Constipation
374mg=2 tablets
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/28/17-2100 Stop Date 08/27/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $1.20
Rx Number 01532339

Discontinued Comments DC'd by Discharge

History
07/28/17 0851 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525286
07/28/17 1009 - EDIT by AADEGBAMIG
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/28/17-2100 STOP: 08/27/17 SOFT STOP:
TO:
START: 07/28/17-2100 STOP: 08/27/17-0859 SOFT STOP:
07/28/17 1010 - VERIFIED by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 07/28/17 - 2100
For: 07/29/17 - 2100
For: 07/30/17 - 2100
For: 07/31/17 - 2100
For: 08/01/17 - 2100
07/31/17 0826 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/02/17 - 2100
For: 08/03/17 - 2100
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/04/17 2349 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
Items Auto Credited: 10 Doses Auto Credited: 5
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/02/17-0900 Stop Date 08/01/17 0859 DC: 07/31/17-0925
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 30 Total Costs $0.00 Total Charges $1.50
Rx Number 01525294

History
07/01/17 1256 - POM ORDER by NBALCETIS
07/01/17 1322 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 07/02/17 - 0900
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0828 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0811 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0810 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 0900
07/31/17 0926 - DISCONTINUE by NBALCETIS Eff: 07/31/17 0925
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
07/31/17 0926 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01419337
07/31/17 1104 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 07/31/17 0926
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

AMATO,DONNA W00001219007 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/30/17 0859 DC: 08/04/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.20
Rx Number 01532872

Discontinued Comments DC'd by Discharge

History
07/31/17 0926 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01525294
07/31/17 1103 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/01/17-0900 STOP: 08/30/17 SOFT STOP:
TO:
START: 08/01/17-0900 STOP: 08/30/17-0859 SOFT STOP: 0
07/31/17 1103 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/04/17 2349 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1700
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient ANNUNZIATA,THOMAS A Responsible Doctor BRIONES,MARIA M.D.

Account Number W00001219622 Location B1EA Unit Number M000209417
Age/Sex 69/M Room 108 Registered Date 08/31/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 2.99 in 160 cm Body Surface Area 1.81 m2

Weight 172 lb oz 78.018 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/31/17-1629 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

BISM262O - BISMUTH SUBSALICYLATE BTL (KAOPECTATE)

Dose 30 ML (0.1271186 MLS)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: DIARRHEA - FOR DIARRHEA
Start Date 08/31/17-1600 Stop Date 09/30/17 1559
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541753

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1627 - VERIFIED by AADEGBAMIG

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1530 Stop Date 09/30/17 1529
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541744

History
08/31/17 1536 - POM ORDER by DSPUNBERG
08/31/17 1626 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1600 Stop Date 09/30/17 1559
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541752

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1627 - VERIFIED by AADEGBAMIG

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions Mild pain/Fever
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/31/17-1530 Stop Date 09/30/17 1529
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541743

History
08/31/17 1536 - POM ORDER by DSPUNBERG
08/31/17 1626 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

ALLP100T - ALLOPURINOL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $2.10
Rx Number 01541754

History
08/31/17 1621 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

C500T - ASCORBIC ACID 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01541761

History
08/31/17 1621 - POM ORDER by DSPUNBERG
08/31/17 1628 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $0.09
Rx Number 01541755

History
08/31/17 1621 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions Constipation
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1530 Stop Date 09/30/17 1529
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541746

History
08/31/17 1536 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 2,000 UNIT (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $0.75
Rx Number 01541762

History
08/31/17 1621 - POM ORDER by DSPUNBERG
08/31/17 1628 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1530 Stop Date 09/30/17 1529
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541742

History
08/31/17 1536 - POM ORDER by DSPUNBERG
08/31/17 1626 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $0.90
Rx Number 01541751

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1627 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

IRON45TA - IRON,CARBONYL (FERRO SEQUELS) TAB

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $1.50
Rx Number 01541749

History
08/31/17 1536 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

LOSA50TA - LOSARTAN POTASSIUM 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $55.65
Rx Number 01541756

History
08/31/17 1621 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Dose Instructions Dyspepsia/Abdominal Discomfort
Admin Route ORAL
Frequency AFTER MEALS & BEDTIM (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/31/17-1530 Stop Date 09/30/17 1529
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541747

History
08/31/17 1536 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1530 Stop Date 09/30/17 1529
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541745

History
08/31/17 1536 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MLX7.5T - MELOXICAM 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $1.05
Rx Number 01541837

History
08/31/17 2044 - POM ORDER by HMOHAMED
08/31/17 2045 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

NEBI5TAB2 - NEBIVOLOL HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $29.85
Rx Number 01541808

History
08/31/17 1702 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 09/01/17-0800 Stop Date 10/01/17 0759
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $2.64
Rx Number 01541771

History
08/31/17 1630 - POM ORDER by MBRIONES
08/31/17 1639 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/31/17-1615 Stop Date 09/07/17 1614
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01541758

History
08/31/17 1621 - POM ORDER by DSPUNBERG
08/31/17 1628 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/31/17-1615 Stop Date 09/07/17 1614
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01541759

History
08/31/17 1621 - POM ORDER by DSPUNBERG
08/31/17 1628 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

RIVA10TA - RIVAROXABAN 10 MG TABLET

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/22/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $96.99
Rx Number 01541760

History
08/31/17 1621 - POM ORDER by DSPUNBERG
08/31/17 1628 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions 374 MG = 2 tablets
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1530 Stop Date 09/30/17 1529
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541750

History
08/31/17 1536 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/31/17-1530 Stop Date 09/07/17 1529
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541748

History
08/31/17 1536 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1600 Stop Date 09/30/17 1559 DC: 08/31/17-1615
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541727

Discontinued Comments duplicate

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1616 - DISCONTINUE by DSPUNBERG Eff: 08/31/17 1615
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
duplicate
08/31/17 1616 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1624 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SYSTEM Eff: 08/31/17 1616
Discontinue by DSPUNBERG Eff: 08/31/17 1616
duplicate
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1600 Stop Date 09/30/17 1559 DC: 08/31/17-1615
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541729

Discontinued Comments duplicate

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1616 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1616 - DISCONTINUE by DSPUNBERG Eff: 08/31/17 1615
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
duplicate
08/31/17 1624 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SYSTEM Eff: 08/31/17 1616
Discontinue by DSPUNBERG Eff: 08/31/17 1616
duplicate
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

IRON45TA - IRON,CARBONYL (FERRO SEQUELS) TAB

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/01/17 0900 DC: 09/01/17-0900
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541731

Discontinued Comments duplicate

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1616 - EDIT by DSPUNBERG
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
FROM:
START: 09/01/17-0900 STOP: 10/01/17 0859 SOFT STOP: 0
DISPENSE: 3
DC COMMENTS:
TO:
START: 09/01/17-0900 STOP: 09/01/17-0900 SOFT STOP:
DISPENSE: 0
DC COMMENTS:
duplicate
08/31/17 1616 - DISCONTINUE by DSPUNBERG Eff: 09/01/17 0900
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
DC COMMENTS:
duplicate
08/31/17 1616 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1624 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by DSPUNBERG Eff: 08/31/17 1616
Edit by SYSTEM Eff: 08/31/17 1616
Discontinue by DSPUNBERG Eff: 08/31/17 1616
duplicate
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency AFTER MEALS & BEDTIM (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/31/17-1600 Stop Date 09/30/17 1559 DC: 08/31/17-1615
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541730

Discontinued Comments duplicate

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1616 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1616 - DISCONTINUE by DSPUNBERG Eff: 08/31/17 1615
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
duplicate
08/31/17 1624 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SYSTEM Eff: 08/31/17 1616
Discontinue by DSPUNBERG Eff: 08/31/17 1616
duplicate
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1600 Stop Date 09/30/17 1559 DC: 08/31/17-1615
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541728

Discontinued Comments duplicate

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1616 - DISCONTINUE by DSPUNBERG Eff: 08/31/17 1615
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
duplicate
08/31/17 1616 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1624 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SYSTEM Eff: 08/31/17 1616
Discontinue by DSPUNBERG Eff: 08/31/17 1616
duplicate
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

MLX7.5T - MELOXICAM 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/01/17 0900 DC: 09/01/17-0900
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01541757

History
08/31/17 1621 - POM ORDER by DSPUNBERG
08/31/17 1627 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1630 - DISCONTINUE by MBRIONES Eff: 09/01/17 0900
EDIT DOCTOR: BRIONES,MARIA M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/31/17 1630 - EDIT by MBRIONES
EDIT DOCTOR: BRIONES,MARIA M.D.
FROM:
START: 09/01/17-0900 STOP: 10/01/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 09/01/17-0900 STOP: 09/01/17-0900 SOFT STOP:
DISPENSE: 0
08/31/17 1639 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by MBRIONES Eff: 08/31/17 1630
Discontinue by MBRIONES Eff: 08/31/17 1630
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 5 EA (0 EACHS)
Dose Instructions Nebivolol (Bystolic) 5 mg tablet by mouth daily
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859 DC: 09/01/17-0900
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541809

History
08/31/17 1652 - POM ORDER by DSPUNBERG
08/31/17 1702 - DISCONTINUE by AADEGBAMIG Eff: 09/01/17 0900
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/31/17 1702 - VERIFIED by SYSTEM
Verified in order to DC

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1600 Stop Date 09/30/17 1559 DC: 08/31/17-1615
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541733

Discontinued Comments duplicate

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1616 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1616 - DISCONTINUE by DSPUNBERG Eff: 08/31/17 1615
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
duplicate
08/31/17 1624 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SYSTEM Eff: 08/31/17 1616
Discontinue by DSPUNBERG Eff: 08/31/17 1616
duplicate
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

ANNUNZIATA,THOMAS A W00001219622 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleep
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/31/17-1600 Stop Date 09/07/17 1559 DC: 08/31/17-1615
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541732

Discontinued Comments duplicate

History
08/31/17 1600 - POM ORDER by MBRIONES
08/31/17 1616 - DISCONTINUE by DSPUNBERG Eff: 08/31/17 1615
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
duplicate
08/31/17 1616 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1624 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SYSTEM Eff: 08/31/17 1616
Discontinue by DSPUNBERG Eff: 08/31/17 1616
duplicate
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient ARONOFF,MILLICENT Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001220412 Location B2EA Unit Number M000115121
Age/Sex 93/F Room 217 Registered Date 09/02/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft in 152.4 cm Body Surface Area 1.67 m2

Weight 153 lb 6.4 oz 69.581 kg
Hem-Onc No

Drug Allergies Penicillins, iodine

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies: LACTOSE
Primary Diagnosis: CVA
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/02/17-1315 Stop Date 10/02/17 1314
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542191

History
09/02/17 1311 - POM ORDER by HAZIZI
09/02/17 1339 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 7 Total Costs $0.00 Total Charges $32.36
Rx Number 01542192

History
09/02/17 1313 - POM ORDER by HAZIZI
09/02/17 1339 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 8 Total Costs $0.00 Total Charges $68.30
Rx Number 01542198

History
09/02/17 1313 - POM ORDER by HAZIZI
09/02/17 1340 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1315 Stop Date 10/02/17 1314
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542193

History
09/02/17 1311 - POM ORDER by HAZIZI
09/02/17 1340 - VERIFIED by MHAIMOWITZ

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 1,000 UNIT (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.13
Rx Number 01542199

History
09/02/17 1313 - POM ORDER by HAZIZI
09/02/17 1340 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: constipation
Start Date 09/02/17-1315 Stop Date 10/02/17 1314
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542197

History
09/02/17 1311 - POM ORDER by HAZIZI
09/02/17 1340 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.43
Rx Number 01542200

History
09/02/17 1313 - POM ORDER by HAZIZI
09/02/17 1341 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

LOSA50TA - LOSARTAN POTASSIUM 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $9.28
Rx Number 01542201

History
09/02/17 1313 - POM ORDER by HAZIZI
09/02/17 1341 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 09/02/17-1315 Stop Date 10/02/17 1314
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542195

History
09/02/17 1311 - POM ORDER by HAZIZI
09/02/17 1340 - VERIFIED by MHAIMOWITZ

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1315 Stop Date 10/02/17 1314
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542194

History
09/02/17 1311 - POM ORDER by HAZIZI
09/02/17 1340 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 7 Total Costs $0.00 Total Charges $0.25
Rx Number 01542202

History
09/02/17 1313 - POM ORDER by HAZIZI
09/02/17 1341 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100

NFD60TCR - NIFEDIPINE 60 MG TABCR

Dose 60 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $5.03
Rx Number 01542203

History
09/02/17 1313 - POM ORDER by HAZIZI
09/02/17 1341 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 8 Total Costs $0.00 Total Charges $0.20
Rx Number 01542196

History
09/02/17 1311 - POM ORDER by HAZIZI
09/02/17 1340 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BISM262O4 - BISMUTH SUBSALICYLATE (KAOPECTATE) BTL

Dose 30 ML (0.1271186 BOTTLES)

Dose Instructions After each loose BM (8 doses maximum in 24 hours)
Admin Route ORAL
Frequency EVERY 1 HOUR (PRN) PRN REASON: DIARRHEA - FOR DIARRHEA
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $0.25
Rx Number 01259663

Discontinued Comments DC'd by Discharge

History
07/30/14 1244 - POM ORDER by KPECHMAN
07/30/14 1312 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 07/30/14 - 1245
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/02/14-0900 Stop Date 09/01/14 0859 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 15 Total Costs $0.00 Total Charges $330.75
Rx Number 01260108

Discontinued Comments DC'd by Discharge

History
08/01/14 0920 - POM ORDER by KPECHMAN
08/01/14 1104 - VERIFIED by GZEIARATI
Items Dispensed: 5 Doses Dispensed: 1
For: 08/02/14 - 0900
08/01/14 1105 - DEBIT by GZEIARATI
ITEMS: 1
08/01/14 1105 - CREDIT by GZEIARATI
ITEMS: 2
08/04/14 1413 - DEBIT by GZEIARATI
ITEMS: 1
08/08/14 0822 - DEBIT by BGIRLING
ITEMS: 1
DEBIT COMMENTS:
sent up 8/8/14
08/12/14 0733 - DEBIT by BGIRLING
ITEMS: 1
DEBIT COMMENTS:
sent up 8/12/14
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency 0916 (ONE)
Start Date 08/01/14-0916 Stop Date 08/01/14 0917 DC: 08/01/14-0917
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01260109

Discontinued Comments Reached Stop Date

History
08/01/14 0920 - POM ORDER by KPECHMAN
08/01/14 1104 - VERIFIED by GZEIARATI
Items Dispensed: 5 Doses Dispensed: 1
For: 08/01/14 - 0916
08/01/14 1104 - DISCONTINUE by PHABKGJOB Eff: 08/01/14 0917
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01259675

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1315 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Dose Instructions Constipation
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01259678

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1318 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions Mild Pain/Fever
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 07/30/14-1245 Stop Date 08/01/14 0916 DC: 08/01/14-0916
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01259655

History
07/30/14 1244 - POM ORDER by KPECHMAN
07/30/14 1309 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0920 - DISCONTINUE by KPECHMAN Eff: 08/01/14 0916
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/01/14 0920 - EDIT by KPECHMAN
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
FROM:
START: 07/30/14-1245 STOP: 08/29/14 1244 SOFT STOP: 0
TO:
START: 07/30/14-1245 STOP: 08/01/14-0916 SOFT STOP:
08/01/14 0920 - POM COPY AND EDIT by KPECHMAN
TO: Rx #U01152074
08/01/14 1104 - REVIEW PROVIDER ACTIVITY by GZEIARATI
by KPECHMAN Eff: 08/01/14 0920
by KPECHMAN Eff: 08/01/14 0920
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 1,000 MG (3.0769231 TABLETS)

Dose Instructions Mild Pain/Fever
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/01/14-1400 Stop Date 08/01/14 1400 DC: 08/01/14-1400
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01260106

History
08/01/14 0920 - POM COPY AND EDIT by KPECHMAN
FROM: Rx #01259655
Result of Sig/Schedule Edit
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: As Needed
Last Administration: 07/31/14 - 1816
Old Sig/Sch: EVERY 4 HOURS (PRN)
New Sig/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 08/01/14 - 0916
New Order Start: 08/01/14 - 1400
08/01/14 1104 - REVIEW PROVIDER ACTIVITY by GZEIARATI
by KPECHMAN Eff: 08/01/14 0920
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: As Needed
Last Administration: 07/31/14 - 1816
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 08/01/14 - 0916
New Order Start: 08/01/14 - 1400
08/01/14 1104 - VERIFIED by GZEIARATI
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 1122 - COPY AND EDIT by GZEIARATI
TO: Rx #01260167
08/01/14 1122 - DISCONTINUE by GZEIARATI Eff: 08/01/14 1400
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 1,000 MG (3.0769231 TABLETS)

Dose Instructions Mild Pain/Fever
Admin Route ORAL
Frequency 0916 (ONE)
Start Date 08/01/14-0916 Stop Date 08/01/14 0917 DC: 08/01/14-0917
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01260107

Discontinued Comments Reached Stop Date

History
08/01/14 0920 - POM ORDER by KPECHMAN
08/01/14 1104 - VERIFIED by GZEIARATI
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 1104 - DISCONTINUE by PHABKGJOB Eff: 08/01/14 0917
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Dose Instructions Mild Pain/Fever
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/01/14-1400 Stop Date 08/31/14 1359 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $5.50
Rx Number 01260167

Discontinued Comments DC'd by Discharge

History
08/01/14 1122 - COPY AND EDIT by GZEIARATI
FROM: Rx #01260106
08/01/14 1122 - ENTER by GZEIARATI
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 1122 - SYSTEM COPY AND EDIT by GZEIARATI
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
MED: AC325T - TYLENOL
RX ID: ACETAMINOPHEN 325 MG TAB
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
MED: AC500T - TYLENOL EXTRA STRENGTH
RX ID: ACETAMINOPHEN 500 MG TAB
RX COMMENTS:
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/06/14 - 1400
For: 08/06/14 - 2200
For: 08/07/14 - 0600
For: 08/07/14 - 1400
For: 08/07/14 - 2200
For: 08/08/14 - 0600
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 08/08/14 - 1400
For: 08/08/14 - 2200
For: 08/09/14 - 0600
For: 08/09/14 - 1400
For: 08/09/14 - 2200
For: 08/10/14 - 0600
For: 08/10/14 - 1400
For: 08/10/14 - 2200
For: 08/11/14 - 0600
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/11/14 - 1400
For: 08/11/14 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

For: 08/12/14 - 0600

For: 08/12/14 - 1400
For: 08/12/14 - 2200
For: 08/13/14 - 0600
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/13/14 - 1400
For: 08/13/14 - 2200
For: 08/14/14 - 0600
For: 08/14/14 - 1400
For: 08/14/14 - 2200
For: 08/15/14 - 0600
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 18 Doses Dispensed: 9
For: 08/15/14 - 1400
For: 08/15/14 - 2200
For: 08/16/14 - 0600
For: 08/16/14 - 1400
For: 08/16/14 - 2200
For: 08/17/14 - 0600
For: 08/17/14 - 1400
For: 08/17/14 - 2200
For: 08/18/14 - 0600
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 12 Doses Dispensed: 6
For: 08/18/14 - 1400
For: 08/18/14 - 2200
For: 08/19/14 - 0600
For: 08/19/14 - 1400
For: 08/19/14 - 2200
For: 08/20/14 - 0600
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/01/14-1130 Stop Date 08/01/14 1131 DC: 08/01/14-1131
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01260168

Discontinued Comments Reached Stop Date

History
08/01/14 1123 - ENTER by GZEIARATI
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 1130 - DISCONTINUE by PHABKGJOB Eff: 08/01/14 1131
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Dose Instructions PRN WHEEZING
Admin Route NEBULIZER
Frequency EVERY 6 HOURS (PRN) PRN REASON: WHEEZE - for Wheezing
Start Date 08/02/14-0945 Stop Date 09/01/14 0944 DC: 08/13/14-1210
Ordering Doctor COFFEY,ALEXANDRA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01260565

History
08/02/14 0935 - POM ORDER by ACOFFEY
08/02/14 1013 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 1211 - DISCONTINUE by KPECHMAN Eff: 08/13/14 1210
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
09/13/14 0027 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by KPECHMAN Eff: 08/13/14 1211) removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

ASPI325T5 - ASPIRIN 325 MG TABEC

Dose 325 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/30/14-1700 Stop Date 08/29/14 1659 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 32 Total Costs $0.00 Total Charges $5.76
Rx Number 01259656

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1310 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 07/30/14 - 1700
For: 07/31/14 - 0900
For: 07/31/14 - 1700
For: 08/01/14 - 0900
For: 08/01/14 - 1700
For: 08/02/14 - 0900
For: 08/02/14 - 1700
For: 08/03/14 - 0900
For: 08/03/14 - 1700
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/04/14 - 0900
For: 08/04/14 - 1700
For: 08/05/14 - 0900
For: 08/05/14 - 1700
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/06/14 - 0900
For: 08/06/14 - 1700
For: 08/07/14 - 0900
For: 08/07/14 - 1700
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/08/14 - 0900
For: 08/08/14 - 1700
For: 08/09/14 - 0900
For: 08/09/14 - 1700
For: 08/10/14 - 0900
For: 08/10/14 - 1700
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/11/14 - 0900
For: 08/11/14 - 1700
For: 08/12/14 - 0900
For: 08/12/14 - 1700
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/13/14 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

For: 08/13/14 - 1700

For: 08/14/14 - 0900
For: 08/14/14 - 1700
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 6 Doses Dispensed: 6
For: 08/15/14 - 0900
For: 08/15/14 - 1700
For: 08/16/14 - 0900
For: 08/16/14 - 1700
For: 08/17/14 - 0900
For: 08/17/14 - 1700
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 4 Doses Dispensed: 4
For: 08/18/14 - 0900
For: 08/18/14 - 1700
For: 08/19/14 - 0900
For: 08/19/14 - 1700
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/15/14 - 1700
For: 08/16/14 - 0900
For: 08/16/14 - 1700
For: 08/17/14 - 0900
For: 08/17/14 - 1700
For: 08/18/14 - 0900
For: 08/18/14 - 1700
For: 08/19/14 - 0900
For: 08/19/14 - 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

ATRV10T - ATORVASTATIN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/30/14-2100 Stop Date 08/29/14 2059 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 16 Total Costs $0.00 Total Charges $196.48
Rx Number 01259657

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1310 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 07/30/14 - 2100
For: 07/31/14 - 2100
For: 08/01/14 - 2100
For: 08/02/14 - 2100
For: 08/03/14 - 2100
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/04/14 - 2100
For: 08/05/14 - 2100
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/06/14 - 2100
For: 08/07/14 - 2100
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/08/14 - 2100
For: 08/09/14 - 2100
For: 08/10/14 - 2100
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/11/14 - 2100
For: 08/12/14 - 2100
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/13/14 - 2100
For: 08/14/14 - 2100
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/14 - 2100
For: 08/16/14 - 2100
For: 08/17/14 - 2100
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 2 Doses Dispensed: 2
For: 08/18/14 - 2100
For: 08/19/14 - 2100
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/15/14 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

For: 08/16/14 - 2100

For: 08/17/14 - 2100
For: 08/18/14 - 2100
For: 08/19/14 - 2100
DC COMMENTS:
DC'd by Discharge

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 5 MG (1 TABLET, ENTERIC COATED)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01259658

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1310 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 10 MG (2 TABLET, ENTERIC COATEDS)

Dose Instructions 10mg is equal to 2 tablets
Severe Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01259662

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1312 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

CLCX200C - CELECOXIB 200 MG CAP

Dose 200 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/30/14-1700 Stop Date 08/29/14 1659 DC: 08/13/14-1210
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 10 Total Costs $0.00 Total Charges $114.64
Rx Number 01259659

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1311 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 07/30/14 - 1700
For: 07/31/14 - 0900
For: 07/31/14 - 1700
For: 08/01/14 - 0900
For: 08/01/14 - 1700
For: 08/02/14 - 0900
For: 08/02/14 - 1700
For: 08/03/14 - 0900
For: 08/03/14 - 1700
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/04/14 - 0900
For: 08/04/14 - 1700
For: 08/05/14 - 0900
For: 08/05/14 - 1700
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/06/14 - 0900
For: 08/06/14 - 1700
For: 08/07/14 - 0900
For: 08/07/14 - 1700
08/04/14 1053 - HOLD by KPECHMAN Eff: 08/04/14 1039
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/04/14 - 1700
For: 08/05/14 - 0900
For: 08/05/14 - 1700
For: 08/06/14 - 0900
For: 08/06/14 - 1700
For: 08/07/14 - 0900
For: 08/07/14 - 1700
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/04/14 1108 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/04/14 1053
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

Items Dispensed: 0 Doses Dispensed: 0

08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 1211 - DISCONTINUE by KPECHMAN Eff: 08/13/14 1210
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
09/13/14 0027 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by KPECHMAN Eff: 08/13/14 1211) removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 1,000 UNIT (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/31/14-0900 Stop Date 08/30/14 0859 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 16 Total Costs $0.00 Total Charges $3.00
Rx Number 01259664

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1312 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/14 - 0900
For: 08/01/14 - 0900
For: 08/02/14 - 0900
For: 08/03/14 - 0900
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/04/14 - 0900
For: 08/05/14 - 0900
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/06/14 - 0900
For: 08/07/14 - 0900
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/08/14 - 0900
For: 08/09/14 - 0900
For: 08/10/14 - 0900
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/11/14 - 0900
For: 08/12/14 - 0900
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/13/14 - 0900
For: 08/14/14 - 0900
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/14 - 0900
For: 08/16/14 - 0900
For: 08/17/14 - 0900
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 2 Doses Dispensed: 2
For: 08/18/14 - 0900
For: 08/19/14 - 0900
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/16/14 - 0900
For: 08/17/14 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

For: 08/18/14 - 0900

For: 08/19/14 - 0900
DC COMMENTS:
DC'd by Discharge

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Dose Instructions Puritis/Sleeplessness
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: ITCH - Itching
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01259661

Discontinued Comments DC'd by Discharge

History
07/30/14 1244 - POM ORDER by KPECHMAN
07/30/14 1312 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01259665

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1312 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/30/14-1300 Stop Date 08/29/14 1259 DC: 08/01/14-1158
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01259666

History
07/30/14 1244 - POM ORDER by KPECHMAN
07/30/14 1312 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/14 - 0900
For: 08/04/14 - 1300
For: 08/04/14 - 1700
For: 08/05/14 - 0900
For: 08/05/14 - 1300
For: 08/05/14 - 1700
08/01/14 1200 - DISCONTINUE by KPECHMAN Eff: 08/01/14 1158
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/01/14 1200 - POM COPY AND EDIT by KPECHMAN
TO: Rx #U01152159
08/01/14 1205 - REVIEW PROVIDER ACTIVITY by GZEIARATI
by KPECHMAN Eff: 08/01/14 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/01/14-1300 Stop Date 08/31/14 1259 DC: 08/04/14-1039
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01260214

History
08/01/14 1200 - POM COPY AND EDIT by KPECHMAN
FROM: Rx #01259666
08/01/14 1205 - VERIFIED by GZEIARATI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/06/14 - 0900
For: 08/06/14 - 1300
For: 08/06/14 - 1700
For: 08/07/14 - 0900
For: 08/07/14 - 1300
For: 08/07/14 - 1700
08/04/14 1053 - DISCONTINUE by KPECHMAN Eff: 08/04/14 1039
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/04/14 1053 - POM COPY AND EDIT by KPECHMAN
TO: Rx #U01152785
08/04/14 1108 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/04/14 1053
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/04/14-1045 Stop Date 09/03/14 1044 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01260847

Discontinued Comments DC'd by Discharge

History
08/04/14 1053 - POM COPY AND EDIT by KPECHMAN
FROM: Rx #01260214
08/04/14 1108 - VERIFIED by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/30/14-1300 Stop Date 08/29/14 1259 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01259667

Discontinued Comments DC'd by Discharge

History
07/30/14 1244 - POM ORDER by KPECHMAN
07/30/14 1313 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/14 - 0900
For: 08/04/14 - 1300
For: 08/04/14 - 1700
For: 08/05/14 - 0900
For: 08/05/14 - 1300
For: 08/05/14 - 1700
08/01/14 1200 - HOLD by KPECHMAN Eff: 08/01/14 1158
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/01/14 1205 - REVIEW PROVIDER ACTIVITY by GZEIARATI
by KPECHMAN Eff: 08/01/14 1200
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

FESO4TAB2 - FESOTERODINE FUMARATE 4 MG TABSR 24H

Dose 8 MG (2 TAB.SR.24HS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/31/14-0900 Stop Date 08/06/14 1059 DC: 08/06/14-1059
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 22 Total Costs $0.00 Total Charges $165.90
Rx Number 01259682

History
07/30/14 1323 - ENTER by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 07/31/14 - 0900
For: 08/01/14 - 0900
For: 08/02/14 - 0900
For: 08/03/14 - 0900
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/04/14 - 0900
For: 08/05/14 - 0900
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/06/14 - 0900
For: 08/07/14 - 0900
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/08/14 - 0900
For: 08/09/14 - 0900
For: 08/10/14 - 0900
08/06/14 1101 - EDIT by KPECHMAN
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
FROM:
START: 07/31/14-0900 STOP: 08/30/14 0859 SOFT STOP: 0
TO:
START: 07/31/14-0900 STOP: 08/06/14-1059 SOFT STOP:
08/06/14 1101 - DISCONTINUE by KPECHMAN Eff: 08/06/14 1059
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/06/14 1101 - POM COPY AND EDIT by KPECHMAN
TO: Rx #U01153469
08/06/14 1115 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/06/14 1101
by KPECHMAN Eff: 08/06/14 1101
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

FESO4TAB2 - FESOTERODINE FUMARATE 4 MG TABSR 24H

Dose 8 MG (2 TAB.SR.24HS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/06/14-2100 Stop Date 09/05/14 2059 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 18 Total Costs $0.00 Total Charges $248.85
Rx Number 01261520

Discontinued Comments DC'd by Discharge

History
08/06/14 1101 - POM COPY AND EDIT by KPECHMAN
FROM: Rx #01259682
Result of Sig/Schedule Edit
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: 08/06/14 - 0900
Last Administration: 08/06/14 - 0900
Old Sig/Sch: DAILY (SCH)
New Sig/Sch: NIGHTLY (SCH)
Old Order Stop: 08/06/14 - 1059
New Order Start: 08/06/14 - 2100
08/06/14 1115 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/06/14 1101
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: 08/06/14 - 0900
Last Administration: 08/06/14 - 0900
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/06/14 - 1059
New Order Start: 08/06/14 - 2100
08/06/14 1115 - VERIFIED by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 5
For: 08/06/14 - 2100
For: 08/07/14 - 2100
For: 08/08/14 - 2100
For: 08/09/14 - 2100
For: 08/10/14 - 2100
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/11/14 - 2100
For: 08/12/14 - 2100
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/13/14 - 2100
For: 08/14/14 - 2100
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 6 Doses Dispensed: 3
For: 08/15/14 - 2100
For: 08/16/14 - 2100
For: 08/17/14 - 2100
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 4 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

For: 08/18/14 - 2100

For: 08/19/14 - 2100
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 10 Doses Auto Credited: 5
For: 08/15/14 - 2100
For: 08/16/14 - 2100
For: 08/17/14 - 2100
For: 08/18/14 - 2100
For: 08/19/14 - 2100
DC COMMENTS:
DC'd by Discharge

GLCR3SU - GLYCERIN SUPP 1 EA SUPP

Dose 1 EA (1 SUPPOSITORY)
Dose Instructions Constipation
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01259668

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1313 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

HCLS50125 - HCTZ/LOSARTAN 12.5-50 MG TAB

Dose 1 EA (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/31/14-0900 Stop Date 08/06/14 1800 DC: 08/06/14-1122
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 11 Total Costs $0.00 Total Charges $38.71
Rx Number 01259669

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1313 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/14 - 0900
For: 08/01/14 - 0900
For: 08/02/14 - 0900
For: 08/03/14 - 0900
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/04/14 - 0900
For: 08/05/14 - 0900
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/06/14 - 0900
For: 08/07/14 - 0900
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/08/14 - 0900
For: 08/09/14 - 0900
For: 08/10/14 - 0900
08/06/14 1121 - EDIT by KPECHMAN
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
FROM:
START: 07/31/14-0900 STOP: 08/30/14 0859 SOFT STOP: 0
TO:
START: 07/31/14-0900 STOP: 08/06/14-1800 SOFT STOP:
08/06/14 1121 - POM COPY AND EDIT by KPECHMAN
TO: Rx #U01153490
08/06/14 1122 - DISCONTINUE by AMOLINARI Eff: 08/06/14 1122
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/06/14 1123 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/06/14 1121
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

HCLS50125 - HCTZ/LOSARTAN 12.5-50 MG TAB

Dose 1 EA (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY@06 (SCH)
Start Date 08/07/14-0600 Stop Date 09/06/14 0559 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 9 Total Costs $0.00 Total Charges $49.77
Rx Number 01261548

Discontinued Comments DC'd by Discharge

History
08/06/14 1121 - POM COPY AND EDIT by KPECHMAN
FROM: Rx #01259669
Result of Sig/Schedule Edit
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: 08/06/14 - 0900
Last Administration: 08/06/14 - 0843
Old Sig/Sch: DAILY (SCH)
New Sig/Sch: DAILY@06 (SCH)
Old Order Stop: 08/06/14 - 1800
New Order Start: 08/07/14 - 0600
08/06/14 1122 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/06/14 1121
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: 08/06/14 - 0900
Last Administration: 08/06/14 - 0843
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@06 (SCH)
Old Order Stop: 08/06/14 - 1800
New Order Start: 08/07/14 - 0600
08/06/14 1122 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/07/14 - 0600
For: 08/08/14 - 0600
For: 08/09/14 - 0600
For: 08/10/14 - 0600
For: 08/11/14 - 0600
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/12/14 - 0600
For: 08/13/14 - 0600
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/14 - 0600
For: 08/15/14 - 0600
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 08/16/14 - 0600
For: 08/17/14 - 0600
For: 08/18/14 - 0600
08/15/14 0810 - FILL by JORPHAL
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/19/14 - 0600
For: 08/20/14 - 0600
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/16/14 - 0600
For: 08/17/14 - 0600
For: 08/18/14 - 0600
For: 08/19/14 - 0600
For: 08/20/14 - 0600
DC COMMENTS:
DC'd by Discharge

LPRM2T - LOPERAMIDE HCL 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DIARRHEA - FOR DIARRHEA
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 11 Total Costs $0.00 Total Charges $0.35
Rx Number 01259660

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1311 - VERIFIED by MHAIMOWITZ
Items Dispensed: 11 Doses Dispensed: 11
For: 07/30/14 - 1245
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Dose Instructions Dyspepsia/Abdominal Discomfort
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01259674

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1314 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01259676

Discontinued Comments DC'd by Discharge

History
07/30/14 1244 - POM ORDER by KPECHMAN
07/30/14 1316 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/02/14-0945 Stop Date 09/01/14 0944 DC: 08/15/14-1107
Ordering Doctor COFFEY,ALEXANDRA MD
Total Dispensed 14 Total Costs $0.00 Total Charges $21.00
Rx Number 01260566

Discontinued Comments DC'd by Discharge

History
08/02/14 0934 - POM ORDER by ACOFFEY
08/02/14 0934 - NOW DOSE by ACOFFEY
Now Dose: 08/02/14 0945
08/02/14 0934 - KEEP NEXT DOSE by System
Keep Next Dose: 08/03/14 0900
08/02/14 1013 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by ACOFFEY Eff: 08/02/14 0934
Now Dose 08/02/14 - 0945
Keep Next Dose 08/03/14 - 0900
08/02/14 1013 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/02/14 - 0945
For: 08/03/14 - 0900
For: 08/04/14 - 0900
For: 08/05/14 - 0900
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/06/14 - 0900
For: 08/07/14 - 0900
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/08/14 - 0900
For: 08/09/14 - 0900
For: 08/10/14 - 0900
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/11/14 - 0900
For: 08/12/14 - 0900
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/13/14 - 0900
For: 08/14/14 - 0900
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/14 - 0900
For: 08/16/14 - 0900
For: 08/17/14 - 0900
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 2 Doses Dispensed: 2
For: 08/18/14 - 0900
For: 08/19/14 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107

Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/16/14 - 0900
For: 08/17/14 - 0900
For: 08/18/14 - 0900
For: 08/19/14 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

OXB5T - OXYBUTYNIN CHLORIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/30/14-1700 Stop Date 08/06/14 1119 DC: 08/06/14-1119
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 23 Total Costs $0.00 Total Charges $15.00
Rx Number 01259677

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1317 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 07/30/14 - 1700
For: 07/31/14 - 0900
For: 07/31/14 - 1700
For: 08/01/14 - 0900
For: 08/01/14 - 1700
For: 08/02/14 - 0900
For: 08/02/14 - 1700
For: 08/03/14 - 0900
For: 08/03/14 - 1700
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/04/14 - 0900
For: 08/04/14 - 1700
For: 08/05/14 - 0900
For: 08/05/14 - 1700
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/06/14 - 0900
For: 08/06/14 - 1700
For: 08/07/14 - 0900
For: 08/07/14 - 1700
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/08/14 - 0900
For: 08/08/14 - 1700
For: 08/09/14 - 0900
For: 08/09/14 - 1700
For: 08/10/14 - 0900
For: 08/10/14 - 1700
08/06/14 1121 - EDIT by KPECHMAN
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
FROM:
START: 07/30/14-1700 STOP: 08/29/14 1659 SOFT STOP: 0
TO:
START: 07/30/14-1700 STOP: 08/06/14-1119 SOFT STOP:
08/06/14 1121 - DISCONTINUE by KPECHMAN Eff: 08/06/14 1119
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

EDIT SOURCE: Written

08/06/14 1121 - POM COPY AND EDIT by KPECHMAN
TO: Rx #U01153491
08/06/14 1123 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/06/14 1121
by KPECHMAN Eff: 08/06/14 1121
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

OXB5T - OXYBUTYNIN CHLORIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@06,18 (SCH)
Start Date 08/06/14-1800 Stop Date 08/07/14 1038 DC: 08/07/14-1038
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 10 Total Costs $0.00 Total Charges $1.50
Rx Number 01261549

History
08/06/14 1121 - POM COPY AND EDIT by KPECHMAN
FROM: Rx #01259677
Result of Sig/Schedule Edit
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: 08/06/14 - 0900
Last Administration: 08/06/14 - 0900
Old Sig/Sch: 2 TIMES A DAY (SCH)
New Sig/Sch: DAILY@06,18 (SCH)
Old Order Stop: 08/06/14 - 1119
New Order Start: 08/06/14 - 1800
08/06/14 1123 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/06/14 1121
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: 08/06/14 - 0900
Last Administration: 08/06/14 - 0900
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: DAILY@06,18 (SCH)
Old Order Stop: 08/06/14 - 1119
New Order Start: 08/06/14 - 1800
08/06/14 1123 - VERIFIED by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 10
For: 08/06/14 - 1800
For: 08/07/14 - 0600
For: 08/07/14 - 1800
For: 08/08/14 - 0600
For: 08/08/14 - 1800
For: 08/09/14 - 0600
For: 08/09/14 - 1800
For: 08/10/14 - 0600
For: 08/10/14 - 1800
For: 08/11/14 - 0600
08/07/14 1040 - EDIT by KPECHMAN
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
FROM:
START: 08/06/14-1800 STOP: 09/05/14 1759 SOFT STOP: 0
TO:
START: 08/06/14-1800 STOP: 08/07/14-1038 SOFT STOP:
08/07/14 1040 - DISCONTINUE by KPECHMAN Eff: 08/07/14 1038
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/07/14 1040 - POM COPY AND EDIT by KPECHMAN
TO: Rx #U01153779
08/07/14 1042 - REVIEW PROVIDER ACTIVITY by GZEIARATI
by KPECHMAN Eff: 08/07/14 1040
by KPECHMAN Eff: 08/07/14 1040
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

OXB5T - OXYBUTYNIN CHLORIDE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY@21 (SCH)
Start Date 08/07/14-2100 Stop Date 09/06/14 2059 DC: 08/11/14-1155
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 8 Total Costs $0.00 Total Charges $6.00
Rx Number 01261840

History
08/07/14 1040 - POM COPY AND EDIT by KPECHMAN
FROM: Rx #01261549
Result of Sig/Schedule Edit
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: 08/07/14 - 0600
Last Administration: 08/07/14 - 0600
Old Sig/Sch: DAILY@06,18 (SCH)
New Sig/Sch: DAILY@21 (SCH)
Old Order Stop: 08/07/14 - 1038
New Order Start: 08/07/14 - 2100
08/07/14 1042 - REVIEW PROVIDER ACTIVITY by GZEIARATI
by KPECHMAN Eff: 08/07/14 1040
Ordering Doctor: PECHMAN,KAREN MD.
Last Scheduled Dose: 08/07/14 - 0600
Last Administration: 08/07/14 - 0600
Old Freq/Sch: DAILY@06,18 (SCH)
New Freq/Sch: DAILY@21 (SCH)
Old Order Stop: 08/07/14 - 1038
New Order Start: 08/07/14 - 2100
08/07/14 1042 - VERIFIED by GZEIARATI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/07/14 - 2100
For: 08/08/14 - 2100
For: 08/09/14 - 2100
For: 08/10/14 - 2100
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/11/14 - 2100
For: 08/12/14 - 2100
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/13/14 - 2100
For: 08/14/14 - 2100
08/11/14 1156 - DISCONTINUE by KPECHMAN Eff: 08/11/14 1155
Items Auto Credited: 8 Doses Auto Credited: 4
For: 08/11/14 - 2100
For: 08/12/14 - 2100
For: 08/13/14 - 2100
For: 08/14/14 - 2100
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
09/11/14 0035 - REVIEW PROVIDER ACTIVITY by SYSTEM
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

(Discontinue by KPECHMAN Eff: 08/11/14 1156) removed by File Maintenance.

OXYC10TA2 - OXYCODONE HCL 10 MG TABCR

Dose 10 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/30/14-2100 Stop Date 08/06/14 2059 DC: 08/05/14-1059
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.75
Rx Number 01259671

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1314 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/04/14 - 0900
For: 08/04/14 - 2100
For: 08/05/14 - 0900
For: 08/05/14 - 2100
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/06/14 - 0900
08/05/14 1102 - DISCONTINUE by KPECHMAN Eff: 08/05/14 1059
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/05/14 1110 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/05/14 1102
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 07/30/14-1245 Stop Date 08/06/14 1244 DC: 08/05/14-1059
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01259672

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1314 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/05/14 1102 - DISCONTINUE by KPECHMAN Eff: 08/05/14 1059
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/05/14 1102 - POM COPY AND EDIT by KPECHMAN
TO: Rx #U01153061
08/05/14 1110 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/05/14 1102
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 07/30/14-1245 Stop Date 08/06/14 1244 DC: 08/05/14-1059
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01259673

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1314 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/05/14 1102 - DISCONTINUE by KPECHMAN Eff: 08/05/14 1059
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/05/14 1102 - POM COPY AND EDIT by KPECHMAN
TO: Rx #U01153062
08/05/14 1110 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by KPECHMAN Eff: 08/05/14 1102
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/05/14-1100 Stop Date 08/12/14 1059 DC: 08/08/14-1053
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01261123

Alternating Links: Rx Num 01261124

History
08/05/14 1102 - POM COPY AND EDIT by KPECHMAN
FROM: Rx #01259672
08/05/14 1110 - VERIFIED by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/05/14 1112 - LINK by AMOLINARI
FROM:
TO: Alternating: 01261124
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 1054 - DISCONTINUE by KPECHMAN Eff: 08/08/14 1053
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/08/14 1058 - REVIEW PROVIDER ACTIVITY by GZEIARATI
by KPECHMAN Eff: 08/08/14 1054
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/05/14-1100 Stop Date 08/12/14 1059 DC: 08/08/14-1053
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01261124

Alternating Links: Rx Num 01261123

History
08/05/14 1102 - POM COPY AND EDIT by KPECHMAN
FROM: Rx #01259673
08/05/14 1110 - VERIFIED by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/05/14 1112 - LINK by AMOLINARI
FROM:
TO: Alternating: 01261123
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 1054 - DISCONTINUE by KPECHMAN Eff: 08/08/14 1053
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/08/14 1058 - REVIEW PROVIDER ACTIVITY by GZEIARATI
by KPECHMAN Eff: 08/08/14 1054
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

PREG25CA - PREGABALIN 25 MG (NON-FORM.) CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/30/14-1300 Stop Date 08/06/14 1259 DC: 08/01/14-1158
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $36.60
Rx Number 01259679

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1318 - VERIFIED by MHAIMOWITZ
Items Dispensed: 0 Doses Dispensed: 0
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/14 - 0900
For: 08/04/14 - 1300
For: 08/04/14 - 1700
For: 08/05/14 - 0900
For: 08/05/14 - 1300
For: 08/05/14 - 1700
08/01/14 1200 - DISCONTINUE by KPECHMAN Eff: 08/01/14 1158
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: Written
08/01/14 1205 - REVIEW PROVIDER ACTIVITY by GZEIARATI
by KPECHMAN Eff: 08/01/14 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Dose Instructions Moderate Constipation
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01259680

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1319 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 2
For: 07/30/14 - 1245
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions 374mg = 2 tablets, prn for severe constipation
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/30/14-1245 Stop Date 08/29/14 1244 DC: 08/15/14-1107
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01259681

Discontinued Comments DC'd by Discharge

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1319 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 07/30/14 - 1245
08/01/14 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/14 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/06/14 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/14 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1107 - DISCONTINUE by DISCHARGE Eff: 08/15/14 1107
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/08/14-1100 Stop Date 08/15/14 1059 DC: 08/15/14-1059
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01262050

Discontinued Comments Reached Stop Date

History
08/08/14 1054 - POM ORDER by KPECHMAN
08/08/14 1057 - VERIFIED by GZEIARATI
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1058 - DISCONTINUE by PHABKGJOB Eff: 08/15/14 1059
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/08/14-1100 Stop Date 08/15/14 1059 DC: 08/15/14-1059
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01262051

Discontinued Comments Reached Stop Date

History
08/08/14 1054 - POM ORDER by KPECHMAN
08/08/14 1057 - VERIFIED by GZEIARATI
Items Dispensed: 0 Doses Dispensed: 0
08/11/14 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/13/14 0837 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 0810 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
08/15/14 1058 - DISCONTINUE by PHABKGJOB Eff: 08/15/14 1059
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

ARONOFF,MILLICENT W00001220412 (Continued)

TROS60CA - TROSPIUM CHLORIDE 60 MG CPSR

Dose 60 MG (1 CAP SUSTAINED RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01428239

Activity Needing Review

RAD - Administration of Unverified Order by JDWARKA Eff: 09/03/17 0852

History
09/02/17 1313 - POM ORDER by HAZIZI
09/02/17 1659 - EDIT by MHAIMOWITZ
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
LABEL COMMENTS:
TO:
LABEL COMMENTS:
medication on order Tues. 9/5/17
MD aware

FESO8TAB2 - FESOTERODINE FUMARATE 8 MG TABSR 24H

Dose 8 MG (1 TAB SUSTAINED RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/31/14-0900 Stop Date 08/30/14 0859 CAN: 07/30/14-1321
Ordering Doctor PECHMAN,KAREN MD.
Total Dispensed Total Costs $ Total Charges $
Rx Number U01151635

History
07/30/14 1245 - POM ORDER by KPECHMAN
07/30/14 1321 - CANCEL by MHAIMOWITZ
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: PECHMAN,KAREN MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
CANCELLATION COMMENTS:
CHANGE TO TOVIAZ 4MG X2TABS
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient BAKER,QUINTON Responsible Doctor BRIONES,MARIA M.D.

Account Number W00001219538 Location B1EA Unit Number M000209330
Age/Sex 55/M Room 105 Registered Date 08/26/17
Status ADM IN Bed 02 Discharged Date

Height 6 ft 0.99 in 185.4 cm Body Surface Area 2.43 m2

Weight 266 lb 12.8 oz 121.018 kg
Hem-Onc No

Drug Allergies No Known Drug Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: Fever/mild pain
Start Date 08/26/17-1215 Stop Date 09/25/17 1214
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01540327

History
08/26/17 1208 - POM ORDER by HAZIZI
08/26/17 1222 - VERIFIED by AADEGBAMIG
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/26/17-1215 Stop Date 09/25/17 1214
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01540328

History
08/26/17 1208 - POM ORDER by HAZIZI
08/26/17 1222 - VERIFIED by AADEGBAMIG
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY OTHER DAY (SCH)
Start Date 08/28/17-0900 Stop Date 09/27/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $0.28
Rx Number 01540332

History
08/26/17 1208 - POM ORDER by HAZIZI
08/26/17 1222 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
08/29/17 1107 - HOLD by MBRIONES Eff: 08/29/17 1104
EDIT DOCTOR: BRIONES,MARIA M.D.
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/30/17 - 0900
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 1513 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by MBRIONES Eff: 08/29/17 1107
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 2.5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/27/17-0900 Stop Date 09/26/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.06
Rx Number 01540333

History
08/26/17 1208 - POM ORDER by HAZIZI
08/26/17 1222 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/29/17 1107 - HOLD by MBRIONES Eff: 08/29/17 1104
EDIT DOCTOR: BRIONES,MARIA M.D.
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 1513 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by MBRIONES Eff: 08/29/17 1107
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

MTP100TCR - METOPROLOL SUCCINATE XL 100 MG TABCR

Dose 200 MG (2 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/27/17-0900 Stop Date 09/26/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 20 Total Costs $0.00 Total Charges $33.90
Rx Number 01540345

History
08/26/17 1406 - ENTER by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/02/17-1700 Stop Date 09/09/17 1544
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01542232

History
09/02/17 1545 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01542228
Result of Frequency/Schedule Edit
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 3 HOURS (PRN)
New Freq/Sch: EVERY 4 HOURS (PRN)
Old Order Stop: 09/02/17 - 1545
New Order Start: 09/02/17 - 1700
New Order Stop: 09/09/17 - 1544
09/02/17 1546 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by HAZIZI Eff: 09/02/17 1545
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 3 HOURS (PRN)
New Freq/Sch: EVERY 4 HOURS (PRN)
Old Order Stop: 09/02/17 - 1545
New Order Start: 09/02/17 - 1700
New Order Stop: 09/09/17 - 1544
09/02/17 1546 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

RIVA10TA - RIVAROXABAN 10 MG TABLET

Dose 20 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 16 Total Costs $0.00 Total Charges $387.90
Rx Number 01540904

History
08/29/17 0819 - POM COPY AND EDIT by MBRIONES
FROM: Rx #01540335
08/29/17 0838 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/26/17-1215 Stop Date 09/25/17 1214
Ordering Doctor AZIZI,HANA MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.40
Rx Number 01540329

History
08/26/17 1208 - POM ORDER by HAZIZI
08/26/17 1222 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 1
For: 08/26/17 - 1215
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

DIAZ2TAB26 - DIAZEPAM 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/26/17-2200 Stop Date 08/26/17 2201 DC: 08/26/17-2201
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.08
Rx Number 01540430

Discontinued Comments Reached Stop Date

History
08/26/17 2159 - POM ORDER by HAZIZI
08/27/17 1005 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by SKEMAL Eff: 08/26/17 2207
08/27/17 1005 - VERIFIED by AADEGBAMIG
08/27/17 1006 - DISCONTINUE by PHABKGJOB Eff: 08/26/17 2201
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

MTP50TCR - METOPROLOL SUCCINATE XL 50 MG TABCR

Dose 50 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/27/17-0900 Stop Date 09/26/17 0859 DC: 08/27/17-0900
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540334

History
08/26/17 1209 - POM ORDER by HAZIZI
08/26/17 1222 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/26/17 1233 - DISCONTINUE by HAZIZI Eff: 08/27/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
EDIT DOCTOR: AZIZI,HANA MD
08/26/17 1233 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01426483
08/26/17 1238 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HAZIZI Eff: 08/26/17 1233
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

MTP50TCR - METOPROLOL SUCCINATE XL 50 MG TABCR

Dose 200 MG (4 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/27/17-0900 Stop Date 09/26/17 0859 DC: 08/27/17-0900
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540338

History
08/26/17 1233 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01540334
08/26/17 1238 - VERIFIED by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 3
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/26/17 1405 - DISCONTINUE by AADEGBAMIG Eff: 08/27/17 0900
Items Auto Credited: 12 Doses Auto Credited: 3
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/26/17-1215 Stop Date 09/02/17 1214 DC: 08/26/17-2158
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540330

History
08/26/17 1208 - POM ORDER by HAZIZI
08/26/17 1222 - VERIFIED by AADEGBAMIG
08/26/17 2159 - DISCONTINUE by HAZIZI Eff: 08/26/17 2158
EDIT DOCTOR: AZIZI,HANA MD
08/26/17 2159 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01426578
08/27/17 1518 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HAZIZI Eff: 08/26/17 2159
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/26/17-1215 Stop Date 09/02/17 1214 DC: 09/02/17-1214
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $8.25
Rx Number 01540331

Discontinued Comments Reached Stop Date

History
08/26/17 1208 - POM ORDER by HAZIZI
08/26/17 1222 - VERIFIED by AADEGBAMIG
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/02/17 1214 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 1214
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: FOR mild to MODERATE PAIN
Start Date 08/26/17-2200 Stop Date 09/02/17 2159 DC: 09/02/17-2159
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540431

Discontinued Comments Reached Stop Date

History
08/26/17 2159 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01540330
08/27/17 1005 - VERIFIED by AADEGBAMIG
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/02/17 2200 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 2159
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/02/17-1545 Stop Date 09/09/17 1544 DC: 09/02/17-1545
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542228

History
09/02/17 1541 - POM ORDER by HAZIZI
09/02/17 1544 - VERIFIED by MHAIMOWITZ
09/02/17 1545 - DISCONTINUE by HAZIZI Eff: 09/02/17 1545
EDIT DOCTOR: AZIZI,HANA MD
09/02/17 1545 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01428275
09/02/17 1546 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by HAZIZI Eff: 09/02/17 1545
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

BAKER,QUINTON W00001219538 (Continued)

RIVA10TA - RIVAROXABAN 10 MG TABLET

Dose 20 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/27/17-0900 Stop Date 09/26/17 0859 DC: 08/29/17-0817
Ordering Doctor AZIZI,HANA MD
Total Dispensed 4 Total Costs $0.00 Total Charges $129.30
Rx Number 01540335

History
08/26/17 1209 - POM ORDER by HAZIZI
08/26/17 1222 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/29/17 0819 - DISCONTINUE by MBRIONES Eff: 08/29/17 0817
Items Auto Credited: 6 Doses Auto Credited: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: BRIONES,MARIA M.D.
08/29/17 0819 - POM COPY AND EDIT by MBRIONES
TO: Rx #U01427004
08/29/17 0838 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MBRIONES Eff: 08/29/17 0819
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient BANIK,SUNIL Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219364 Location B2WEII Unit Number M000209250
Age/Sex 48/M Room 252 Registered Date 08/25/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 4.02 in 162.6 cm Body Surface Area 1.71 m2

Weight 145 lb 8 oz 65.998 kg
Hem-Onc No

Drug Allergies No Known Drug Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/25/17-1800 Stop Date 09/24/17 1759
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540225

History
08/25/17 1800 - POM ORDER by SDAS
08/25/17 1817 - VERIFIED by AADEGBAMIG
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

AMIT25TA2 - AMITRIPTYLINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/30/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $2.19
Rx Number 01541564

History
08/31/17 1148 - POM ORDER by JRUSSO
08/31/17 1157 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 23 Total Costs $0.00 Total Charges $291.24
Rx Number 01540229

History
08/25/17 1810 - POM ORDER by HMOHAMED
08/25/17 1817 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 24 Total Costs $0.00 Total Charges $614.70
Rx Number 01540232

History
08/25/17 1810 - POM ORDER by HMOHAMED
08/25/17 1817 - VERIFIED by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1800 Stop Date 09/24/17 1759
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540228

History
08/25/17 1800 - POM ORDER by SDAS
08/25/17 1817 - VERIFIED by AADEGBAMIG
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $6.00
Rx Number 01540224

History
08/25/17 1800 - POM ORDER by SDAS
08/25/17 1816 - VERIFIED by AADEGBAMIG
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 900 MG (3 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 36 Total Costs $0.00 Total Charges $5.40
Rx Number 01540230

History
08/25/17 1810 - POM ORDER by HMOHAMED
08/25/17 1817 - VERIFIED by AADEGBAMIG
Items Dispensed: 15 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 22 Total Costs $0.00 Total Charges $3.60
Rx Number 01540296

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
08/25/17 2308 - POM ORDER by SDAS
08/25/17 2336 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@1500 (SCH)
Start Date 08/30/17-1500 Stop Date 09/29/17 1459
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $0.80
Rx Number 01541159

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/29/17 1717 - POM ORDER by JRUSSO
08/29/17 1718 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1500
For: 08/31/17 - 1500
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1500
For: 09/02/17 - 1500
For: 09/03/17 - 1500
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1500
For: 09/05/17 - 1500
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 15 MG (3 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 15 Total Costs $0.00 Total Charges $0.16
Rx Number 01541563

History
08/31/17 1154 - ENTER by AMACCA
Items Dispensed: 9 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/25/17-1800 Stop Date 09/24/17 1759
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540227

History
08/25/17 1800 - POM ORDER by SDAS
08/25/17 1817 - VERIFIED by AADEGBAMIG
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1800 Stop Date 09/24/17 1759
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540226

History
08/25/17 1800 - POM ORDER by SDAS
08/25/17 1817 - VERIFIED by AADEGBAMIG
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MTF500TCR - METFORMIN HCL XR 500 MG TABCR

Dose 500 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY @ BREAKFAST (SCH)
Start Date 08/26/17-0800 Stop Date 09/25/17 0759
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $2.97
Rx Number 01540235

History
08/25/17 1821 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0800
For: 08/27/17 - 0800
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $13.16
Rx Number 01540233

History
08/25/17 1810 - POM ORDER by HMOHAMED
08/25/17 1817 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/26/17-0900 Stop Date 08/26/17 0900 DC: 08/26/17-0900
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 16 Total Costs $ Total Charges $
Rx Number 01540231

History
08/25/17 1810 - POM ORDER by HMOHAMED
08/25/17 1817 - VERIFIED by AADEGBAMIG
Items Dispensed: 16 Doses Dispensed: 8
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/25/17 2308 - DISCONTINUE by SDAS Eff: 08/26/17 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/25/17 2308 - EDIT by SDAS
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
START: 08/26/17-0900 STOP: 09/25/17 0859 SOFT STOP: 0
DISPENSE: 16
TO:
START: 08/26/17-0900 STOP: 08/26/17-0900 SOFT STOP:
DISPENSE: 0
08/27/17 1520 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SDAS Eff: 08/25/17 2308
Discontinue by SDAS Eff: 08/25/17 2308
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859 DC: 08/31/17-1145
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $1.50
Rx Number 01540234

History
08/25/17 1810 - POM ORDER by HMOHAMED
08/25/17 1817 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1148 - DISCONTINUE by JRUSSO Eff: 08/31/17 1145
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/31/17 1148 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01427633
08/31/17 1151 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 08/31/17 1148
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

BANIK,SUNIL W00001219364 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 15 MG (0.75 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859 DC: 09/01/17-0900
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541562

History
08/31/17 1148 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540234
08/31/17 1153 - DISCONTINUE by AMACCA Eff: 09/01/17 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/31/17 1153 - VERIFIED by SYSTEM
Verified in order to DC

MTF500T - METFORMIN HCL 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY @ BREAKFAST (SCH)
Start Date 08/26/17-0800 Stop Date 09/25/17 0759 DC: 08/26/17-0800
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540236

History
08/25/17 1810 - POM ORDER by HMOHAMED
08/25/17 1822 - DISCONTINUE by AADEGBAMIG Eff: 08/26/17 0800
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/25/17 1822 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient BARRETO,MARIA Responsible Doctor ELASHVILI, MERY

Account Number W00001219298 Location B2EA Unit Number M000208943
Age/Sex 79/F Room 219 Registered Date 08/21/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 2.01 in 157.5 cm Body Surface Area 1.66 m2

Weight 144 lb 3.2 oz 65.408 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/21/17-1330 Stop Date 09/20/17 1329
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01538600

History
08/21/17 1318 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 140
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 7 Total Costs $0.00 Total Charges $2.15
Rx Number 01541007

History
08/29/17 1446 - POM ORDER by MELASHVI
08/29/17 1448 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 15 Total Costs $0.00 Total Charges $0.39
Rx Number 01538605

History
08/21/17 1323 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-1330 Stop Date 09/20/17 1329
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538601

History
08/21/17 1318 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

DABI75CA4 - DABIGATRAN ETEXILATE MESYLATE 75 MG CAPSULE

Dose 75 MG (1 CAPSULE)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/21/17-1700 Stop Date 09/20/17 1659
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 31 Total Costs $0.00 Total Charges $237.38
Rx Number 01538610

History
08/21/17 1323 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

For: 09/05/17 - 0900

For: 09/05/17 - 1700

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/22/17-1700 Stop Date 09/21/17 1659
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $6.00
Rx Number 01538950

History
08/22/17 1137 - POM ORDER by YCHO
08/22/17 1145 - VERIFIED by EBALILO
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/21/17-1700 Stop Date 09/20/17 1659
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 31 Total Costs $0.00 Total Charges $3.90
Rx Number 01538608

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 200 MG/DAY
is below the Low Daily Dose.

History
08/21/17 1323 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

For: 09/02/17 - 0900

For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/21/17-1330 Stop Date 09/20/17 1329
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538603

History
08/21/17 1318 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-1330 Stop Date 09/20/17 1329
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538602

History
08/21/17 1318 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

MTF500TCR - METFORMIN HCL XR 500 MG TABCR

Dose 500 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 15 Total Costs $0.00 Total Charges $4.29
Rx Number 01538629

History
08/21/17 1434 - POM ORDER by MELASHVI
08/21/17 1501 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

MTP50TCR - METOPROLOL SUCCINATE XL 50 MG TABCR

Dose 50 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 50
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/28/17-1800 Stop Date 09/27/17 1759
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 9 Total Costs $0.00 Total Charges $11.28
Rx Number 01540658

History
08/28/17 1229 - POM ORDER by YCHO
08/28/17 1304 - VERIFIED by YLEE
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 1800
For: 08/29/17 - 1800
For: 08/30/17 - 1800
For: 08/31/17 - 1800
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1800
For: 09/02/17 - 1800
For: 09/03/17 - 1800
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1800
For: 09/05/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Dose Instructions gi ppx
Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/25/17-0800 Stop Date 09/24/17 0759
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 12 Total Costs $0.00 Total Charges $8.80
Rx Number 01539608

History
08/24/17 1343 - POM ORDER by YCHO
08/24/17 1348 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

ROSU10TA - ROSUVASTATIN CALCIUM 10 MG TAB

Dose 20 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 30 Total Costs $0.00 Total Charges $565.50
Rx Number 01538607

History
08/21/17 1323 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-1330 Stop Date 09/20/17 1329
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01538604

History
08/21/17 1318 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 1330
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

ABCT - ACETAMIN/BUTALBITAL/CAFFEINE 1 EA TAB

Dose 1 TAB (1 TABLET)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/23/17-1000 Stop Date 08/23/17 1001 DC: 08/23/17-1001
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $1.68
Rx Number 01539196

Discontinued Comments Reached Stop Date

History
08/23/17 1000 - POM ORDER by CDOHLE
08/23/17 1027 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 1000
08/23/17 1027 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 1001
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/22/17 0900 DC: 08/22/17-0900
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01538609

History
08/21/17 1323 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/21/17 1434 - DISCONTINUE by MELASHVI Eff: 08/22/17 0900
EDIT DOCTOR: ELASHVILI, MERY
08/21/17 1434 - EDIT by MELASHVI
EDIT DOCTOR: ELASHVILI, MERY
FROM:
START: 08/22/17-0900 STOP: 09/21/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/22/17-0900 STOP: 08/22/17-0900 SOFT STOP:
DISPENSE: 0
08/21/17 1501 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by MELASHVI Eff: 08/21/17 1434
Discontinue by MELASHVI Eff: 08/21/17 1434
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/21/17-1700 Stop Date 08/24/17 1106 DC: 08/24/17-1106
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 13 Total Costs $0.00 Total Charges $9.40
Rx Number 01538611

History
08/21/17 1323 - POM ORDER by YCHO
08/21/17 1421 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/24/17 1108 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/21/17-1700 STOP: 09/20/17 1659 SOFT STOP: 0
TO:
START: 08/21/17-1700 STOP: 08/24/17-1106 SOFT STOP:
08/24/17 1108 - DISCONTINUE by YCHO Eff: 08/24/17 1106
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/24/17 1108 - POM COPY AND EDIT by YCHO
TO: Rx #U01425707
08/24/17 1110 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by YCHO Eff: 08/24/17 1108
Discontinue by YCHO Eff: 08/24/17 1108
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 09/20/17 1659 DC: 08/28/17-1227
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $15.04
Rx Number 01539537

History
08/24/17 1108 - POM COPY AND EDIT by YCHO
FROM: Rx #01538611
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/24/17 - 0900
Last Actual Administration Time: 08/24/17 - 1026
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/24/17 - 1106
New Order Start: 08/24/17 - 2100
New Order Stop: 09/20/17 - 1659
08/24/17 1110 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by YCHO Eff: 08/24/17 1108
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/24/17 - 0900
Last Actual Administration Time: 08/24/17 - 1026
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/24/17 - 1106
New Order Start: 08/24/17 - 2100
New Order Stop: 09/20/17 - 1659
08/24/17 1110 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

BARRETO,MARIA W00001219298 (Continued)

For: 08/31/17 - 2100

08/28/17 1229 - DISCONTINUE by YCHO Eff: 08/28/17 1227
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 1303 - REVIEW PROVIDER ACTIVITY by YLEE
Discontinue by YCHO Eff: 08/28/17 1229

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/24/17-1345 Stop Date 08/24/17 1346 DC: 08/24/17-1346
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.88
Rx Number 01539607

Discontinued Comments Reached Stop Date

History
08/24/17 1343 - POM ORDER by YCHO
08/24/17 1348 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 1345
08/24/17 1348 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient BARRON,CHRISTINE Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219507 Location B2WEII Unit Number M000209319
Age/Sex 61/F Room 244 Registered Date 08/25/17
Status ADM IN Bed 02 Discharged Date

Height 6 ft 0.01 in 182.9 cm Body Surface Area 2.45 m2

Weight 278 lb 9.6 oz 126.371 kg
Hem-Onc No

Drug Allergies [ACE INHIBITOR], ACE Inhibitors

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/28/17-1235 ALLERGY VERIFICATION CALL COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/25/17-1315 Stop Date 09/24/17 1314
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01540056

History
08/25/17 1316 - POM ORDER by SDAS
08/25/17 1348 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

BARRON,CHRISTINE W00001219507 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $0.27
Rx Number 01540060

History
08/25/17 1318 - POM ORDER by SDAS
08/25/17 1349 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

BARRON,CHRISTINE W00001219507 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $307.35
Rx Number 01540061

History
08/25/17 1318 - POM ORDER by SDAS
08/25/17 1349 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

BARRON,CHRISTINE W00001219507 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1315 Stop Date 09/24/17 1314
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540059

History
08/25/17 1316 - POM ORDER by SDAS
08/25/17 1349 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

BARRON,CHRISTINE W00001219507 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 1,000 UNIT (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $1.17
Rx Number 01540062

History
08/25/17 1318 - POM ORDER by SDAS
08/25/17 1349 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

BARRON,CHRISTINE W00001219507 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $5.25
Rx Number 01540055

History
08/25/17 1316 - POM ORDER by SDAS
08/25/17 1348 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

BARRON,CHRISTINE W00001219507 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/28/17-1400 Stop Date 09/27/17 1359
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 27 Total Costs $0.00 Total Charges $176.32
Rx Number 01540664

History
08/28/17 1236 - POM ORDER by YOLEE
08/28/17 1307 - VERIFIED by YLEE
Items Dispensed: 12 Doses Dispensed: 12
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

BARRON,CHRISTINE W00001219507 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/25/17-1315 Stop Date 09/24/17 1314
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540058

History
08/25/17 1316 - POM ORDER by SDAS
08/25/17 1349 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1315 Stop Date 09/24/17 1314
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540057

History
08/25/17 1316 - POM ORDER by SDAS
08/25/17 1348 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient BENTLEY,JANICE Responsible Doctor ELASHVILI, MERY

Account Number W00001219446 Location B2EA Unit Number M000209314
Age/Sex 73/F Room 204 Registered Date 08/25/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 5.98 in 167.6 cm Body Surface Area 1.81 m2

Weight 158 lb oz 71.668 kg
Hem-Onc No

Drug Allergies Penicillins, wool

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/25/17-1245 Stop Date 09/24/17 1244
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540033

History
08/25/17 1258 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 23 Total Costs $0.00 Total Charges $291.24
Rx Number 01540038

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

C500T - ASCORBIC ACID 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01540039

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 11 Total Costs $0.00 Total Charges $0.27
Rx Number 01540040

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 24 Total Costs $0.00 Total Charges $614.70
Rx Number 01540041

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1245 Stop Date 09/24/17 1244
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540034

History
08/25/17 1258 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01540032

History
08/25/17 1258 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 11 Total Costs $0.00 Total Charges $2.40
Rx Number 01540042

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/25/17-1245 Stop Date 09/24/17 1244
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540036

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1245 Stop Date 09/24/17 1244
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540035

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

MTF500TCR - METFORMIN HCL XR 500 MG TABCR

Dose 2,000 MG (4 TABLET, CONTROLLED-RELEASES)

Admin Route ORAL
Frequency DAILY @ DINNER (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 48 Total Costs $0.00 Total Charges $11.70
Rx Number 01540112

History
08/25/17 1447 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540082
08/25/17 1503 - VERIFIED by AADEGBAMIG
Items Dispensed: 20 Doses Dispensed: 5
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 12.5 MG (0.5 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 11 Total Costs $0.00 Total Charges $15.04
Rx Number 01540044

Warnings
Type: BURKE
Range: METOPROLOL SUCCINATE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 25 MG/DAY - 400 MG/DAY. Ordered dose of 12.5 MG/DAY is
below the Low Daily Dose.

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

OMEG1CAP31 - OMEGA-3 FATTY ACIDS 1000 MG 1 EA CAP

Dose 1 EA (1 CAPSULE)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 23 Total Costs $0.00 Total Charges $2.34
Rx Number 01540089

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1439 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

PANT20TA - PANTOPRAZOLE SOD 20 MG TABEC

Dose 20 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 11 Total Costs $0.00 Total Charges $295.02
Rx Number 01540083

History
08/25/17 1358 - POM ORDER by TKOUTZEVA
08/25/17 1405 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/26/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540037

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

VITE400C - VITAMIN E 400 IUNITS CAP

Dose 400 IUNITS (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 11 Total Costs $0.00 Total Charges $1.35
Rx Number 01540045

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

MTF500TCR - METFORMIN HCL XR 500 MG TABCR

Dose 500 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859 DC: 08/26/17-0900
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540043

History
08/25/17 1259 - POM ORDER by MELASHVI
08/25/17 1329 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/25/17 1357 - DISCONTINUE by TKOUTZEVA Eff: 08/26/17 0900
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/25/17 1357 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426246
08/25/17 1405 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 08/25/17 1357
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

BENTLEY,JANICE W00001219446 (Continued)

MTF500TCR - METFORMIN HCL XR 500 MG TABCR

Dose 500 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY @ DINNER (SCH)
Start Date 08/25/17-1700 Stop Date 09/25/17 0859 DC: 08/25/17-1700
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540082

History
08/25/17 1357 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540043
Result of Frequency/Schedule Edit
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: 08/26/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY @ DINNER (SCH)
Old Order Stop: 08/26/17 - 0900
New Order Start: 08/25/17 - 1700
New Order Stop: 09/25/17 - 0859
08/25/17 1405 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by TKOUTZEVA Eff: 08/25/17 1357
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: 08/26/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY @ DINNER (SCH)
Old Order Stop: 08/26/17 - 0900
New Order Start: 08/25/17 - 1700
New Order Stop: 09/25/17 - 0859
08/25/17 1405 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/25/17 1447 - DISCONTINUE by TKOUTZEVA Eff: 08/25/17 1700
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
For: 08/28/17 - 1700
For: 08/29/17 - 1700
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/25/17 1447 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426254
08/25/17 1503 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 08/25/17 1447
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient BRECHT,GEORGE J Responsible Doctor GITLER, ELLEN M.D.

Account Number W00001219739 Location B1EA Unit Number M000209464
Age/Sex 88/M Room 107 Registered Date 09/02/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 10 in 177.8 cm Body Surface Area 2.03 m2

Weight 187 lb 11.2 oz 85.139 kg
Hem-Onc No

Drug Allergies No Known Allergies (NKA)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: L THR
Secondary Diagnosis:

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1445 Stop Date 10/02/17 1444
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542221

History
09/02/17 1437 - POM ORDER by HAZIZI
09/02/17 1516 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

BRECHT,GEORGE J W00001219739 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/02/17-1545 Stop Date 10/02/17 1544
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542236

History
09/02/17 1541 - POM ORDER by HAZIZI
09/02/17 1548 - EDIT by MHAIMOWITZ
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
PRN REASON: moderate pain
TO:
PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
09/02/17 1548 - VERIFIED by MHAIMOWITZ

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.03
Rx Number 01542234

History
09/02/17 1541 - POM ORDER by HAZIZI
09/02/17 1547 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

BRECHT,GEORGE J W00001219739 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions Constipation
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1445 Stop Date 10/02/17 1444
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542223

History
09/02/17 1437 - POM ORDER by HAZIZI
09/02/17 1516 - VERIFIED by MHAIMOWITZ

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1445 Stop Date 10/02/17 1444
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542220

History
09/02/17 1437 - POM ORDER by HAZIZI
09/02/17 1516 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

BRECHT,GEORGE J W00001219739 (Continued)

ENXP30I.3 - ENOXAPARIN 30 MG/0.3 ML SYR

Dose 30 MG (0.3 ML)

Dose Instructions until INR is 2 or higher
Admin Route SUBCUTAN.
Frequency DAILY@1800 (SCH)
Start Date 09/02/17-1800 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 4 Total Costs $0.00 Total Charges $63.93
Rx Number 01542244

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.35
MG/KG/DAY is below the Low Daily Dose.

History
09/02/17 1622 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01542235
Result of Frequency/Schedule Edit
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/03/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@1800 (SCH)
Old Order Stop: 09/03/17 - 0900
New Order Start: 09/02/17 - 1800
New Order Stop: 10/03/17 - 0859
09/02/17 1634 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by HAZIZI Eff: 09/02/17 1622
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/03/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@1800 (SCH)
Old Order Stop: 09/03/17 - 0900
New Order Start: 09/02/17 - 1800
New Order Stop: 10/03/17 - 0859
09/02/17 1634 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 1800
For: 09/03/17 - 1800
For: 09/04/17 - 1800
For: 09/05/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

BRECHT,GEORGE J W00001219739 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.28
Rx Number 01542237

History
09/02/17 1541 - POM ORDER by HAZIZI
09/02/17 1548 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

IRON45TA - IRON,CARBONYL (FERRO SEQUELS) TAB

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.50
Rx Number 01542226

History
09/02/17 1437 - POM ORDER by HAZIZI
09/02/17 1516 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

BRECHT,GEORGE J W00001219739 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Dose Instructions Dyspepsia/Abdominal Discomfort
Admin Route ORAL
Frequency AFTER MEALS & BEDTIM (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 09/02/17-1445 Stop Date 10/02/17 1444
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542224

History
09/02/17 1437 - POM ORDER by HAZIZI
09/02/17 1516 - VERIFIED by MHAIMOWITZ

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1445 Stop Date 10/02/17 1444
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542222

History
09/02/17 1437 - POM ORDER by HAZIZI
09/02/17 1516 - VERIFIED by MHAIMOWITZ

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 09/03/17-0800 Stop Date 10/03/17 0759
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $20.88
Rx Number 01542238

History
09/02/17 1541 - POM ORDER by HAZIZI
09/02/17 1548 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0800
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

BRECHT,GEORGE J W00001219739 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions 374 MG = 2 tablets
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1445 Stop Date 10/02/17 1444
Ordering Doctor AZIZI,HANA MD
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01542227

History
09/02/17 1437 - POM ORDER by HAZIZI
09/02/17 1517 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 1
For: 09/02/17 - 1445

SPIR25TA12 - SPIRONOLACTONE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.68
Rx Number 01542233

History
09/02/17 1541 - POM ORDER by HAZIZI
09/02/17 1547 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

BRECHT,GEORGE J W00001219739 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 09/02/17-1445 Stop Date 09/09/17 1444
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542225

History
09/02/17 1437 - POM ORDER by HAZIZI
09/02/17 1516 - VERIFIED by MHAIMOWITZ

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions Mild pain/Fever
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/02/17-1445 Stop Date 10/02/17 1444 DC: 09/02/17-1536
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542219

History
09/02/17 1437 - POM ORDER by HAZIZI
09/02/17 1458 - VERIFIED by MHAIMOWITZ
09/02/17 1541 - DISCONTINUE by HAZIZI Eff: 09/02/17 1536
EDIT DOCTOR: AZIZI,HANA MD
09/02/17 1548 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by HAZIZI Eff: 09/02/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

BRECHT,GEORGE J W00001219739 (Continued)

ENXP30I.3 - ENOXAPARIN 30 MG/0.3 ML SYR

Dose 30 MG (0.3 ML)

Dose Instructions until INR is 2 or higher
Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859 DC: 09/03/17-0900
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542235

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.35
MG/KG/DAY is below the Low Daily Dose.

History
09/02/17 1541 - POM ORDER by HAZIZI
09/02/17 1547 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
09/02/17 1622 - DISCONTINUE by HAZIZI Eff: 09/03/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
EDIT DOCTOR: AZIZI,HANA MD
09/02/17 1622 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01428287
09/02/17 1634 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by HAZIZI Eff: 09/02/17 1622
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

BRECHT,GEORGE J W00001219739 (Continued)

WRF1T - WARFARIN SOD 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/02/17-2100 Stop Date 09/02/17 2101 DC: 09/02/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542239

Discontinued Comments Reached Stop Date

History
09/02/17 1541 - POM ORDER by HAZIZI
09/02/17 1548 - VERIFIED by MHAIMOWITZ
09/02/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient BROUTMAN,SHELDON Responsible Doctor VALLES,JENNIE MD

Account Number W00001219645 Location B1NN Unit Number M000206827
Age/Sex 77/M Room 125 Registered Date 09/01/17
Status ADM IN Bed 02 Discharged Date

Height ft 5.98 in 15.2 cm Body Surface Area 0.28 m2

Weight 117 lb 9.6 oz 53.342 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CERVICAL MYELOPATHY, LUMBAR LAMI
Secondary Diagnosis:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Dose 2 UNIT (0.02 ML)

Admin Route SUBCUTAN.
Frequency AFTER MEALS (SCH)
Start Date 09/03/17-1300 Stop Date 10/01/17 1659
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01542299

History
09/03/17 1124 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01542002
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 09/03/17 - 0800
Last Actual Administration Time: 09/03/17 - 0857
Old Freq/Sch: WITH MEALS (SCH)
New Freq/Sch: AFTER MEALS (SCH)
Old Order Stop: 09/03/17 - 1122
New Order Start: 09/03/17 - 1300
New Order Stop: 10/01/17 - 1659
09/03/17 1244 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by JRUSSO Eff: 09/03/17 1124
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 09/03/17 - 0800
Last Actual Administration Time: 09/03/17 - 0857
Old Freq/Sch: WITH MEALS (SCH)
New Freq/Sch: AFTER MEALS (SCH)
Old Order Stop: 09/03/17 - 1122
New Order Start: 09/03/17 - 1300
New Order Stop: 10/01/17 - 1659
09/03/17 1244 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/03/17 - 1300
09/03/17 1301 - CREDIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 3 UNIT (0.03 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01542029

History
09/01/17 1646 - POM ORDER by TKOUTZEVA
09/01/17 1649 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency AFTER MEALS & BEDTIM (SCH)
Start Date 09/03/17-1300 Stop Date 10/01/17 1659
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01542300

History
09/03/17 1124 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01542030
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 09/03/17 - 0800
Last Actual Administration Time: 09/03/17 - 0800 (Not Given)
Old Freq/Sch: BEFORE MEALS & BED (SCH)
New Freq/Sch: AFTER MEALS & BEDTIM (SCH)
Old Order Stop: 09/03/17 - 1122
New Order Start: 09/03/17 - 1300
New Order Stop: 10/01/17 - 1659
09/03/17 1244 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by JRUSSO Eff: 09/03/17 1124
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 09/03/17 - 0800
Last Actual Administration Time: 09/03/17 - 0800 (Not Given)
Old Freq/Sch: BEFORE MEALS & BED (SCH)
New Freq/Sch: AFTER MEALS & BEDTIM (SCH)
Old Order Stop: 09/03/17 - 1122
New Order Start: 09/03/17 - 1300
New Order Stop: 10/01/17 - 1659
Administration of Unverified Order by LOBRIEN Eff: 09/03/17 1238
09/03/17 1244 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/03/17 - 1300
09/03/17 1301 - CREDIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: FEVER - Fever
Start Date 09/01/17-1530 Stop Date 10/01/17 1529
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541998

History
09/01/17 1530 - POM ORDER by TKOUTZEVA
09/01/17 1532 - VERIFIED by AADEGBAMIG

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $0.63
Rx Number 01541999

History
09/01/17 1530 - POM ORDER by TKOUTZEVA
09/01/17 1532 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 09/01/17-1700 Stop Date 10/01/17 1659
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 9 Total Costs $0.00 Total Charges $3.00
Rx Number 01542000

History
09/01/17 1530 - POM ORDER by TKOUTZEVA
09/01/17 1532 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1530 Stop Date 10/01/17 1529
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542010

History
09/01/17 1533 - POM ORDER by TKOUTZEVA
09/01/17 1543 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 09/01/17-1700 Stop Date 10/01/17 1659
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01542001

History
09/01/17 1530 - POM ORDER by TKOUTZEVA
09/01/17 1532 - VERIFIED by AADEGBAMIG

LSNP5T - LISINOPRIL 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $0.03
Rx Number 01542004

History
09/01/17 1530 - POM ORDER by TKOUTZEVA
09/01/17 1532 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 09/03/17-1300 Stop Date 10/03/17 1259
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542314

History
09/03/17 1249 - POM ORDER by SDAS
09/03/17 1300 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/01/17-1530 Stop Date 09/08/17 1529
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01542006

History
09/01/17 1533 - POM ORDER by TKOUTZEVA
09/01/17 1542 - VERIFIED by AADEGBAMIG

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $41.76
Rx Number 01542007

History
09/01/17 1533 - POM ORDER by TKOUTZEVA
09/01/17 1542 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

ROSU10TA - ROSUVASTATIN CALCIUM 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 5 Total Costs $0.00 Total Charges $43.50
Rx Number 01542008

History
09/01/17 1533 - POM ORDER by TKOUTZEVA
09/01/17 1543 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 10 Total Costs $0.00 Total Charges $0.40
Rx Number 01542009

History
09/01/17 1533 - POM ORDER by TKOUTZEVA
09/01/17 1543 - VERIFIED by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

HCA25SU - HYDROCORTISONE ACETATE 25 MG BOX

Dose 25 MG (1 BOX)
Admin Route RECTALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 05/04/17-1700 Stop Date 05/11/17 1659 DC: 05/08/17-0921
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 1 Total Costs $0.00 Total Charges $14.55
Rx Number 01509346

History
05/04/17 0929 - POM ORDER by VHUANG
05/04/17 1007 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 05/04/17 - 1700
05/08/17 0921 - DISCONTINUE by HMOHAMED Eff: 05/08/17 0921
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/08/17 1059 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by HMOHAMED Eff: 05/08/17 0921

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Dose 2 UNIT (0.02 ML)

Admin Route SUBCUTAN.
Frequency WITH MEALS (SCH)
Start Date 09/01/17-1700 Stop Date 09/03/17 1122 DC: 09/03/17-1122
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $134.43
Rx Number 01542002

History
09/01/17 1530 - POM ORDER by TKOUTZEVA
09/01/17 1532 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1700
09/03/17 1124 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 09/01/17-1700 STOP: 10/01/17 1659 SOFT STOP: 0
TO:
START: 09/01/17-1700 STOP: 09/03/17-1122 SOFT STOP:
09/03/17 1124 - DISCONTINUE by JRUSSO Eff: 09/03/17 1122
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/03/17 1124 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01428334
09/03/17 1245 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by JRUSSO Eff: 09/03/17 1124
Discontinue by JRUSSO Eff: 09/03/17 1124
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 3 UNIT (0.03 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 09/01/17 2100 DC: 09/01/17-2100
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01542003

History
09/01/17 1530 - POM ORDER by TKOUTZEVA
09/01/17 1532 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
09/01/17 1646 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1646 - EDIT by TKOUTZEVA
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
START: 09/01/17-2100 STOP: 10/01/17 2059 SOFT STOP: 0
TO:
START: 09/01/17-2100 STOP: 09/01/17-2100 SOFT STOP:
09/01/17 1650 - CREDIT by MHAIMOWITZ
ITEMS: 1
09/01/17 1650 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by TKOUTZEVA Eff: 09/01/17 1646
Discontinue by TKOUTZEVA Eff: 09/01/17 1646

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 10 UNIT (0.1 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 04/26/17-2100 Stop Date 05/26/17 2059 DC: 04/28/17-2203
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01507073

History
04/26/17 1217 - POM ORDER by ACORDOVA
04/26/17 1223 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 04/26/17 - 2100
04/28/17 2204 - DISCONTINUE by GSYRKIN Eff: 04/28/17 2203
EDIT DOCTOR: SYRKIN,GRIGORY MD
04/28/17 2204 - POM COPY AND EDIT by GSYRKIN
TO: Rx #U01395325
04/29/17 0950 - REVIEW PROVIDER ACTIVITY by AMACCA
by GSYRKIN Eff: 04/28/17 2204
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 6 UNIT (0.06 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 04/29/17-2100 Stop Date 05/29/17 2059 DC: 04/29/17-2100
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01508100

History
04/28/17 2204 - POM COPY AND EDIT by GSYRKIN
FROM: Rx #01507073
04/28/17 2212 - VERIFIED by SYSTEM
Verified in order to DC
04/28/17 2212 - DISCONTINUE by GSYRKIN Eff: 04/29/17 2100
EDIT DOCTOR: SYRKIN,GRIGORY MD
04/28/17 2212 - POM COPY AND EDIT by GSYRKIN
TO: Rx #U01395326
04/29/17 0950 - REVIEW PROVIDER ACTIVITY by AMACCA
by SYSTEM Eff: 04/28/17 2212
by GSYRKIN Eff: 04/28/17 2212
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 10 UNIT (0.1 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 04/29/17-2100 Stop Date 05/29/17 2059 DC: 05/29/17-2059
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01508112

Discontinued Comments Reached Stop Date

History
04/28/17 2212 - POM COPY AND EDIT by GSYRKIN
FROM: Rx #01508100
04/29/17 0951 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 04/29/17 - 2100
04/29/17 0952 - CREDIT by AMACCA
ITEMS: 1
05/02/17 2151 - HOLD/RESUME by SBARRY
EDIT DOCTOR: BARRY,STEVEN
FROM: 05/02/17-2150
TO: 05/03/17-2100
05/08/17 1059 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by SBARRY Eff: 05/02/17 2151
05/29/17 2059 - DISCONTINUE by PHABKGJOB Eff: 05/29/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
05/29/17 2059 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 6 UNIT (0.06 ML)

Admin Route SUBCUTAN.
Frequency ONETIME (ONE)
Start Date 04/28/17-2215 Stop Date 04/28/17 2216 DC: 04/28/17-2216
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01508113

Discontinued Comments Reached Stop Date

History
04/28/17 2213 - POM ORDER by GSYRKIN
04/29/17 0951 - REVIEW PROVIDER ACTIVITY by AMACCA
by CMATTHIE Eff: 04/28/17 2227
04/29/17 0951 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 04/28/17 - 2215
04/29/17 0951 - DISCONTINUE by PHABKGJOB Eff: 04/28/17 2216
DC COMMENTS:
Reached Stop Date

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 6 UNIT (0.06 ML)

Admin Route SUBCUTAN.
Frequency ONETIME (ONE)
Start Date 05/16/17-2300 Stop Date 05/16/17 2301 DC: 05/16/17-2301
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01513049

Discontinued Comments Reached Stop Date

History
05/16/17 2255 - POM ORDER by RNOVITCH
05/17/17 0741 - REVIEW PROVIDER ACTIVITY by JDIMARCO
by STAYLORMOO Eff: 05/16/17 2306
05/17/17 0741 - VERIFIED by JDIMARCO
Items Dispensed: 1 Doses Dispensed: 1
For: 05/16/17 - 2300
05/17/17 0743 - DISCONTINUE by PHABKGJOB Eff: 05/16/17 2301
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 10 UNIT (0.1 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 05/30/17-2100 Stop Date 06/29/17 2059 DC: 05/30/17-2100
Ordering Doctor KARKVANDEIAN,FARZAD DO
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01516196

Discontinued Comments DC'd by Discharge

History
05/29/17 2139 - POM ORDER by FKARKVANDE
05/30/17 0737 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 05/30/17 - 2100
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 10 UNIT (0.1 ML)

Admin Route SUBCUTAN.
Frequency 2137 (ONE)
Start Date 05/29/17-2137 Stop Date 05/29/17 2138 DC: 05/29/17-2138
Ordering Doctor KARKVANDEIAN,FARZAD DO
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01516197

Discontinued Comments Reached Stop Date

History
05/29/17 2139 - POM ORDER by FKARKVANDE
05/30/17 0737 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by SHTHOMAS Eff: 05/29/17 2143
05/30/17 0737 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 05/29/17 - 2137
05/30/17 0737 - DISCONTINUE by PHABKGJOB Eff: 05/29/17 2138
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
05/30/17 0737 - CREDIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

INSU100V26 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose 5 UNIT (0.05 ML)

Admin Route SUBCUTAN.
Frequency BEFORE BREAKFAST (SCH)
Start Date 04/27/17-0800 Stop Date 05/27/17 0759 DC: 04/27/17-1001
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $229.32
Rx Number 01507262

History
04/26/17 1825 - POM ORDER by RNOVITCH
04/26/17 1829 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 04/27/17 - 0800
04/27/17 1003 - DISCONTINUE by ACORDOVA Eff: 04/27/17 1001
EDIT DOCTOR: CORDOVA,ANDREA MD
04/27/17 1007 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by ACORDOVA Eff: 04/27/17 1003

INSU100V26 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose 6 UNIT (0.06 ML)

Admin Route SUBCUTAN.
Frequency 13,1830 (SCH)
Start Date 04/26/17-1830 Stop Date 05/26/17 1829 DC: 04/27/17-1001
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01507263

History
04/26/17 1825 - POM ORDER by RNOVITCH
04/26/17 1829 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 04/26/17 - 1830
04/26/17 1830 - CREDIT by AMACCA
ITEMS: 1
04/27/17 1003 - DISCONTINUE by ACORDOVA Eff: 04/27/17 1001
EDIT DOCTOR: CORDOVA,ANDREA MD
04/27/17 1007 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by ACORDOVA Eff: 04/27/17 1003
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 04/27/17-1700 Stop Date 05/27/17 1659 DC: 04/29/17-1533
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $229.32
Rx Number 01507593

History
04/27/17 1626 - POM ORDER by ACORDOVA
04/27/17 1628 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 04/27/17 - 1700
04/29/17 1534 - DISCONTINUE by FKARKVANDE Eff: 04/29/17 1533
EDIT DOCTOR: KARKVANDEIAN,FARZAD DO
04/29/17 1534 - POM COPY AND EDIT by FKARKVANDE
TO: Rx #U01395401
04/29/17 1538 - REVIEW PROVIDER ACTIVITY by AMACCA
by FKARKVANDE Eff: 04/29/17 1534
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 3 UNITS SUBCUT.
201 TO 250 = 5 UNITS SUBCUT.
251 TO 300 = 8 UNITS SUBCUT.
> 300 = 10 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 04/29/17-1700 Stop Date 05/29/17 1659 DC: 05/29/17-1659
Ordering Doctor KARKVANDEIAN,FARZAD DO
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01508193

Discontinued Comments Reached Stop Date

History
04/29/17 1534 - POM COPY AND EDIT by FKARKVANDE
FROM: Rx #01507593
04/29/17 1539 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 04/29/17 - 1700
04/29/17 1539 - CREDIT by AMACCA
ITEMS: 1
05/29/17 1700 - DISCONTINUE by PHABKGJOB Eff: 05/29/17 1659
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
05/29/17 1700 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 05/30/17-1200 Stop Date 06/29/17 1159 DC: 05/30/17-1426
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 1 Total Costs $0.00 Total Charges $229.32
Rx Number 01516246

Discontinued Comments DC'd by Discharge

History
05/30/17 1033 - POM ORDER by JLEVIN
05/30/17 1037 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 05/30/17 - 1200
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency 3 TIMES A DAY (SCH)
Start Date 09/01/17-1700 Stop Date 09/01/17 1700 DC: 09/01/17-1700
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01542013

History
09/01/17 1537 - POM ORDER by TKOUTZEVA
09/01/17 1551 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1700
09/01/17 1647 - EDIT by TKOUTZEVA
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
START: 09/01/17-1700 STOP: 10/01/17 1659 SOFT STOP: 0
TO:
START: 09/01/17-1700 STOP: 09/01/17-1700 SOFT STOP:
09/01/17 1647 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 1700
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1650 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by TKOUTZEVA Eff: 09/01/17 1647
Discontinue by TKOUTZEVA Eff: 09/01/17 1647
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 09/01/17-1700 Stop Date 09/03/17 1122 DC: 09/03/17-1122
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01542030

History
09/01/17 1649 - POM ORDER by TKOUTZEVA
09/01/17 1650 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1700
09/03/17 1124 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 09/01/17-1700 STOP: 10/01/17 1659 SOFT STOP: 0
TO:
START: 09/01/17-1700 STOP: 09/03/17-1122 SOFT STOP:
09/03/17 1124 - DISCONTINUE by JRUSSO Eff: 09/03/17 1122
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
09/03/17 1124 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01428335
09/03/17 1245 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by JRUSSO Eff: 09/03/17 1124
Discontinue by JRUSSO Eff: 09/03/17 1124
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

KETO5DRO57 - KETOROLAC TROMETHAMINE 0.4% OPHTH DROPS

Dose 4 DROP (0.8 DROPSS)

Dose Instructions 4 DROPS IN BOTH EYES DAILY
Admin Route OPHTHALMIC
Frequency DAILY (SCH)
Start Date 04/27/17-1055 Stop Date 05/27/17 1054 DC: 04/27/17-1716
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 0.8 Total Costs $0.00 Total Charges $0.00
Rx Number 01507335

History
04/27/17 1056 - ENTER by AMOLINARI
Items Dispensed: 0.8 Doses Dispensed: 1
For: 04/27/17 - 1055
04/27/17 1056 - NOW DOSE by AMOLINARI
Now Dose: 04/27/17 1055
04/27/17 1056 - KEEP NEXT DOSE by AMOLINARI
Keep Next Dose: 04/28/17 0900
04/27/17 1716 - COPY AND EDIT by MHAIMOWITZ
TO: Rx #01507621
04/27/17 1716 - DISCONTINUE by MHAIMOWITZ Eff: 04/27/17 1716
EDIT DOCTOR: HUANG,VINCENT MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

KETO5DRO57 - KETOROLAC TROMETHAMINE 0.4% OPHTH DROPS

Dose 4 DROP (0.8 DROPSS)

Dose Instructions 4 DROPS IN BOTH EYES DAILY
Admin Route OPHTHALMIC
Frequency NIGHTLY (SCH)
Start Date 04/28/17-2100 Stop Date 04/28/17 2100 DC: 04/28/17-2100
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01507621

History
04/27/17 1716 - COPY AND EDIT by MHAIMOWITZ
FROM: Rx #01507335
04/27/17 1716 - ENTER by MHAIMOWITZ
04/27/17 1716 - SYSTEM COPY AND EDIT by MHAIMOWITZ
EDIT DOCTOR: HUANG,VINCENT MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
SIG: DAILY
START: 04/27/17-1055 STOP: 05/27/17 1054 SOFT STOP: 0
DISPENSE: 0.8
TO:
SIG: NIGHTLY
START: 04/28/17-2100 STOP: 05/27/17-1054 SOFT STOP: 0
DISPENSE: 0
04/27/17 1718 - COPY AND EDIT by MHAIMOWITZ
TO: Rx #01507622
04/27/17 1718 - DISCONTINUE by MHAIMOWITZ Eff: 04/28/17 2100
EDIT DOCTOR: HUANG,VINCENT MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

KETO5DRO57 - KETOROLAC TROMETHAMINE 0.4% OPHTH DROPS

Dose 4 DROP (0.8 DROPSS)

Dose Instructions 4 DROPS IN BOTH EYES NIGHTLY
Admin Route OPHTHALMIC
Frequency NIGHTLY (SCH)
Start Date 04/28/17-2100 Stop Date 05/27/17 1054 DC: 05/24/17-1540
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01507622

History
04/27/17 1718 - COPY AND EDIT by MHAIMOWITZ
FROM: Rx #01507621
04/27/17 1718 - ENTER by MHAIMOWITZ
04/27/17 1718 - SYSTEM COPY AND EDIT by MHAIMOWITZ
EDIT DOCTOR: HUANG,VINCENT MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
4 DROPS IN BOTH EYES DAILY
TO:
DOSE INSTRUCTIONS:
4 DROPS IN BOTH EYES NIGHTLY
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402261
05/24/17 1549 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 04/27/17-2215 Stop Date 04/27/17 2216 DC: 04/27/17-2216
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01507672

Discontinued Comments Reached Stop Date

History
04/27/17 2203 - POM ORDER by HMOHAMED
04/28/17 0729 - REVIEW PROVIDER ACTIVITY by JDIMARCO
by CMATTHIE Eff: 04/27/17 2257
04/28/17 0729 - VERIFIED by JDIMARCO
04/28/17 0730 - DISCONTINUE by PHABKGJOB Eff: 04/27/17 2216
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

CFTR2V - CEFTRIAXONE SOD 2 GM VIAL - 2 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency ONETIME (ONE)
Start Date 05/25/17-1530 Stop Date 05/25/17 1559 DC: 05/25/17-1559
Ordering Doctor WELBEL,RACHEL MD
Clinical Indication BACTEREMIA
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $37.84
Rx Number 01515520

Warnings
Type: MAINTENANCE
Range: CEFTRIAXONE SOD (2 GM)
Condition: ALL COMMON INDICATIONS
Duration Ordered duration of 1 day is below the duration range of 2 - 10
days.
Daily Dose This is an exact dosage calculation of 83.333 MG/HR Ordered dose of
4,000 MG/HR exceeds the exact dose by 3,916.667 MG/HR.
Single Dose Maximum Single Dose is 83.333 MG/HR. Ordered dose of 4,000 MG/HR
exceeds the Maximum Single Dose.

Type: MAINTENANCE
Range: CEFTRIAXONE SOD (2 GM)
Condition: ALL COMMON INDICATIONS
Warnings CFTR2V: Unable to check Max Single dose ranges for G/DOSE (Dose Units).

Discontinued Comments Reached Stop Date

History
05/25/17 1523 - POM ORDER by RWELBEL
05/25/17 1524 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 05/25/17 - 1530
05/25/17 1559 - DISCONTINUE by PHABKGJOB Eff: 05/25/17 1559
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

CFTR2V - CEFTRIAXONE SOD 2 GM VIAL - 2 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency DAILY (SCH)
Start Date 05/26/17-0900 Stop Date 06/02/17 0859 DC: 05/30/17-1027
Ordering Doctor BARRY,STEVEN
Clinical Indication DOCUMENTED INFECTION
Last Bag 5
Total Dispensed 5 Total Costs $0.00 Total Charges $189.20
Rx Number 01515588

History
05/25/17 2023 - POM ORDER by SBARRY
05/25/17 2043 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 05/26/17 - 0900
05/26/17 0952 - FILL by JDIMARCO
Items Dispensed: 1 Doses Dispensed: 1
For: 05/27/17 - 0900
05/27/17 1040 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 05/28/17 - 0900
05/28/17 1024 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 05/29/17 - 0900
05/29/17 1124 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 05/30/17 - 0900
05/30/17 1007 - FILL by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 05/31/17 - 0900
05/30/17 1029 - DISCONTINUE by VHUANG Eff: 05/30/17 1027
Items Auto Credited: 1 Doses Auto Credited: 1
For: 05/31/17 - 0900
EDIT DOCTOR: HUANG,VINCENT MD
06/30/17 0014 - REVIEW PROVIDER ACTIVITY by SYSTEM
( by VHUANG Eff: 05/30/17 1029)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 04/26/17-1215 Stop Date 05/26/17 1214 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $5.75
Rx Number 01507060

History
04/26/17 1206 - POM ORDER by ACORDOVA
04/26/17 1209 - VERIFIED by AADEGBAMIG
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
05/17/17 0854 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402255
05/24/17 1545 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 05/24/17-1545 Stop Date 06/23/17 1544 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01515276

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507060
05/24/17 1544 - VERIFIED by MHAIMOWITZ
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
For: 05/30/17 - 2100
For: 05/31/17 - 2100
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/27/17-0900 Stop Date 05/27/17 0859 DC: 05/01/17-1607
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 5 Total Costs $0.00 Total Charges $3.15
Rx Number 01507072

History
04/26/17 1215 - POM ORDER by ACORDOVA
04/26/17 1217 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 04/27/17 - 0900
For: 04/28/17 - 0900
For: 04/29/17 - 0900
For: 04/30/17 - 0900
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/01/17 - 0900
For: 05/02/17 - 0900
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/03/17 - 0900
For: 05/04/17 - 0900
05/01/17 1610 - DISCONTINUE by HMOHAMED Eff: 05/01/17 1607
Items Auto Credited: 3 Doses Auto Credited: 3
For: 05/02/17 - 0900
For: 05/03/17 - 0900
For: 05/04/17 - 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/01/17 1610 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01395775
05/01/17 1611 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
by HMOHAMED Eff: 05/01/17 1610
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/02/17-0900 Stop Date 06/01/17 0859 DC: 05/02/17-0900
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01508577

History
05/01/17 1610 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507072
05/01/17 1611 - DISCONTINUE by AADEGBAMIG Eff: 05/02/17 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
05/01/17 1611 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/02/17-0900 Stop Date 06/01/17 0859 DC: 05/03/17-1006
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01508578

History
05/01/17 1612 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 05/02/17 - 0900
For: 05/03/17 - 0900
For: 05/04/17 - 0900
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
05/03/17 1007 - DISCONTINUE by VHUANG Eff: 05/03/17 1006
Items Auto Credited: 4 Doses Auto Credited: 4
For: 05/04/17 - 0900
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
EDIT DOCTOR: HUANG,VINCENT MD
05/03/17 1007 - POM COPY AND EDIT by VHUANG
TO: Rx #U01396187
05/03/17 1023 - REVIEW PROVIDER ACTIVITY by EBALILO
by VHUANG Eff: 05/03/17 1007
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/04/17-0900 Stop Date 06/03/17 0859 DC: 05/04/17-0926
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01509000

History
05/03/17 1022 - ENTER by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 05/04/17 - 0900
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
05/04/17 0928 - DISCONTINUE by HMOHAMED Eff: 05/04/17 0926
Items Auto Credited: 3 Doses Auto Credited: 3
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/08/17 1059 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by HMOHAMED Eff: 05/04/17 0928
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/09/17-0900 Stop Date 06/08/17 0859 DC: 05/10/17-1019
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01510379

History
05/08/17 0956 - POM ORDER by VHUANG
05/08/17 1059 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/09/17 - 0900
For: 05/10/17 - 0900
For: 05/11/17 - 0900
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/12/17 - 0900
For: 05/13/17 - 0900
For: 05/14/17 - 0900
05/10/17 1021 - DISCONTINUE by VHUANG Eff: 05/10/17 1019
Items Auto Credited: 4 Doses Auto Credited: 4
For: 05/11/17 - 0900
For: 05/12/17 - 0900
For: 05/13/17 - 0900
For: 05/14/17 - 0900
EDIT DOCTOR: HUANG,VINCENT MD
05/11/17 0941 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by VHUANG Eff: 05/10/17 1021
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/19/17-0900 Stop Date 06/18/17 0859 DC: 05/22/17-1003
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 4 Total Costs $0.00 Total Charges $0.43
Rx Number 01513466

History
05/18/17 0945 - POM ORDER by VHUANG
05/18/17 0949 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/19/17 - 0900
For: 05/20/17 - 0900
For: 05/21/17 - 0900
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/22/17 - 0900
For: 05/23/17 - 0900
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/24/17 - 0900
For: 05/25/17 - 0900
05/22/17 1003 - DISCONTINUE by HMOHAMED Eff: 05/22/17 1003
Items Auto Credited: 3 Doses Auto Credited: 3
For: 05/23/17 - 0900
For: 05/24/17 - 0900
For: 05/25/17 - 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1545 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/22/17 1003
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/31/17-0900 Stop Date 06/30/17 0859 DC: 05/31/17-0900
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01516247

Discontinued Comments DC'd by Discharge

History
05/30/17 1036 - POM ORDER by JLEVIN
05/30/17 1038 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/31/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency 1035 (ONE)
Start Date 05/30/17-1035 Stop Date 05/30/17 1036 DC: 05/30/17-1036
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 1 Total Costs $0.00 Total Charges $0.43
Rx Number 01516248

Discontinued Comments Reached Stop Date

History
05/30/17 1036 - POM ORDER by JLEVIN
05/30/17 1038 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 05/30/17 - 1035
05/30/17 1038 - DISCONTINUE by PHABKGJOB Eff: 05/30/17 1036
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 04/26/17-2000 Stop Date 05/26/17 1959 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01507059

History
04/26/17 1206 - POM ORDER by ACORDOVA
04/26/17 1209 - VERIFIED by AADEGBAMIG
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/01/17 - 2000
For: 05/02/17 - 2000
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/03/17 - 2000
For: 05/04/17 - 2000
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/05/17 - 2000
For: 05/06/17 - 2000
For: 05/07/17 - 2000
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/08/17 - 2000
For: 05/09/17 - 2000
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/10/17 - 2000
For: 05/11/17 - 2000
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/12/17 - 2000
For: 05/13/17 - 2000
For: 05/14/17 - 2000
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/15/17 - 2000
For: 05/16/17 - 2000
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 05/17/17 - 2000
For: 05/18/17 - 2000
05/17/17 0854 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/19/17 - 2000
For: 05/20/17 - 2000
For: 05/21/17 - 2000
05/19/17 0810 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 05/22/17 - 2000
For: 05/23/17 - 2000
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/24/17 - 2000
For: 05/25/17 - 2000
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402256
05/24/17 1546 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 05/18/17-1900 Stop Date 05/18/17 1901 DC: 05/18/17-1901
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01513451

Discontinued Comments Reached Stop Date

History
05/18/17 0759 - POM ORDER by HMOHAMED
05/18/17 0826 - VERIFIED by AMOLINARI
05/18/17 1902 - DISCONTINUE by PHABKGJOB Eff: 05/18/17 1901
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 05/24/17-2000 Stop Date 06/23/17 1959 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01515277

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507059
05/24/17 1544 - VERIFIED by MHAIMOWITZ
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/29/17 - 2000
For: 05/30/17 - 2000
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/31/17 - 2000
For: 06/01/17 - 2000
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
For: 05/30/17 - 2100
For: 05/31/17 - 2100
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

CPR500T - CIPROFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 05/30/17-2100 Stop Date 06/09/17 2059 DC: 05/30/17-2100
Ordering Doctor HUANG,VINCENT MD
Clinical Indication BACTEREMIA
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01516245

Discontinued Comments DC'd by Discharge

History
05/30/17 1029 - POM ORDER by VHUANG
05/30/17 1031 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 05/30/17 - 2100
For: 05/31/17 - 0900
For: 05/31/17 - 2100
For: 06/01/17 - 0900
For: 06/01/17 - 2100
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 2100
Items Auto Credited: 5 Doses Auto Credited: 5
For: 05/30/17 - 2100
For: 05/31/17 - 0900
For: 05/31/17 - 2100
For: 06/01/17 - 0900
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/27/17-0900 Stop Date 05/27/17 0859 DC: 05/25/17-1524
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 29 Total Costs $0.00 Total Charges $467.77
Rx Number 01507071

History
04/26/17 1215 - POM ORDER by ACORDOVA
04/26/17 1217 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 04/27/17 - 0900
For: 04/28/17 - 0900
For: 04/29/17 - 0900
For: 04/30/17 - 0900
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/01/17 - 0900
For: 05/02/17 - 0900
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/03/17 - 0900
For: 05/04/17 - 0900
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/08/17 - 0900
For: 05/09/17 - 0900
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/10/17 - 0900
For: 05/11/17 - 0900
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/12/17 - 0900
For: 05/13/17 - 0900
For: 05/14/17 - 0900
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/15/17 - 0900
For: 05/16/17 - 0900
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 05/17/17 - 0900
For: 05/18/17 - 0900
05/17/17 0854 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 05/19/17 - 0900
For: 05/20/17 - 0900
For: 05/21/17 - 0900
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/22/17 - 0900
For: 05/23/17 - 0900
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/24/17 - 0900
For: 05/25/17 - 0900
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 05/26/17 - 0900
05/25/17 1525 - DISCONTINUE by RWELBEL Eff: 05/25/17 1524
Items Auto Credited: 1 Doses Auto Credited: 1
For: 05/26/17 - 0900
EDIT DOCTOR: WELBEL,RACHEL MD
05/25/17 1525 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
05/25/17 1525 - POM COPY AND EDIT by RWELBEL
TO: Rx #U01402494
05/25/17 1532 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RWELBEL Eff: 05/25/17 1525
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/26/17-0900 Stop Date 06/24/17 DC: 05/30/17-1426
Ordering Doctor WELBEL,RACHEL MD
Total Dispensed 5 Total Costs $0.00 Total Charges $80.65
Rx Number 01515524

Discontinued Comments DC'd by Discharge

History
05/25/17 1525 - POM COPY AND EDIT by RWELBEL
FROM: Rx #01507071
05/25/17 1532 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 05/26/17 - 0900
For: 05/27/17 - 0900
For: 05/28/17 - 0900
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/29/17 - 0900
For: 05/30/17 - 0900
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
Items Auto Credited: 2 Doses Auto Credited: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

CCLB10T - CYCLOBENZAPRINE HCL 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 05/26/17-0245 Stop Date 05/26/17 0246 DC: 05/26/17-0246
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 1 Total Costs $0.00 Total Charges $0.25
Rx Number 01515594

Discontinued Comments Reached Stop Date

History
05/26/17 0249 - POM ORDER by GGARRISON
05/26/17 0730 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Administration of Unverified Order by CMATTHIE Eff: 05/26/17 0255
05/26/17 0730 - VERIFIED by JDIMARCO
Items Dispensed: 1 Doses Dispensed: 1
For: 05/26/17 - 0245
05/26/17 0730 - DISCONTINUE by PHABKGJOB Eff: 05/26/17 0246
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 04/26/17-1215 Stop Date 05/26/17 1214 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01507063

History
04/26/17 1206 - POM ORDER by ACORDOVA
04/26/17 1209 - VERIFIED by AADEGBAMIG
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
05/17/17 0854 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402257
05/24/17 1546 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 05/24/17-1545 Stop Date 06/23/17 1544 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01515278

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507063
05/24/17 1544 - VERIFIED by MHAIMOWITZ
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
For: 05/30/17 - 2100
For: 05/31/17 - 2100
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 04/26/17-1300 Stop Date 05/26/17 1259 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $15.50
Rx Number 01507056

History
04/26/17 1206 - POM ORDER by ACORDOVA
04/26/17 1208 - VERIFIED by AADEGBAMIG
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 05/01/17 - 0900
For: 05/01/17 - 1300
For: 05/01/17 - 1700
For: 05/02/17 - 0900
For: 05/02/17 - 1300
For: 05/02/17 - 1700
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 05/03/17 - 0900
For: 05/03/17 - 1300
For: 05/03/17 - 1700
For: 05/04/17 - 0900
For: 05/04/17 - 1300
For: 05/04/17 - 1700
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 05/05/17 - 0900
For: 05/05/17 - 1300
For: 05/05/17 - 1700
For: 05/06/17 - 0900
For: 05/06/17 - 1300
For: 05/06/17 - 1700
For: 05/07/17 - 0900
For: 05/07/17 - 1300
For: 05/07/17 - 1700
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 05/08/17 - 0900
For: 05/08/17 - 1300
For: 05/08/17 - 1700
For: 05/09/17 - 0900
For: 05/09/17 - 1300
For: 05/09/17 - 1700
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/10/17 - 0900
For: 05/10/17 - 1300
For: 05/10/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

For: 05/11/17 - 0900

For: 05/11/17 - 1300
For: 05/11/17 - 1700
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 05/12/17 - 0900
For: 05/12/17 - 1300
For: 05/12/17 - 1700
For: 05/13/17 - 0900
For: 05/13/17 - 1300
For: 05/13/17 - 1700
For: 05/14/17 - 0900
For: 05/14/17 - 1300
For: 05/14/17 - 1700
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/15/17 - 0900
For: 05/15/17 - 1300
For: 05/15/17 - 1700
For: 05/16/17 - 0900
For: 05/16/17 - 1300
For: 05/16/17 - 1700
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 6 Doses Dispensed: 6
For: 05/17/17 - 0900
For: 05/17/17 - 1300
For: 05/17/17 - 1700
For: 05/18/17 - 0900
For: 05/18/17 - 1300
For: 05/18/17 - 1700
05/17/17 0854 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 05/19/17 - 0900
For: 05/19/17 - 1300
For: 05/19/17 - 1700
For: 05/20/17 - 0900
For: 05/20/17 - 1300
For: 05/20/17 - 1700
For: 05/21/17 - 0900
For: 05/21/17 - 1300
For: 05/21/17 - 1700
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 05/22/17 - 0900
For: 05/22/17 - 1300
For: 05/22/17 - 1700
For: 05/23/17 - 0900
For: 05/23/17 - 1300
For: 05/23/17 - 1700
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 05/24/17 - 0900
For: 05/24/17 - 1300
For: 05/24/17 - 1700
For: 05/25/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

For: 05/25/17 - 1300

For: 05/25/17 - 1700
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 05/26/17 - 0900
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402258
05/24/17 1546 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 05/24/17-1700 Stop Date 06/23/17 1659 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.75
Rx Number 01515279

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507056
05/24/17 1545 - VERIFIED by MHAIMOWITZ
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/29/17 - 0900
For: 05/29/17 - 1300
For: 05/29/17 - 1700
For: 05/30/17 - 0900
For: 05/30/17 - 1300
For: 05/30/17 - 1700
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/31/17 - 0900
For: 05/31/17 - 1300
For: 05/31/17 - 1700
For: 06/01/17 - 0900
For: 06/01/17 - 1300
For: 06/01/17 - 1700
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
For: 05/30/17 - 2100
For: 05/31/17 - 2100
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 04/27/17-0900 Stop Date 05/27/17 0859 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 28 Total Costs $0.00 Total Charges $2386.44
Rx Number 01507074

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.75
MG/KG/DAY is below the Low Daily Dose.

History
04/26/17 1221 - POM ORDER by ACORDOVA
04/26/17 1224 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 04/27/17 - 0900
For: 04/28/17 - 0900
For: 04/29/17 - 0900
For: 04/30/17 - 0900
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/01/17 - 0900
For: 05/02/17 - 0900
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/03/17 - 0900
For: 05/04/17 - 0900
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/08/17 - 0900
For: 05/09/17 - 0900
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/10/17 - 0900
For: 05/11/17 - 0900
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/12/17 - 0900
For: 05/13/17 - 0900
For: 05/14/17 - 0900
05/12/17 0820 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 05/15/17 - 0900
For: 05/16/17 - 0900
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 05/17/17 - 0900
For: 05/18/17 - 0900
05/17/17 0854 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/19/17 - 0900
For: 05/20/17 - 0900
For: 05/21/17 - 0900
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/22/17 - 0900
For: 05/23/17 - 0900
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/24/17 - 0900
For: 05/25/17 - 0900
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 05/26/17 - 0900
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
Items Auto Credited: 2 Doses Auto Credited: 2
For: 05/25/17 - 0900
For: 05/26/17 - 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402259
05/24/17 1549 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 05/25/17-0900 Stop Date 06/24/17 0859 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $511.38
Rx Number 01515283

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.73
MG/KG/DAY is below the Low Daily Dose.

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507074
05/24/17 1547 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 05/25/17 - 0900
For: 05/26/17 - 0900
For: 05/27/17 - 0900
For: 05/28/17 - 0900
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/29/17 - 0900
For: 05/30/17 - 0900
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
Items Auto Credited: 2 Doses Auto Credited: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/27/17-0900 Stop Date 05/27/17 0859 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 56 Total Costs $0.00 Total Charges $19.60
Rx Number 01507069

History
04/26/17 1215 - POM ORDER by ACORDOVA
04/26/17 1216 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 04/27/17 - 0900
For: 04/28/17 - 0900
For: 04/29/17 - 0900
For: 04/30/17 - 0900
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/01/17 - 0900
For: 05/02/17 - 0900
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/03/17 - 0900
For: 05/04/17 - 0900
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/08/17 - 0900
For: 05/09/17 - 0900
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/10/17 - 0900
For: 05/11/17 - 0900
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 05/12/17 - 0900
For: 05/13/17 - 0900
For: 05/14/17 - 0900
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/15/17 - 0900
For: 05/16/17 - 0900
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 4 Doses Dispensed: 2
For: 05/17/17 - 0900
For: 05/18/17 - 0900
05/17/17 0854 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

Items Dispensed: 6 Doses Dispensed: 3

For: 05/19/17 - 0900
For: 05/20/17 - 0900
For: 05/21/17 - 0900
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/22/17 - 0900
For: 05/23/17 - 0900
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/24/17 - 0900
For: 05/25/17 - 0900
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 05/26/17 - 0900
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
Items Auto Credited: 4 Doses Auto Credited: 2
For: 05/25/17 - 0900
For: 05/26/17 - 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402260
05/24/17 1549 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/25/17-0900 Stop Date 06/24/17 0859 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $4.20
Rx Number 01515284

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507069
05/24/17 1547 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 05/25/17 - 0900
For: 05/26/17 - 0900
For: 05/27/17 - 0900
For: 05/28/17 - 0900
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/29/17 - 0900
For: 05/30/17 - 0900
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
Items Auto Credited: 4 Doses Auto Credited: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/27/17-0900 Stop Date 05/27/17 0859 DC: 05/03/17-1006
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 7 Total Costs $0.00 Total Charges $0.60
Rx Number 01507068

History
04/26/17 1215 - POM ORDER by ACORDOVA
04/26/17 1216 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 04/27/17 - 0900
For: 04/28/17 - 0900
For: 04/29/17 - 0900
For: 04/30/17 - 0900
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/01/17 - 0900
For: 05/02/17 - 0900
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/03/17 - 0900
For: 05/04/17 - 0900
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
05/03/17 1007 - DISCONTINUE by VHUANG Eff: 05/03/17 1006
Items Auto Credited: 4 Doses Auto Credited: 4
For: 05/04/17 - 0900
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
EDIT DOCTOR: HUANG,VINCENT MD
05/03/17 1007 - POM COPY AND EDIT by VHUANG
TO: Rx #U01396188
05/03/17 1023 - REVIEW PROVIDER ACTIVITY by EBALILO
by VHUANG Eff: 05/03/17 1007
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/04/17-0900 Stop Date 05/04/17 0926 DC: 05/04/17-0926
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01508999

History
05/03/17 1007 - POM COPY AND EDIT by VHUANG
FROM: Rx #01507068
05/03/17 1019 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 05/04/17 - 0900
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
05/04/17 0928 - DISCONTINUE by HMOHAMED Eff: 05/04/17 0926
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
05/04/17 0928 - EDIT by HMOHAMED
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
FROM:
START: 05/04/17-0900 STOP: 06/03/17 0859 SOFT STOP: 0
TO:
START: 05/04/17-0900 STOP: 05/04/17-0926 SOFT STOP:
05/04/17 0928 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01396492
05/04/17 1007 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/04/17 0928
by HMOHAMED Eff: 05/04/17 0928
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 05/04/17-2100 Stop Date 06/03/17 2059 DC: 05/08/17-0954
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 4 Total Costs $0.00 Total Charges $0.30
Rx Number 01509344

History
05/04/17 0928 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01508999
Result of Sig/Schedule Edit
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD
Last Scheduled Dose: 05/04/17 - 0900
Last Administration:
Old Sig/Sch: DAILY (SCH)
New Sig/Sch: NIGHTLY (SCH)
Old Order Stop: 05/04/17 - 0926
New Order Start: 05/04/17 - 2100
05/04/17 1007 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/04/17 0928
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD
Last Scheduled Dose: 05/04/17 - 0900
Last Administration:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 05/04/17 - 0926
New Order Start: 05/04/17 - 2100
05/04/17 1007 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 05/04/17 - 2100
For: 05/05/17 - 2100
For: 05/06/17 - 2100
For: 05/07/17 - 2100
05/04/17 2130 - HOLD/RESUME by RSHARMA
EDIT DOCTOR: SHARMA,RAMAN MD
FROM: 05/04/17-2125
TO: 05/05/17-0700
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/08/17 - 2100
For: 05/09/17 - 2100
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/10/17 - 2100
For: 05/11/17 - 2100
05/08/17 0956 - DISCONTINUE by VHUANG Eff: 05/08/17 0954
Items Auto Credited: 4 Doses Auto Credited: 4
For: 05/08/17 - 2100
For: 05/09/17 - 2100
For: 05/10/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

For: 05/11/17 - 2100

EDIT DOCTOR: HUANG,VINCENT MD
05/08/17 0956 - POM COPY AND EDIT by VHUANG
TO: Rx #U01397505
05/08/17 1059 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by RSHARMA Eff: 05/04/17 2130
by VHUANG Eff: 05/08/17 0956

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 05/08/17-2100 Stop Date 06/07/17 2059 DC: 05/08/17-2148
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01510378

History
05/08/17 0956 - POM COPY AND EDIT by VHUANG
FROM: Rx #01509344
05/08/17 1059 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 05/08/17 - 2100
For: 05/09/17 - 2100
For: 05/10/17 - 2100
For: 05/11/17 - 2100
05/08/17 2150 - DISCONTINUE by SVAIDYA Eff: 05/08/17 2148
Items Auto Credited: 3 Doses Auto Credited: 3
For: 05/09/17 - 2100
For: 05/10/17 - 2100
For: 05/11/17 - 2100
EDIT DOCTOR: VAIDYA, SUDHIR M.D.
05/08/17 2150 - POM COPY AND EDIT by SVAIDYA
TO: Rx #U01397828
05/09/17 0730 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by SVAIDYA Eff: 05/08/17 2150
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions Hold if SBP less than 110
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 05/09/17-2100 Stop Date 06/08/17 2059 DC: 05/10/17-1019
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01510710

History
05/08/17 2150 - POM COPY AND EDIT by SVAIDYA
FROM: Rx #01510378
05/09/17 0730 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/09/17 - 2100
For: 05/10/17 - 2100
For: 05/11/17 - 2100
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/12/17 - 2100
For: 05/13/17 - 2100
For: 05/14/17 - 2100
05/10/17 1021 - DISCONTINUE by VHUANG Eff: 05/10/17 1019
Items Auto Credited: 5 Doses Auto Credited: 5
For: 05/10/17 - 2100
For: 05/11/17 - 2100
For: 05/12/17 - 2100
For: 05/13/17 - 2100
For: 05/14/17 - 2100
EDIT DOCTOR: HUANG,VINCENT MD
05/11/17 0941 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by VHUANG Eff: 05/10/17 1021
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

KETO5DRO57 - KETOROLAC TROMETHAMINE 0.4% OPHTH DROPS

Dose 4 DROP (0.8 DROPSS)

Dose Instructions 4 DROPS IN BOTH EYES NIGHTLY
Admin Route OPHTHALMIC
Frequency NIGHTLY (SCH)
Start Date 05/24/17-2100 Stop Date 06/23/17 2059 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 4.8 Total Costs $0.00 Total Charges $0.00
Rx Number 01515287

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507622
05/24/17 1549 - EDIT by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
TO:
CHARGE TYPE: PSM - PATIENT'S SELF MEDS
CHARGE: $0.00
05/24/17 1549 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 5
For: 05/24/17 - 2100
For: 05/25/17 - 2100
For: 05/26/17 - 2100
For: 05/27/17 - 2100
For: 05/28/17 - 2100
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 1.6 Doses Dispensed: 2
For: 05/29/17 - 2100
For: 05/30/17 - 2100
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 1.6 Doses Dispensed: 2
For: 05/31/17 - 2100
For: 06/01/17 - 2100
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
Items Auto Credited: 2.4 Doses Auto Credited: 3
For: 05/30/17 - 2100
For: 05/31/17 - 2100
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 04/26/17-1215 Stop Date 05/26/17 1214 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01507061

History
04/26/17 1206 - POM ORDER by ACORDOVA
04/26/17 1209 - VERIFIED by AADEGBAMIG
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
05/17/17 0854 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402262
05/24/17 1549 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 05/24/17-1545 Stop Date 06/23/17 1544 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01515280

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507061
05/24/17 1545 - VERIFIED by MHAIMOWITZ
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
For: 05/30/17 - 2100
For: 05/31/17 - 2100
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 04/26/17-1215 Stop Date 05/26/17 1214 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01507062

History
04/26/17 1206 - POM ORDER by ACORDOVA
04/26/17 1209 - VERIFIED by AADEGBAMIG
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
05/17/17 0854 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402263
05/24/17 1549 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 05/24/17-1545 Stop Date 06/23/17 1544 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01515281

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507062
05/24/17 1545 - VERIFIED by MHAIMOWITZ
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
For: 05/30/17 - 2100
For: 05/31/17 - 2100
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (0 EACHS)
Dose Instructions Valsartan 320mg daily
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/27/17-0900 Stop Date 05/27/17 0859 DC: 04/27/17-0900
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01507076

History
04/26/17 1215 - POM ORDER by ACORDOVA
04/26/17 1225 - DISCONTINUE by AADEGBAMIG Eff: 04/27/17 0900
EDIT DOCTOR: CORDOVA,ANDREA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
04/26/17 1225 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 04/26/17-1215 Stop Date 05/26/17 1214 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 6 Total Costs $ Total Charges $
Rx Number 01507057

History
04/26/17 1206 - POM ORDER by ACORDOVA
04/26/17 1208 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 04/26/17 - 1215
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
05/17/17 0854 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402264
05/24/17 1549 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 05/24/17-1545 Stop Date 06/23/17 1544 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 01515282

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507057
05/24/17 1545 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 05/24/17 - 1545
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 04/28/17-0015 Stop Date 04/28/17 0016 DC: 04/28/17-0016
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01507673

Discontinued Comments Reached Stop Date

History
04/28/17 0018 - POM ORDER by GGARRISON
04/28/17 0729 - REVIEW PROVIDER ACTIVITY by JDIMARCO
by CMATTHIE Eff: 04/28/17 0026
04/28/17 0729 - VERIFIED by JDIMARCO
04/28/17 0730 - DISCONTINUE by PHABKGJOB Eff: 04/28/17 0016
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

ROSU10TA - ROSUVASTATIN CALCIUM 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 04/26/17-2100 Stop Date 05/26/17 2059 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 28 Total Costs $0.00 Total Charges $594.30
Rx Number 01507070

History
04/26/17 1215 - POM ORDER by ACORDOVA
04/26/17 1217 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 04/26/17 - 2100
For: 04/27/17 - 2100
For: 04/28/17 - 2100
For: 04/29/17 - 2100
For: 04/30/17 - 2100
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/01/17 - 2100
For: 05/02/17 - 2100
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/03/17 - 2100
For: 05/04/17 - 2100
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/05/17 - 2100
For: 05/06/17 - 2100
For: 05/07/17 - 2100
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/08/17 - 2100
For: 05/09/17 - 2100
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/10/17 - 2100
For: 05/11/17 - 2100
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/12/17 - 2100
For: 05/13/17 - 2100
For: 05/14/17 - 2100
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/15/17 - 2100
For: 05/16/17 - 2100
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 05/17/17 - 2100
For: 05/18/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

05/17/17 0854 - FILL by AMOLINARI

Items Dispensed: 3 Doses Dispensed: 3
For: 05/19/17 - 2100
For: 05/20/17 - 2100
For: 05/21/17 - 2100
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/22/17 - 2100
For: 05/23/17 - 2100
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/24/17 - 2100
For: 05/25/17 - 2100
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
Items Auto Credited: 2 Doses Auto Credited: 2
For: 05/24/17 - 2100
For: 05/25/17 - 2100
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402265
05/24/17 1549 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

ROSU10TA - ROSUVASTATIN CALCIUM 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 05/24/17-2100 Stop Date 06/23/17 2059 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $130.50
Rx Number 01515285

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507070
05/24/17 1548 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 05/24/17 - 2100
For: 05/25/17 - 2100
For: 05/26/17 - 2100
For: 05/27/17 - 2100
For: 05/28/17 - 2100
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/29/17 - 2100
For: 05/30/17 - 2100
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/31/17 - 2100
For: 06/01/17 - 2100
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
Items Auto Credited: 3 Doses Auto Credited: 3
For: 05/30/17 - 2100
For: 05/31/17 - 2100
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 04/27/17-1200 Stop Date 05/27/17 1159 DC: 05/24/17-1540
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 56 Total Costs $0.00 Total Charges $4.40
Rx Number 01507058

History
04/26/17 1206 - POM ORDER by ACORDOVA
04/26/17 1208 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 04/27/17 - 1200
For: 04/28/17 - 1200
For: 04/29/17 - 1200
For: 04/30/17 - 1200
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/01/17 - 1200
For: 05/02/17 - 1200
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/03/17 - 1200
For: 05/04/17 - 1200
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 05/05/17 - 1200
For: 05/06/17 - 1200
For: 05/07/17 - 1200
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/08/17 - 1200
For: 05/09/17 - 1200
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/10/17 - 1200
For: 05/11/17 - 1200
05/10/17 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 05/12/17 - 1200
For: 05/13/17 - 1200
For: 05/14/17 - 1200
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/15/17 - 1200
For: 05/16/17 - 1200
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 4 Doses Dispensed: 2
For: 05/17/17 - 1200
For: 05/18/17 - 1200
05/17/17 0854 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

Items Dispensed: 6 Doses Dispensed: 3

For: 05/19/17 - 1200
For: 05/20/17 - 1200
For: 05/21/17 - 1200
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/22/17 - 1200
For: 05/23/17 - 1200
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/24/17 - 1200
For: 05/25/17 - 1200
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 05/26/17 - 1200
05/24/17 1541 - DISCONTINUE by HMOHAMED Eff: 05/24/17 1540
Items Auto Credited: 4 Doses Auto Credited: 2
For: 05/25/17 - 1200
For: 05/26/17 - 1200
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01402266
05/24/17 1549 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/24/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 05/25/17-1200 Stop Date 06/24/17 1159 DC: 05/30/17-1426
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $0.80
Rx Number 01515286

Discontinued Comments DC'd by Discharge

History
05/24/17 1541 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507058
05/24/17 1548 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 05/25/17 - 1200
For: 05/26/17 - 1200
For: 05/27/17 - 1200
For: 05/28/17 - 1200
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/29/17 - 1200
For: 05/30/17 - 1200
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/31/17 - 1200
For: 06/01/17 - 1200
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
Items Auto Credited: 4 Doses Auto Credited: 2
For: 05/31/17 - 1200
For: 06/01/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

TS160800 - TRIMETHOPRIM/SULFAMETHOXAZOLE 160-800 MG TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 05/25/17-0900 Stop Date 06/01/17 0859 DC: 05/26/17-0726
Ordering Doctor HUANG,VINCENT MD
Clinical Indication COMPLICATED UTI
Total Dispensed 2 Total Costs $0.00 Total Charges $0.96
Rx Number 01515317

History
05/24/17 1725 - POM ORDER by VHUANG
05/24/17 1740 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 8
For: 05/25/17 - 0900
For: 05/25/17 - 1700
For: 05/26/17 - 0900
For: 05/26/17 - 1700
For: 05/27/17 - 0900
For: 05/27/17 - 1700
For: 05/28/17 - 0900
For: 05/28/17 - 1700
05/26/17 0727 - DISCONTINUE by SBARRY Eff: 05/26/17 0726
Items Auto Credited: 6 Doses Auto Credited: 6
For: 05/26/17 - 0900
For: 05/26/17 - 1700
For: 05/27/17 - 0900
For: 05/27/17 - 1700
For: 05/28/17 - 0900
For: 05/28/17 - 1700
EDIT DOCTOR: BARRY,STEVEN
05/26/17 0727 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
05/26/17 0730 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by SBARRY Eff: 05/26/17 0727
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

TS160800 - TRIMETHOPRIM/SULFAMETHOXAZOLE 160-800 MG TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency 1723 (ONE)
Start Date 05/24/17-1723 Stop Date 05/24/17 1724 DC: 05/24/17-1724
Ordering Doctor HUANG,VINCENT MD
Clinical Indication COMPLICATED UTI
Total Dispensed 1 Total Costs $0.00 Total Charges $0.48
Rx Number 01515316

Discontinued Comments Reached Stop Date

History
05/24/17 1725 - POM ORDER by VHUANG
05/24/17 1740 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 05/24/17 - 1723
05/24/17 1740 - DISCONTINUE by PHABKGJOB Eff: 05/24/17 1724
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

VLS80C - VALSARTAN 80 MG TAB

Dose 320 MG (4 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/27/17-0900 Stop Date 05/04/17 0926 DC: 05/04/17-0926
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed 44 Total Costs $0.00 Total Charges $227.50
Rx Number 01507075

History
04/26/17 1225 - ENTER by AADEGBAMIG
Items Dispensed: 16 Doses Dispensed: 4
For: 04/27/17 - 0900
For: 04/28/17 - 0900
For: 04/29/17 - 0900
For: 04/30/17 - 0900
04/28/17 0813 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 2
For: 05/01/17 - 0900
For: 05/02/17 - 0900
05/01/17 0829 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 2
For: 05/03/17 - 0900
For: 05/04/17 - 0900
05/03/17 0813 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 3
For: 05/05/17 - 0900
For: 05/06/17 - 0900
For: 05/07/17 - 0900
05/04/17 0928 - EDIT by HMOHAMED
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
FROM:
START: 04/27/17-0900 STOP: 05/27/17 0859 SOFT STOP: 0
TO:
START: 04/27/17-0900 STOP: 05/04/17-0926 SOFT STOP:
05/04/17 0928 - DISCONTINUE by HMOHAMED Eff: 05/04/17 0926
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD
05/04/17 0928 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01396493
05/04/17 1007 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/04/17 0928
by HMOHAMED Eff: 05/04/17 0928
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

VLS80C - VALSARTAN 80 MG TAB

Dose 320 MG (4 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 05/04/17-2100 Stop Date 06/03/17 2059 DC: 05/08/17-2148
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $97.50
Rx Number 01509345

History
05/04/17 0928 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01507075
Result of Sig/Schedule Edit
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD
Last Scheduled Dose: 05/03/17 - 0900
Last Administration: 05/03/17 - 0936
Old Sig/Sch: DAILY (SCH)
New Sig/Sch: NIGHTLY (SCH)
Old Order Stop: 05/04/17 - 0926
New Order Start: 05/04/17 - 2100
05/04/17 1007 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by HMOHAMED Eff: 05/04/17 0928
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD
Last Scheduled Dose: 05/03/17 - 0900
Last Administration: 05/03/17 - 0936
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 05/04/17 - 0926
New Order Start: 05/04/17 - 2100
05/04/17 1007 - VERIFIED by MHAIMOWITZ
Items Dispensed: 16 Doses Dispensed: 4
For: 05/04/17 - 2100
For: 05/05/17 - 2100
For: 05/06/17 - 2100
For: 05/07/17 - 2100
05/04/17 2130 - HOLD/RESUME by RSHARMA
EDIT DOCTOR: SHARMA,RAMAN MD
FROM: 05/04/17-2125
TO: 05/05/17-0700
05/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 2
For: 05/08/17 - 2100
For: 05/09/17 - 2100
05/08/17 0811 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 05/10/17 - 2100
For: 05/11/17 - 2100
05/08/17 1059 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by RSHARMA Eff: 05/04/17 2130
05/08/17 2150 - DISCONTINUE by SVAIDYA Eff: 05/08/17 2148
Items Auto Credited: 12 Doses Auto Credited: 3
For: 05/09/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

For: 05/10/17 - 2100

For: 05/11/17 - 2100
EDIT DOCTOR: VAIDYA, SUDHIR M.D.
05/08/17 2150 - POM COPY AND EDIT by SVAIDYA
TO: Rx #U01397829
05/09/17 0730 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by SVAIDYA Eff: 05/08/17 2150

VLS80C - VALSARTAN 80 MG TAB

Dose 320 MG (4 TABLETS)

Dose Instructions Hold if SBP less than 110
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 05/09/17-2100 Stop Date 06/08/17 2059 DC: 05/11/17-0939
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 8 Total Costs $ Total Charges $
Rx Number 01510711

History
05/08/17 2150 - POM COPY AND EDIT by SVAIDYA
FROM: Rx #01509345
05/09/17 0730 - VERIFIED by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 3
For: 05/09/17 - 2100
For: 05/10/17 - 2100
For: 05/11/17 - 2100
05/10/17 0814 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 3
For: 05/12/17 - 2100
For: 05/13/17 - 2100
For: 05/14/17 - 2100
05/11/17 0940 - DISCONTINUE by VHUANG Eff: 05/11/17 0939
Items Auto Credited: 16 Doses Auto Credited: 4
For: 05/11/17 - 2100
For: 05/12/17 - 2100
For: 05/13/17 - 2100
For: 05/14/17 - 2100
EDIT DOCTOR: HUANG,VINCENT MD
05/11/17 0940 - POM COPY AND EDIT by VHUANG
TO: Rx #U01398628
05/11/17 0941 - REVIEW PROVIDER ACTIVITY by AMOLINARI
by VHUANG Eff: 05/11/17 0940
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

VLS80C - VALSARTAN 80 MG TAB

Dose 320 MG (4 TABLETS)

Dose Instructions Hold if SBP less than 95
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 05/11/17-2100 Stop Date 06/10/17 2059 DC: 05/30/17-1426
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 76 Total Costs $0.00 Total Charges $520.00
Rx Number 01511517

Discontinued Comments DC'd by Discharge

History
05/11/17 0940 - POM COPY AND EDIT by VHUANG
FROM: Rx #01510711
05/11/17 0941 - VERIFIED by AMOLINARI
Items Dispensed: 16 Doses Dispensed: 4
For: 05/11/17 - 2100
For: 05/12/17 - 2100
For: 05/13/17 - 2100
For: 05/14/17 - 2100
05/12/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 05/15/17 - 2100
For: 05/16/17 - 2100
05/15/17 0831 - FILL by JSATTARELL
Items Dispensed: 8 Doses Dispensed: 2
For: 05/17/17 - 2100
For: 05/18/17 - 2100
05/17/17 0854 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 3
For: 05/19/17 - 2100
For: 05/20/17 - 2100
For: 05/21/17 - 2100
05/19/17 0810 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 2
For: 05/22/17 - 2100
For: 05/23/17 - 2100
05/22/17 0820 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 2
For: 05/24/17 - 2100
For: 05/25/17 - 2100
05/24/17 0821 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 3
For: 05/26/17 - 2100
For: 05/27/17 - 2100
For: 05/28/17 - 2100
05/26/17 0806 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 05/29/17 - 2100
For: 05/30/17 - 2100
05/29/17 0824 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

For: 05/31/17 - 2100

For: 06/01/17 - 2100
05/30/17 1427 - DISCONTINUE by DISCHARGE Eff: 05/30/17 1426
Items Auto Credited: 12 Doses Auto Credited: 3
For: 05/30/17 - 2100
For: 05/31/17 - 2100
For: 06/01/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
05/30/17 1427 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED

KTR.5OP5 - KETOROLAC 0.5% OP SOLN 5 ML BTL

Dose 4 DROP (4 DROP APPLICATIONS)

Dose Instructions 4 drops to both eyes daily
Admin Route OPHTHALMIC
Frequency DAILY (SCH)
Start Date 04/28/17-0900 Stop Date 05/28/17 0859 CAN: 04/27/17-1054
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01507333

History
04/27/17 1047 - POM ORDER by VHUANG
04/27/17 1049 - EDIT by AMOLINARI
EDIT DOCTOR: HUANG,VINCENT MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DISPENSE: 1
CHARGE TYPE: BULK - BULK MEDICATIONS
CHARGE: $412.74
LABEL COMMENTS:
TO:
DISPENSE: 0
CHARGE TYPE: PSM - PATIENT'S SELF MEDS
CHARGE: $0.00
LABEL COMMENTS:
PATIENT WILL USE OWN MED
04/27/17 1049 - VERIFIED by AMOLINARI
04/27/17 1054 - CANCEL by AMOLINARI
EDIT DOCTOR: HUANG,VINCENT MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
CANCELLATION COMMENTS:
CHANGED TO NF ENTRY
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

KTR.5OP5 - KETOROLAC 0.5% OP SOLN 5 ML BTL

Dose 4 DROP (4 DROP APPLICATIONS)

Dose Instructions 4 drops to both eyes daily
Admin Route OPHTHALMIC
Frequency 1045 (ONE)
Start Date 04/27/17-1045 Stop Date 04/27/17 1046 CAN: 04/27/17-1054
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01507334

History
04/27/17 1047 - POM ORDER by VHUANG
04/27/17 1049 - EDIT by AMOLINARI
EDIT DOCTOR: HUANG,VINCENT MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DISPENSE: 1
CHARGE TYPE: BULK - BULK MEDICATIONS
CHARGE: $412.74
LABEL COMMENTS:
TO:
DISPENSE: 0
CHARGE TYPE: PSM - PATIENT'S SELF MEDS
CHARGE: $0.00
LABEL COMMENTS:
PATIENT WILL USE OWN MED
04/27/17 1049 - VERIFIED by AMOLINARI
04/27/17 1049 - DISCONTINUE by PHABKGJOB Eff: 04/27/17 1046
DC COMMENTS:
Reached Stop Date
04/27/17 1054 - CANCEL by AMOLINARI
EDIT DOCTOR: HUANG,VINCENT MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
CANCELLATION COMMENTS:
CHANGED TO NF ENTRY
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 83
Run Time 1513 PHA Profile

BROUTMAN,SHELDON W00001219645 (Continued)

KTR.5OP5 - KETOROLAC 0.5% OP SOLN 5 ML BTL

Dose 4 DROP (4 DROP APPLICATIONS)

Admin Route OPHTHALMIC
Frequency DAILY (SCH)
Start Date 04/28/17-0900 Stop Date 05/28/17 0859 CAN: 04/27/17-1712
Ordering Doctor CORDOVA,ANDREA MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01394830

History
04/27/17 1647 - POM ORDER by ACORDOVA
04/27/17 1712 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: CORDOVA,ANDREA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
CANCELLATION COMMENTS:
DUPLICATE ORDER

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 2.5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/04/17-0900 Stop Date 06/03/17 0859 CAN: 05/03/17-1021
Ordering Doctor HUANG,VINCENT MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01396187

History
05/03/17 1007 - POM COPY AND EDIT by VHUANG
FROM: Rx #01508578
05/03/17 1021 - CANCEL by EBALILO
EDIT DOCTOR: HUANG,VINCENT MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
CANCELLATION COMMENTS:
CHANGED TO USE 2.5MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CALIDONIO,MANUEL A Responsible Doctor AMBROSE,ANNE MD

Account Number W00001219561 Location B2WEII Unit Number M000209393
Age/Sex 38/M Room 252 Registered Date 08/31/17
Status ADM IN Bed 02 Discharged Date

Height 6 ft 0.01 in 182.9 cm Body Surface Area 2.29 m2

Weight 238 lb 1.6 oz 108 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: L HEMISPERIS SAH SDH
Secondary Diagnosis:

OFLO5DRO2 - OFLOXACIN 0.3% OTIC 5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions apply to R ear daily
Admin Route OTIC
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/08/17 0859
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Clinical Indication EMPIRIC THERAPY
Total Dispensed 1 Total Costs $0.00 Total Charges $222.00
Rx Number 01541738

History
08/31/17 1618 - POM ORDER by YOLEE
08/31/17 1623 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0900

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01541774

History
08/31/17 1639 - POM ORDER by YOLEE
08/31/17 1641 - VERIFIED by AMACCA
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

CALIDONIO,MANUEL A W00001219561 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541777

History
08/31/17 1639 - POM ORDER by YOLEE
08/31/17 1641 - VERIFIED by AMACCA
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01541773

History
08/31/17 1638 - POM ORDER by YOLEE
08/31/17 1641 - VERIFIED by AMACCA
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CALIDONIO,MANUEL A W00001219561 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 10 Total Costs $0.00 Total Charges $0.10
Rx Number 01541737

History
08/31/17 1618 - POM ORDER by YOLEE
08/31/17 1623 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541776

History
08/31/17 1639 - POM ORDER by YOLEE
08/31/17 1641 - VERIFIED by AMACCA
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CALIDONIO,MANUEL A W00001219561 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541775

History
08/31/17 1639 - POM ORDER by YOLEE
08/31/17 1641 - VERIFIED by AMACCA
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CAMINITI,JOSEPH S Responsible Doctor ELASHVILI, MERY

Account Number W00001219115 Location B2EA Unit Number M000205075
Age/Sex 76/M Room 215 Registered Date 08/15/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.99 in 172.7 cm Body Surface Area 1.79 m2

Weight 146 lb 11.2 oz 66.542 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/15/17-1627 DRUG - DRUG INTERACTION COMPLETE
08/15/17-1630 OTHER COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions on medial wrist right side
Admin Route TOPICALLY
Frequency DAILY@0700 (SCH)
Start Date 08/26/17-0700 Stop Date 09/25/17 0659
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01540005

History
08/25/17 1105 - POM ORDER by YCHO
08/25/17 1246 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 08/26/17 - 0700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/15/17-1445 Stop Date 09/14/17 1444
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01536990

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1516 - VERIFIED by EBALILO
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY@0700,1200 (SCH)
Start Date 08/25/17-1200 Stop Date 09/24/17 1159
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $4.50
Rx Number 01540004

History
08/25/17 1105 - POM ORDER by YCHO
08/25/17 1245 - VERIFIED by AMOLINARI
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 1200
For: 08/31/17 - 0700
For: 08/31/17 - 1200
For: 09/01/17 - 0700
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 1200
For: 09/02/17 - 0700
For: 09/02/17 - 1200
For: 09/03/17 - 0700
For: 09/03/17 - 1200
For: 09/04/17 - 0700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 1200
For: 09/05/17 - 0700
For: 09/05/17 - 1200
For: 09/06/17 - 0700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/15/17-1700 Stop Date 09/14/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 29 Total Costs $0.00 Total Charges $420.68
Rx Number 01536997

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1518 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/15/17 - 1700
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

08/28/17 0816 - FILL by BGIRLING

Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/29/17 1725 - HOLD by MELASHVI Eff: 08/29/17 1724
EDIT DOCTOR: ELASHVILI, MERY
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/29/17 1752 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Hold/Resume by MELASHVI Eff: 08/29/17 1725
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/17/17-2100 Stop Date 09/16/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 20 Total Costs $0.00 Total Charges $512.25
Rx Number 01537523

History
08/17/17 1030 - POM ORDER by MELASHVI
08/17/17 1031 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 2100
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/15/17-1445 Stop Date 09/14/17 1444
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01536992

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1516 - VERIFIED by EBALILO
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 1,000 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 14 Total Costs $0.00 Total Charges $0.96
Rx Number 01538917

History
08/22/17 1047 - POM ORDER by YCHO
08/22/17 1050 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/15/17-1700 Stop Date 09/14/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01536991

History
08/15/17 1459 - POM ORDER by MELASHVI
08/15/17 1516 - VERIFIED by EBALILO
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 1700
For: 08/19/17 - 1700
For: 08/20/17 - 1700
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 1700
For: 08/22/17 - 1700
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1700
For: 08/24/17 - 1700
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/16/17-0900 Stop Date 09/15/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $4.75
Rx Number 01536993

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1516 - VERIFIED by EBALILO
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

FLX10C - FLUOXETINE HCL 10 MG CAP

Dose 20 MG (2 CAPSULES)
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/28/17-1800 Stop Date 09/27/17 1759
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $4.20
Rx Number 01540652

History
08/28/17 1250 - POM COPY AND EDIT by YCHO
FROM: Rx #01540090
08/28/17 1256 - VERIFIED by YLEE
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 1800
For: 08/29/17 - 1800
For: 08/30/17 - 1800
For: 08/31/17 - 1800
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1800
For: 09/02/17 - 1800
For: 09/03/17 - 1800
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1800
For: 09/05/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/15/17-1445 Stop Date 09/14/17 1444
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536995

History
08/15/17 1459 - POM ORDER by MELASHVI
08/15/17 1517 - VERIFIED by EBALILO
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/15/17-1445 Stop Date 09/14/17 1444
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536994

History
08/15/17 1459 - POM ORDER by MELASHVI
08/15/17 1517 - VERIFIED by EBALILO
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MTHL5T - METHYLPHENIDATE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@0800 (SCH)
Start Date 08/30/17-0800 Stop Date 09/05/17 0759
Ordering Doctor ELASHVILI, MERY
Total Dispensed 4 Total Costs $0.00 Total Charges $1.25
Rx Number 01541018

History
08/29/17 1456 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01540986
Result of Frequency/Schedule Edit
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 08/30/17 - 0800
Last Actual Administration Time:
Old Freq/Sch: DAILY@0800,1200 (SCH)
New Freq/Sch: DAILY@0800 (SCH)
Old Order Stop: 08/30/17 - 0800
New Order Start: 08/30/17 - 0800
New Order Stop: 09/05/17 - 0759
08/29/17 1459 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by MELASHVI Eff: 08/29/17 1456
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 08/30/17 - 0800
Last Actual Administration Time:
Old Freq/Sch: DAILY@0800,1200 (SCH)
New Freq/Sch: DAILY@0800 (SCH)
Old Order Stop: 08/30/17 - 0800
New Order Start: 08/30/17 - 0800
New Order Stop: 09/05/17 - 0759
08/29/17 1459 - VERIFIED by MHAIMOWITZ
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/16/17-0900 Stop Date 09/15/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $4.75
Rx Number 01537004

History
08/15/17 1529 - ENTER by EBALILO
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 40 MG (2 CAPSULE DELAYED RELEASES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/15/17 0759
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 14 Total Costs $0.00 Total Charges $8.75
Rx Number 01541206

History
08/29/17 1812 - POM COPY AND EDIT by YCHO
FROM: Rx #01541204
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/30/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/30/17 - 0900
New Order Start: 08/30/17 - 0900
New Order Stop: 09/15/17 - 0759
08/29/17 1817 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by YCHO Eff: 08/29/17 1812
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/30/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/30/17 - 0900
New Order Start: 08/30/17 - 0900
New Order Stop: 09/15/17 - 0759
08/29/17 1817 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/15/17-2100 Stop Date 09/16/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $3.75
Rx Number 01536996

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1517 - VERIFIED by EBALILO
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/18/17-1800 Stop Date 09/14/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 38 Total Costs $0.00 Total Charges $272.30
Rx Number 01537983

History
08/18/17 1219 - POM COPY AND EDIT by YCHO
FROM: Rx #01537003
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/17/17 - 2100
Last Actual Administration Time: 08/17/17 - 2057 (Not Given)
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: DAILY@1800 (SCH)
Old Order Stop: 08/18/17 - 1217
New Order Start: 08/18/17 - 1800
New Order Stop: 09/14/17 - 2059
08/18/17 1220 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by YCHO Eff: 08/18/17 1219
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/17/17 - 2100
Last Actual Administration Time: 08/17/17 - 2057 (Not Given)
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: DAILY@1800 (SCH)
Old Order Stop: 08/18/17 - 1217
New Order Start: 08/18/17 - 1800
New Order Stop: 09/14/17 - 2059
08/18/17 1220 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 08/18/17 - 1800
For: 08/19/17 - 1800
For: 08/20/17 - 1800
For: 08/21/17 - 1800
For: 08/22/17 - 1800
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1800
For: 08/24/17 - 1800
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1800
For: 08/26/17 - 1800
For: 08/27/17 - 1800
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1800
For: 08/29/17 - 1800
08/28/17 0816 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

Items Dispensed: 4 Doses Dispensed: 2

For: 08/30/17 - 1800
For: 08/31/17 - 1800
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1800
For: 09/02/17 - 1800
For: 09/03/17 - 1800
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1800
For: 09/05/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AMN50480 - AMANTADINE SYRUP 50 MG/5 ML 480 ML ML

Dose 10 ML (10 MLS)

Admin Route ORAL
Frequency DAILY@0700 (SCH)
Start Date 07/06/17-0700 Stop Date 07/14/17 1406 DC: 07/14/17-1406
Ordering Doctor ELASHVILI, MERY
Total Dispensed 90 Total Costs $0.00 Total Charges $16.20
Rx Number 01526024

History
07/05/17 1012 - POM ORDER by MELASHVI
07/05/17 1107 - EDIT by AMACCA
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
BULK: Y
DISPENSE: 1
CHARGE: $86.40
TO:
BULK: N
DISPENSE: 60
CHARGE: $1.80
07/05/17 1107 - VERIFIED by AMACCA
Items Dispensed: 60 Doses Dispensed: 6
For: 07/06/17 - 0700
07/12/17 0735 - DEBIT by AMOLINARI
ITEMS: 30 DOSES: 3
07/14/17 1409 - EDIT by MELASHVI
EDIT DOCTOR: ELASHVILI, MERY
FROM:
START: 07/06/17-0700 STOP: 08/05/17 0659 SOFT STOP: 0
DISPENSE: 30
TO:
START: 07/06/17-0700 STOP: 07/14/17-1406 SOFT STOP:
DISPENSE: 90
07/14/17 1409 - DISCONTINUE by MELASHVI Eff: 07/14/17 1406
EDIT DOCTOR: ELASHVILI, MERY
07/14/17 1409 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01415342
07/14/17 1417 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by MELASHVI Eff: 07/14/17 1409
Discontinue by MELASHVI Eff: 07/14/17 1409
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AMN50480 - AMANTADINE SYRUP 50 MG/5 ML 480 ML ML

Dose 10 ML (10 MLS)

Admin Route ORAL
Frequency 1010 (ONE)
Start Date 07/05/17-1010 Stop Date 07/05/17 1011 DC: 07/05/17-1011
Ordering Doctor ELASHVILI, MERY
Total Dispensed 10 Total Costs $0.00 Total Charges $1.80
Rx Number 01526023

Discontinued Comments Reached Stop Date

History
07/05/17 1012 - POM ORDER by MELASHVI
07/05/17 1107 - EDIT by AMACCA
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
BULK: Y
DISPENSE: 1
CHARGE: $86.40
TO:
BULK: N
DISPENSE: 10
CHARGE: $1.80
07/05/17 1107 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 1
For: 07/05/17 - 1010
07/05/17 1107 - DISCONTINUE by PHABKGJOB Eff: 07/05/17 1011
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AMN50480 - AMANTADINE SYRUP 50 MG/5 ML 480 ML ML

Dose 10 ML (10 MLS)

Admin Route ORAL
Frequency DAILY@0700,1200 (SCH)
Start Date 07/15/17-0700 Stop Date 08/05/17 0659 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01528761

Discontinued Comments DC'd by Discharge

History
07/14/17 1409 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01526024
Result of Frequency/Schedule Edit
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 07/14/17 - 0700
Last Actual Administration Time: 07/14/17 - 0549
Old Freq/Sch: DAILY@0700 (SCH)
New Freq/Sch: DAILY@0700,1200 (SCH)
Old Order Stop: 07/14/17 - 1406
New Order Start: 07/15/17 - 0700
New Order Stop: 08/05/17 - 0659
07/14/17 1417 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by MELASHVI Eff: 07/14/17 1409
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 07/14/17 - 0700
Last Actual Administration Time: 07/14/17 - 0549
Old Freq/Sch: DAILY@0700 (SCH)
New Freq/Sch: DAILY@0700,1200 (SCH)
Old Order Stop: 07/14/17 - 1406
New Order Start: 07/15/17 - 0700
New Order Stop: 08/05/17 - 0659
07/14/17 1417 - VERIFIED by AMACCA
Items Dispensed: 480 Doses Dispensed: 1
For: 07/15/17 - 0700
07/14/17 1417 - CREDIT by AMACCA
ITEMS: 1
07/19/17 1306 - DEBIT by AMACCA
ITEMS: 1
07/19/17 1306 - CREDIT by AMACCA
ITEMS: 1
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 2 GM (2 GEL APPLICATIONS)

Admin Route TOPICALLY
Frequency 3 TIMES A DAY (SCH)
Start Date 07/03/17-1300 Stop Date 08/02/17 1259 DC: 07/12/17-1114
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $108.60
Rx Number 01525625

History
07/03/17 1156 - POM ORDER by MELASHVI
07/03/17 1200 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/03/17 - 1300
07/12/17 1115 - DISCONTINUE by MELASHVI Eff: 07/12/17 1114
EDIT DOCTOR: ELASHVILI, MERY
07/12/17 1115 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01414594
07/12/17 1204 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by MELASHVI Eff: 07/12/17 1115

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 2 GM (2 GEL APPLICATIONS)

Dose Instructions right U/LE
Admin Route TOPICALLY
Frequency 3 TIMES A DAY (SCH)
Start Date 07/12/17-1300 Stop Date 08/11/17 1259 DC: 07/13/17-1113
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01527985

History
07/12/17 1115 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01525625
07/12/17 1204 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/12/17 - 1300
07/12/17 1204 - CREDIT by AMOLINARI
ITEMS: 1
07/13/17 1118 - DISCONTINUE by SONUOHA Eff: 07/13/17 1113
EDIT DOCTOR: ONUOHA,SOMECHUKWU MD PGY-3
07/13/17 1118 - POM COPY AND EDIT by SONUOHA
TO: Rx #U01414959
07/14/17 0727 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SONUOHA Eff: 07/13/17 1118
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 2 GM (2 GEL APPLICATIONS)

Dose Instructions right U/LE, Right LE(Hip, knee, lateral thigh)
Admin Route TOPICALLY
Frequency 3 TIMES A DAY (SCH)
Start Date 07/13/17-1300 Stop Date 07/14/17 1406 DC: 07/14/17-1406
Ordering Doctor ONUOHA,SOMECHUKWU MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $108.60
Rx Number 01528357

History
07/13/17 1118 - POM COPY AND EDIT by SONUOHA
FROM: Rx #01527985
07/13/17 1121 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/13/17 - 1300
07/14/17 1409 - DISCONTINUE by MELASHVI Eff: 07/14/17 1406
EDIT DOCTOR: ELASHVILI, MERY
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
07/14/17 1409 - EDIT by MELASHVI
EDIT DOCTOR: ELASHVILI, MERY
FROM:
START: 07/13/17-1300 STOP: 08/12/17 1259 SOFT STOP: 0
TO:
START: 07/13/17-1300 STOP: 07/14/17-1406 SOFT STOP:
07/14/17 1409 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01415343
07/14/17 1417 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by MELASHVI Eff: 07/14/17 1409
Discontinue by MELASHVI Eff: 07/14/17 1409
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 2 GM (2 GEL APPLICATIONS)

Dose Instructions right U/LE, Right LE(Hip, knee, lateral thigh)
Admin Route TOPICALLY
Frequency 3 TIMES A DAY (SCH)
Start Date 07/14/17-1700 Stop Date 08/12/17 1259 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 2 Total Costs $0.00 Total Charges $217.20
Rx Number 01528762

Discontinued Comments DC'd by Discharge

History
07/14/17 1409 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01528357
Result of Frequency/Schedule Edit
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 07/14/17 - 1300
Last Actual Administration Time: 07/14/17 - 1319
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 07/14/17 - 1406
New Order Start: 07/14/17 - 1700
New Order Stop: 08/12/17 - 1259
07/14/17 1418 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by MELASHVI Eff: 07/14/17 1409
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 07/14/17 - 1300
Last Actual Administration Time: 07/14/17 - 1319
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 07/14/17 - 1406
New Order Start: 07/14/17 - 1700
New Order Stop: 08/12/17 - 1259
07/14/17 1418 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/14/17 - 1700
07/21/17 1059 - DEBIT by AMOLINARI
ITEMS: 1
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

FLUO20SO8 - FLUOXETINE HCL 20 MG/5 ML 120 ML ML

Dose 2.5 ML (2.5 MLS)

Admin Route ORAL
Frequency DAILY@1700 (SCH)
Start Date 07/03/17-1700 Stop Date 08/02/17 1659 DC: 07/14/17-1406
Ordering Doctor ELASHVILI, MERY
Total Dispensed 120 Total Costs $0.00 Total Charges $370.80
Rx Number 01525717

Warnings
Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DAY (Dose Units).

Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DOSE (Dose Units).

Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DAY (Dose Units).

History
07/03/17 1521 - ENTER by AADEGBAMIG
Items Dispensed: 120 Doses Dispensed: 1
For: 07/03/17 - 1700
07/14/17 1409 - DISCONTINUE by MELASHVI Eff: 07/14/17 1406
EDIT DOCTOR: ELASHVILI, MERY
07/14/17 1409 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01415344
07/14/17 1418 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 07/14/17 1409
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

FLUO20SO8 - FLUOXETINE HCL 20 MG/5 ML 120 ML ML

Dose 5 ML (5 MLS)
Admin Route ORAL
Frequency DAILY@1700 (SCH)
Start Date 07/14/17-1700 Stop Date 08/13/17 1659 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01528763

Warnings
Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DAY (Dose Units).

Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DOSE (Dose Units).

Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DAY (Dose Units).

Discontinued Comments DC'd by Discharge

History
07/14/17 1409 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01525717
07/14/17 1418 - VERIFIED by AMACCA
Items Dispensed: 120 Doses Dispensed: 1
For: 07/14/17 - 1700
07/14/17 1418 - CREDIT by AMACCA
ITEMS: 1
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Admin Route SUBCUTAN.

Frequency 4 TIMES A DAY (SCH)
Start Date 06/26/17-1700 Stop Date 07/26/17 1659 DC: 06/26/17-1728
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $134.43
Rx Number 01523852

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1657 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 06/26/17 - 1700
06/26/17 1733 - DISCONTINUE by MELASHVI Eff: 06/26/17 1728
EDIT DOCTOR: ELASHVILI, MERY
06/26/17 1733 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01410641
06/26/17 1734 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 06/26/17 1733

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Dose 1 UNIT (0.01 ML)

Admin Route SUBCUTAN.
Frequency 4 TIMES A DAY (SCH)
Start Date 06/26/17-2100 Stop Date 07/26/17 2059 DC: 06/26/17-2100
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $134.43
Rx Number 01523874

History
06/26/17 1733 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01523852
06/26/17 1735 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 06/26/17 - 2100
06/26/17 1846 - DISCONTINUE by MELASHVI Eff: 06/26/17 2100
EDIT DOCTOR: ELASHVILI, MERY
06/26/17 1846 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01410672
06/27/17 1056 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by MELASHVI Eff: 06/26/17 1846
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Dose 1 UNIT (0.01 ML)

Dose Instructions hold if BS<90
Admin Route SUBCUTAN.
Frequency 4 TIMES A DAY (SCH)
Start Date 06/26/17-2100 Stop Date 07/26/17 2059 DC: 07/24/17-1154
Ordering Doctor ELASHVILI, MERY
Total Dispensed 2 Total Costs $0.00 Total Charges $268.86
Rx Number 01523904

History
06/26/17 1846 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01523874
06/26/17 1849 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 06/26/17 - 2100
07/16/17 1822 - HOLD/RESUME by SBARRY
EDIT DOCTOR: BARRY,STEVEN
FROM: 07/16/17-1821
TO: 07/17/17-0800
HOLD/RESUME COMMENTS
pt lethargic blood sugar 112
07/18/17 0737 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by SBARRY Eff: 07/16/17 1822
pt lethargic blood sugar 112
07/24/17 0823 - DEBIT by MHAIMOWITZ
ITEMS: 1
07/24/17 1155 - DISCONTINUE by YCHO Eff: 07/24/17 1154
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/24/17 1155 - POM COPY AND EDIT by YCHO
TO: Rx #U01417343
07/24/17 1234 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 07/24/17 1155
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Dose 1 UNIT (0.01 ML)

Dose Instructions hold if BS<90
Admin Route SUBCUTAN.
Frequency 1845 (ONE)
Start Date 06/26/17-1845 Stop Date 06/26/17 1846 DC: 06/26/17-1846
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $134.43
Rx Number 01523905

Discontinued Comments Reached Stop Date

History
06/26/17 1846 - POM ORDER by MELASHVI
06/26/17 1849 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 06/26/17 - 1845
06/26/17 1850 - DISCONTINUE by PHABKGJOB Eff: 06/26/17 1846
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Dose 1 UNIT (0.01 ML)

Dose Instructions hold if BS<90
Admin Route SUBCUTAN.
Frequency 4 TIMES A DAY (SCH)
Start Date 07/24/17-1300 Stop Date 08/23/17 1259 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530874

Discontinued Comments DC'd by Discharge

History
07/24/17 1155 - POM COPY AND EDIT by YCHO
FROM: Rx #01523904
07/24/17 1231 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-1300 STOP: 08/23/17 SOFT STOP:
DISPENSE: 1
TO:
START: 07/24/17-1300 STOP: 08/23/17-1259 SOFT STOP: 0
DISPENSE: 0
07/24/17 1231 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by JDWARKA Eff: 07/24/17 1224
07/24/17 1231 - VERIFIED by MHAIMOWITZ
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

IPRA4AER - IPRATROPIUM/ALBUTEROL (COMBIVENT) RESPIMAT INHALER

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency 4 TIMES A DAY (SCH)
Start Date 06/26/17-1700 Stop Date 07/26/17 1659 DC: 06/26/17-1728
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $865.26
Rx Number 01523850

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1657 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 06/26/17 - 1700
06/26/17 1733 - DISCONTINUE by MELASHVI Eff: 06/26/17 1728
EDIT DOCTOR: ELASHVILI, MERY
06/26/17 1734 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 06/26/17 1733

IPRA4AER - IPRATROPIUM/ALBUTEROL (COMBIVENT) RESPIMAT INHALER

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency 4 TIMES A DAY (PRN) PRN REASON: sob
Start Date 06/26/17-1730 Stop Date 07/26/17 1729 DC: 07/24/17-1154
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $865.26
Rx Number 01523873

History
06/26/17 1733 - POM ORDER by MELASHVI
06/26/17 1735 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 06/26/17 - 1730
07/24/17 1155 - DISCONTINUE by YCHO Eff: 07/24/17 1154
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/24/17 1155 - POM COPY AND EDIT by YCHO
TO: Rx #U01417344
07/24/17 1235 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 07/24/17 1155
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

IPRA4AER - IPRATROPIUM/ALBUTEROL (COMBIVENT) RESPIMAT INHALER

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency 4 TIMES A DAY (PRN) PRN REASON: sob
Start Date 07/24/17-1200 Stop Date 08/23/17 1159 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530879

Discontinued Comments DC'd by Discharge

History
07/24/17 1155 - POM COPY AND EDIT by YCHO
FROM: Rx #01523873
07/24/17 1235 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-1200 STOP: 08/23/17 SOFT STOP:
DISPENSE: 1
TO:
START: 07/24/17-1200 STOP: 08/23/17-1159 SOFT STOP: 0
DISPENSE: 0
07/24/17 1235 - VERIFIED by MHAIMOWITZ
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

LEVA0.63 - LEVALBUTEROL HCL 0.63 MG/3 ML VIAL

Dose 0.63 MG (3 ML)

Admin Route NEBULIZER
Frequency EVERY 6 HOURS (SCH)
Start Date 06/26/17-1800 Stop Date 07/26/17 1759 DC: 07/24/17-1154
Ordering Doctor ELASHVILI, MERY
Total Dispensed 96 Total Costs $0.00 Total Charges $1779.84
Rx Number 01523847

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1657 - VERIFIED by AMACCA
Items Dispensed: 12 Doses Dispensed: 1
For: 06/26/17 - 1800
06/27/17 1335 - DEBIT by MHAIMOWITZ
ITEMS: 1
07/02/17 1042 - DEBIT by AADEGBAMIG
ITEMS: 1
07/05/17 0748 - DEBIT by AMOLINARI
ITEMS: 1
07/10/17 0741 - DEBIT by AMOLINARI
ITEMS: 1
07/13/17 0755 - DEBIT by AMOLINARI
ITEMS: 1
07/18/17 0737 - DEBIT by AMOLINARI
ITEMS: 1
07/22/17 1024 - DEBIT by AADEGBAMIG
ITEMS: 1
07/24/17 1155 - DISCONTINUE by YCHO Eff: 07/24/17 1154
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/24/17 1155 - POM COPY AND EDIT by YCHO
TO: Rx #U01417345
07/24/17 1235 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 07/24/17 1155
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

LEVA0.63 - LEVALBUTEROL HCL 0.63 MG/3 ML VIAL

Dose 0.63 MG (3 ML)

Admin Route NEBULIZER
Frequency EVERY 6 HOURS (SCH)
Start Date 07/24/17-1200 Stop Date 08/23/17 1159 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530875

Discontinued Comments DC'd by Discharge

History
07/24/17 1155 - POM COPY AND EDIT by YCHO
FROM: Rx #01523847
07/24/17 1232 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-1200 STOP: 08/23/17 SOFT STOP:
DISPENSE: 1
TO:
START: 07/24/17-1200 STOP: 08/23/17-1159 SOFT STOP: 0
DISPENSE: 0
07/24/17 1232 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by JDWARKA Eff: 07/24/17 1224
07/24/17 1232 - VERIFIED by MHAIMOWITZ
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions to the right wrist
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 07/03/17-2100 Stop Date 08/02/17 2059 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 25 Total Costs $0.00 Total Charges $551.25
Rx Number 01525624

Discontinued Comments DC'd by Discharge

History
07/03/17 1156 - POM ORDER by MELASHVI
07/03/17 1200 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 07/03/17 - 2100
07/10/17 0741 - DEBIT by AMOLINARI
ITEMS: 1
07/13/17 0755 - DEBIT by AMOLINARI
ITEMS: 1
07/16/17 1030 - DEBIT by MHAIMOWITZ
ITEMS: 1
07/19/17 0738 - DEBIT by AMOLINARI
ITEMS: 1
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 3 EA (0 EACHS)
Admin Route ORAL
Frequency 7 TIMES A DAY (SCH)
Start Date 06/27/17-1500 Stop Date 07/27/17 1459 DC: 07/03/17-1213
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01524057

History
06/27/17 1352 - POM ORDER by MELASHVI
06/27/17 1354 - EDIT by MHAIMOWITZ
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
TO:
ORDER TYPE: BULK - BULK ORDER
06/27/17 1354 - VERIFIED by MHAIMOWITZ
07/03/17 1216 - DISCONTINUE by MELASHVI Eff: 07/03/17 1213
EDIT DOCTOR: ELASHVILI, MERY
07/03/17 1216 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01412328
07/03/17 1223 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by MELASHVI Eff: 07/03/17 1216
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 3 EA (0 EACHS)
Admin Route ORAL
Frequency 7 TIMES A DAY (SCH)
Start Date 07/03/17-1500 Stop Date 08/02/17 1459 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01525636

Discontinued Comments DC'd by Discharge

History
07/03/17 1216 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01524057
07/03/17 1223 - EDIT by AMOLINARI
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
LABEL COMMENTS:
TO:
ORDER TYPE: BULK - BULK ORDER
LABEL COMMENTS:
(any liquids 3 OZ)
07/03/17 1223 - VERIFIED by AMOLINARI
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

SLFL50250 - SALMETEROL XINAF/FLUTICASONE 50-250 MCG/DOSE DISKUS

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 06/26/17-1700 Stop Date 07/26/17 1659 DC: 07/24/17-1154
Ordering Doctor ELASHVILI, MERY
Total Dispensed 4 Total Costs $0.00 Total Charges $1114.68
Rx Number 01523846

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1656 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 06/26/17 - 1700
07/04/17 1009 - DEBIT by EBALILO
ITEMS: 1
07/11/17 1125 - DEBIT by AADEGBAMIG
ITEMS: 1
07/20/17 1755 - DEBIT by MHAIMOWITZ
ITEMS: 1
07/24/17 1155 - DISCONTINUE by YCHO Eff: 07/24/17 1154
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/24/17 1155 - POM COPY AND EDIT by YCHO
TO: Rx #U01417349
07/24/17 1238 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 07/24/17 1155
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

SLFL50250 - SALMETEROL XINAF/FLUTICASONE 50-250 MCG/DOSE DISKUS

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 07/24/17-1700 Stop Date 08/23/17 1659 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530880

Discontinued Comments DC'd by Discharge

History
07/24/17 1155 - POM COPY AND EDIT by YCHO
FROM: Rx #01523846
07/24/17 1237 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-1700 STOP: 08/23/17 SOFT STOP:
DISPENSE: 1
TO:
START: 07/24/17-1700 STOP: 08/23/17-1659 SOFT STOP: 0
DISPENSE: 0
07/24/17 1237 - VERIFIED by MHAIMOWITZ
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions to the coccix
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 06/30/17-2100 Stop Date 07/07/17 2059 DC: 07/05/17-1015
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01525125

History
06/30/17 1649 - POM ORDER by MELASHVI
06/30/17 1653 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 06/30/17 - 2100
07/05/17 1016 - DISCONTINUE by MELASHVI Eff: 07/05/17 1015
EDIT DOCTOR: ELASHVILI, MERY
07/05/17 1016 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01412711
07/05/17 1105 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 07/05/17 1016
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions to the coccix
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 07/05/17-2100 Stop Date 07/12/17 2059 DC: 07/12/17-2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01526022

Discontinued Comments Reached Stop Date

History
07/05/17 1016 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01525125
07/05/17 1105 - EDIT by AMACCA
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/05/17-2100 STOP: 07/12/17 SOFT STOP:
TO:
START: 07/05/17-2100 STOP: 07/12/17-2059 SOFT STOP:
07/05/17 1105 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/05/17 - 2100
07/12/17 2100 - DISCONTINUE by PHABKGJOB Eff: 07/12/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

D5500 - DEXTROSE 5% 500 ML BAG - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 06/27/17-1400 Stop Date 06/28/17 1959 DC: 06/27/17-1504
Ordering Doctor ELASHVILI, MERY
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $15.75
Rx Number 01524055

History
06/27/17 1348 - POM ORDER by MELASHVI
06/27/17 1351 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 06/27/17 - 1400
For: 06/28/17 - 0000
For: 06/28/17 - 1000
06/27/17 1510 - DISCONTINUE by MELASHVI Eff: 06/27/17 1504
Items Auto Credited: 2 Doses Auto Credited: 2
For: 06/28/17 - 0000
For: 06/28/17 - 1000
EDIT DOCTOR: ELASHVILI, MERY
06/27/17 1510 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01410870
06/29/17 1348 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 06/27/17 1510
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

D5500 - DEXTROSE 5% 500 ML BAG - 500 ML

Site
Total Volume 500 MLS Rate 75 MLS/HR Duration 0 SEC
Frequency (SCH)
Start Date 06/27/17-1504 Stop Date None DC: 06/27/17-1552
Ordering Doctor ELASHVILI, MERY
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01524161

History
06/27/17 1510 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01524055
Last Scheduled Administration Time: 06/27/17 - 1400
Last Actual Administration Time: 06/27/17 - 1430
Old Total Bags: 3
New Total Bags: (Defaulted Remaining Bags)
06/27/17 1552 - DISCONTINUE by AADEGBAMIG Eff: 06/27/17 1552
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
06/27/17 1552 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

D5500 - DEXTROSE 5% 500 ML BAG - 500 ML

Site
Total Volume 500 MLS Rate 75 MLS/HR Duration 6 HR 40 MIN
Frequency .Q6H40M (SCH)
Start Date 06/27/17-1600 Stop Date 06/30/17 1559 DC: 06/30/17-1559
Ordering Doctor ELASHVILI, MERY
Last Bag 11
Total Dispensed 11 Total Costs $0.00 Total Charges $157.50
Rx Number 01524160

Discontinued Comments Reached Stop Date

History
06/27/17 1551 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 06/27/17 - 1600
For: 06/27/17 - 2240
For: 06/28/17 - 0520
For: 06/28/17 - 1200
06/28/17 0946 - FILL by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 06/28/17 - 1840
For: 06/29/17 - 0120
For: 06/29/17 - 0800
For: 06/29/17 - 1440
06/29/17 1019 - FILL by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 06/29/17 - 2120
For: 06/30/17 - 0400
For: 06/30/17 - 1040
06/30/17 1559 - DISCONTINUE by PHABKGJOB Eff: 06/30/17 1559
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

D5500 - DEXTROSE 5% 500 ML BAG - 500 ML

Site
Total Volume 500 MLS Rate 75 MLS/HR Duration 6 HR 40 MIN
Frequency .Q6H40M (SCH)
Start Date 07/07/17-1300 Stop Date 07/08/17 1539 DC: 07/08/17-1539
Ordering Doctor ELASHVILI, MERY
Last Bag 4
Total Dispensed 4 Total Costs $0.00 Total Charges $63.00
Rx Number 01526690

Discontinued Comments Reached Stop Date

History
07/07/17 1302 - POM ORDER by MELASHVI
07/07/17 1307 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 07/07/17 - 1300
For: 07/07/17 - 1940
For: 07/08/17 - 0220
For: 07/08/17 - 0900
07/08/17 1539 - DISCONTINUE by PHABKGJOB Eff: 07/08/17 1539
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

D5500 - DEXTROSE 5% 500 ML BAG - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 07/21/17-1600 Stop Date 07/22/17 1159 DC: 07/22/17-1159
Ordering Doctor CHO,YUSIK MD PGY-2
Last Bag 2
Total Dispensed 2 Total Costs $0.00 Total Charges $31.50
Rx Number 01530442

Discontinued Comments Reached Stop Date

History
07/21/17 1559 - ENTER by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 2
For: 07/21/17 - 1600
For: 07/22/17 - 0200
07/22/17 1200 - DISCONTINUE by PHABKGJOB Eff: 07/22/17 1159
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

D5500 - DEXTROSE 5% 500 ML BAG - 1,000 ML

Site
Total Volume 1,000 MLS Rate 50 MLS/HR Duration 20 HR
Frequency .Q20H (ONE)
Start Date 07/22/17-1830 Stop Date 07/23/17 1429 DC: 07/23/17-1429
Ordering Doctor AZIZI,HANA MD
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $31.50
Rx Number 01530721

Discontinued Comments Reached Stop Date

History
07/22/17 1816 - ENTER by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/22/17 - 1830
07/23/17 1429 - DISCONTINUE by PHABKGJOB Eff: 07/23/17 1429
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 06/26/17-1645 Stop Date 07/21/17 1159 DC: 07/21/17-1159
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01523839

Discontinued Comments Reached Stop Date

History
06/26/17 1635 - POM ORDER by MELASHVI
06/26/17 1656 - VERIFIED by AMACCA
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 1108 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 06/26/17-1645 STOP: 07/26/17 1644 SOFT STOP: 0
TO:
START: 06/26/17-1645 STOP: 07/21/17-1200 SOFT STOP:
07/21/17 1108 - POM COPY AND EDIT by YCHO
TO: Rx #U01416855
07/21/17 1130 - EDIT by AMOLINARI
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 06/26/17-1645 STOP: 07/21/17 1200 SOFT STOP:
TO:
START: 06/26/17-1645 STOP: 07/21/17-1159 SOFT STOP: 0
07/21/17 1130 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YCHO Eff: 07/21/17 1108
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

07/21/17 1159 - DISCONTINUE by PHABKGJOB Eff: 07/21/17 1159

FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 6 HOURS (SCH)
Start Date 07/21/17-1200 Stop Date 07/26/17 1644 DC: 07/24/17-1154
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $2.75
Rx Number 01530316

History
07/21/17 1108 - POM COPY AND EDIT by YCHO
FROM: Rx #01523839
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 07/19/17 - 2105
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 6 HOURS (SCH)
Old Order Stop: 07/21/17 - 1200
New Order Start: 07/21/17 - 1200
New Order Stop: 07/26/17 - 1644
07/21/17 1130 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by YCHO Eff: 07/21/17 1108
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 07/19/17 - 2105
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 6 HOURS (SCH)
Old Order Stop: 07/21/17 - 1200
New Order Start: 07/21/17 - 1200
New Order Stop: 07/26/17 - 1644
07/21/17 1130 - VERIFIED by AMOLINARI
07/24/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 07/26/17 - 1200
07/24/17 1155 - DISCONTINUE by YCHO Eff: 07/24/17 1154
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/24/17 1155 - POM COPY AND EDIT by YCHO
TO: Rx #U01417341
07/24/17 1303 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 07/24/17 1155
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 6 HOURS (SCH)
Start Date 07/24/17-1200 Stop Date 07/24/17 1321 DC: 07/24/17-1321
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01530895

History
07/24/17 1155 - POM COPY AND EDIT by YCHO
FROM: Rx #01530316
07/24/17 1302 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-1200 STOP: 07/29/17 SOFT STOP:
TO:
START: 07/24/17-1200 STOP: 07/29/17-1159 SOFT STOP: 0
07/24/17 1302 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by JDWARKA Eff: 07/24/17 1224
07/24/17 1302 - VERIFIED by MHAIMOWITZ
07/24/17 1322 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 07/24/17-1200 STOP: 07/29/17 1159 SOFT STOP: 0
TO:
START: 07/24/17-1200 STOP: 07/24/17-1321 SOFT STOP:
07/24/17 1322 - DISCONTINUE by YCHO Eff: 07/24/17 1321
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
07/24/17 1322 - POM COPY AND EDIT by YCHO
TO: Rx #U01417413
07/24/17 1349 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by YCHO Eff: 07/24/17 1322
Discontinue by YCHO Eff: 07/24/17 1322
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 07/24/17-1400 Stop Date 07/29/17 1159 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01530931

Discontinued Comments DC'd by Discharge

History
07/24/17 1322 - POM COPY AND EDIT by YCHO
FROM: Rx #01530895
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 07/24/17 - 1200
Last Actual Administration Time: 07/24/17 - 1221
Old Freq/Sch: EVERY 6 HOURS (SCH)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 07/24/17 - 1321
New Order Start: 07/24/17 - 1400
New Order Stop: 07/29/17 - 1159
07/24/17 1350 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by YCHO Eff: 07/24/17 1322
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 07/24/17 - 1200
Last Actual Administration Time: 07/24/17 - 1221
Old Freq/Sch: EVERY 6 HOURS (SCH)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 07/24/17 - 1321
New Order Start: 07/24/17 - 1400
New Order Stop: 07/29/17 - 1159
Administration of Unverified Order by JDWARKA Eff: 07/24/17 1331
07/24/17 1350 - VERIFIED by AMACCA
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/27/17-0900 Stop Date 07/27/17 0859 DC: 07/21/17-0907
Ordering Doctor ELASHVILI, MERY
Total Dispensed 25 Total Costs $0.00 Total Charges $259.60
Rx Number 01523853

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1657 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 06/27/17 - 0900
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

07/17/17 0817 - FILL by BGIRLING

Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/21/17 0908 - DISCONTINUE by YCHO Eff: 07/21/17 0907
Items Auto Credited: 4 Doses Auto Credited: 4
For: 07/22/17 - 0900
For: 07/23/17 - 0900
For: 07/24/17 - 0900
For: 07/25/17 - 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/21/17 0908 - POM COPY AND EDIT by YCHO
TO: Rx #U01416817
07/21/17 0947 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 07/21/17 0908

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/22/17-0900 Stop Date 08/21/17 0859 DC: 07/22/17-0900
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $25.95
Rx Number 01530297

Discontinued Comments CHANGED TO 10MG TAB

History
07/21/17 0908 - POM COPY AND EDIT by YCHO
FROM: Rx #01523853
07/21/17 0946 - REVIEW PROVIDER ACTIVITY by SYSTEM
Administration of Unverified Order by DSHELOMI Eff: 07/21/17 0927
07/21/17 0946 - VERIFIED by SYSTEM
Verified in order to DC
07/21/17 0946 - DISCONTINUE by AMOLINARI Eff: 07/22/17 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
CHANGED TO 10MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/22/17-0900 Stop Date 08/21/17 0859 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $2.52
Rx Number 01530298

Discontinued Comments DC'd by Discharge

History
07/21/17 0946 - ENTER by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/22/17 - 0900
For: 07/23/17 - 0900
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/27/17-0900 Stop Date 07/27/17 0859 DC: 07/18/17-0956
Ordering Doctor ELASHVILI, MERY
Total Dispensed 22 Total Costs $0.00 Total Charges $0.63
Rx Number 01523848

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1657 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 06/27/17 - 0900
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0817 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/18/17 0957 - DISCONTINUE by YCHO Eff: 07/18/17 0956
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/18/17 0958 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 07/18/17 0957

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/19/17-0900 Stop Date 08/18/17 0859 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $0.70
Rx Number 01529535

Discontinued Comments DC'd by Discharge

History
07/18/17 0957 - POM ORDER by YCHO
07/18/17 0958 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/16/17-0900 Stop Date 09/15/17 0859 DC: 08/29/17-1454
Ordering Doctor ELASHVILI, MERY
Total Dispensed 14 Total Costs $0.00 Total Charges $1.40
Rx Number 01536999

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1518 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/29/17 1456 - DISCONTINUE by MELASHVI Eff: 08/29/17 1454
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: ELASHVILI, MERY
08/29/17 1752 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by MELASHVI Eff: 08/29/17 1456
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 06/26/17-2100 Stop Date 07/26/17 2059 DC: 06/26/17-2100
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01523856

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1659 - DISCONTINUE by AMACCA Eff: 06/26/17 2100
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
06/26/17 1659 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 06/26/17-2100 Stop Date 07/26/17 2059 DC: 07/24/17-1154
Ordering Doctor ELASHVILI, MERY
Total Dispensed 28 Total Costs $0.00 Total Charges $20.25
Rx Number 01523858

History
06/26/17 1700 - ENTER by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 06/26/17 - 2100
For: 06/27/17 - 2100
For: 06/28/17 - 2100
For: 06/29/17 - 2100
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 2100
For: 07/01/17 - 2100
For: 07/02/17 - 2100
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 2100
For: 07/04/17 - 2100
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 2100
For: 07/06/17 - 2100
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 2100
For: 07/08/17 - 2100
For: 07/09/17 - 2100
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 2100
For: 07/11/17 - 2100
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 2100
For: 07/13/17 - 2100
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 2100
For: 07/15/17 - 2100
For: 07/16/17 - 2100
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 2100
For: 07/18/17 - 2100
07/17/17 0817 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 07/19/17 - 2100
For: 07/20/17 - 2100
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
07/24/17 1155 - DISCONTINUE by YCHO Eff: 07/24/17 1154
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/24/17 1155 - POM COPY AND EDIT by YCHO
TO: Rx #U01417342
07/24/17 1234 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 07/24/17 1155
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/24/17-2100 Stop Date 08/23/17 2059 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.75
Rx Number 01530873

Discontinued Comments DC'd by Discharge

History
07/24/17 1155 - POM COPY AND EDIT by YCHO
FROM: Rx #01523858
07/24/17 1229 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-2100 STOP: 08/23/17 SOFT STOP:
TO:
START: 07/24/17-2100 STOP: 08/23/17-2059 SOFT STOP: 0
07/24/17 1230 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 2100
For: 07/25/17 - 2100
For: 07/26/17 - 2100
For: 07/27/17 - 2100
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 3 Doses Auto Credited: 3
For: 07/25/17 - 2100
For: 07/26/17 - 2100
For: 07/27/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

AZTH250C - AZITHROMYCIN 250 MG CAP

Dose 250 MG (1 CAPSULE)

Dose Instructions chronic COPD
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/27/17-0900 Stop Date 07/26/17 0901 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Clinical Indication OTHER
Total Dispensed 29 Total Costs $0.00 Total Charges $238.00
Rx Number 01523849

Discontinued Comments DC'd by Discharge

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1657 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 06/27/17 - 0900
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

For: 07/17/17 - 0900

For: 07/18/17 - 0900
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0828 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 07/26/17 - 0900
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 1 Doses Auto Credited: 1
For: 07/26/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 06/26/17-1645 Stop Date 07/26/17 1644 DC: 07/13/17-2128
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01523841

History
06/26/17 1635 - POM ORDER by MELASHVI
06/26/17 1656 - VERIFIED by AMACCA
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/13/17 2129 - DISCONTINUE by MELASHVI Eff: 07/13/17 2128
EDIT DOCTOR: ELASHVILI, MERY
07/13/17 2129 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01415204
07/14/17 0727 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by MELASHVI Eff: 07/13/17 2129
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/13/17-2130 Stop Date 08/12/17 2129 DC: 07/14/17-1849
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01528609

History
07/13/17 2129 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01523841
07/14/17 0727 - VERIFIED by AMOLINARI
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 1850 - DISCONTINUE by MELASHVI Eff: 07/14/17 1849
EDIT DOCTOR: ELASHVILI, MERY
07/14/17 1850 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01415560
07/14/17 1910 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by MELASHVI Eff: 07/14/17 1850

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency 2128 (ONE)
Start Date 07/13/17-2128 Stop Date 07/13/17 2129 DC: 07/13/17-2129
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01528610

Discontinued Comments Reached Stop Date

History
07/13/17 2129 - POM ORDER by MELASHVI
07/14/17 0727 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by GLUMANAS Eff: 07/13/17 2211
Administration of Unverified Order by GLUMANAS Eff: 07/14/17 0136
07/14/17 0727 - VERIFIED by AMOLINARI
07/14/17 0727 - DISCONTINUE by PHABKGJOB Eff: 07/13/17 2129
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/14/17-1900 Stop Date 08/13/17 1859 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01528984

Discontinued Comments DC'd by Discharge

History
07/14/17 1850 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01528609
07/14/17 1910 - VERIFIED by MHAIMOWITZ
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency 1849 (ONE)
Start Date 07/14/17-1849 Stop Date 07/14/17 1850 DC: 07/14/17-1850
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01528983

Discontinued Comments Reached Stop Date

History
07/14/17 1850 - POM ORDER by MELASHVI
07/14/17 1910 - VERIFIED by MHAIMOWITZ
07/14/17 1910 - DISCONTINUE by PHABKGJOB Eff: 07/14/17 1850
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

CPT25T - CAPTOPRIL 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 06/26/17-2200 Stop Date 07/26/17 2159 DC: 06/29/17-1346
Ordering Doctor ELASHVILI, MERY
Total Dispensed 8 Total Costs $0.00 Total Charges $25.84
Rx Number 01523860

History
06/26/17 1702 - ENTER by AMACCA
Items Dispensed: 11 Doses Dispensed: 11
For: 06/26/17 - 2200
For: 06/27/17 - 0600
For: 06/27/17 - 1400
For: 06/27/17 - 2200
For: 06/28/17 - 0600
For: 06/28/17 - 1400
For: 06/28/17 - 2200
For: 06/29/17 - 0600
For: 06/29/17 - 1400
For: 06/29/17 - 2200
For: 06/30/17 - 0600
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 06/30/17 - 1400
For: 06/30/17 - 2200
For: 07/01/17 - 0600
For: 07/01/17 - 1400
For: 07/01/17 - 2200
For: 07/02/17 - 0600
For: 07/02/17 - 1400
For: 07/02/17 - 2200
For: 07/03/17 - 0600
06/29/17 1347 - DISCONTINUE by JLEVIN Eff: 06/29/17 1346
Items Auto Credited: 12 Doses Auto Credited: 12
For: 06/29/17 - 1400
For: 06/29/17 - 2200
For: 06/30/17 - 0600
For: 06/30/17 - 1400
For: 06/30/17 - 2200
For: 07/01/17 - 0600
For: 07/01/17 - 1400
For: 07/01/17 - 2200
For: 07/02/17 - 0600
For: 07/02/17 - 1400
For: 07/02/17 - 2200
For: 07/03/17 - 0600
EDIT DOCTOR: LEVIN,JARED MD PGY-4
06/29/17 1347 - POM COPY AND EDIT by JLEVIN
TO: Rx #U01411399
06/29/17 1348 - REVIEW PROVIDER ACTIVITY by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

Discontinue by JLEVIN Eff: 06/29/17 1347

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

CPT25T - CAPTOPRIL 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions Hold for BP <105/55
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 06/29/17-1400 Stop Date 07/29/17 1359 DC: 07/25/17-1300
Ordering Doctor LEVIN,JARED MD PGY-4
Total Dispensed 78 Total Costs $0.00 Total Charges $216.41
Rx Number 01524656

Discontinued Comments DC'd by Discharge

History
06/29/17 1347 - POM COPY AND EDIT by JLEVIN
FROM: Rx #01523860
06/29/17 1348 - VERIFIED by AMACCA
Items Dispensed: 12 Doses Dispensed: 12
For: 06/29/17 - 1400
For: 06/29/17 - 2200
For: 06/30/17 - 0600
For: 06/30/17 - 1400
For: 06/30/17 - 2200
For: 07/01/17 - 0600
For: 07/01/17 - 1400
For: 07/01/17 - 2200
For: 07/02/17 - 0600
For: 07/02/17 - 1400
For: 07/02/17 - 2200
For: 07/03/17 - 0600
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/03/17 - 1400
For: 07/03/17 - 2200
For: 07/04/17 - 0600
For: 07/04/17 - 1400
For: 07/04/17 - 2200
For: 07/05/17 - 0600
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/05/17 - 1400
For: 07/05/17 - 2200
For: 07/06/17 - 0600
For: 07/06/17 - 1400
For: 07/06/17 - 2200
For: 07/07/17 - 0600
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 07/07/17 - 1400
For: 07/07/17 - 2200
For: 07/08/17 - 0600
For: 07/08/17 - 1400
For: 07/08/17 - 2200
For: 07/09/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

For: 07/09/17 - 1400

For: 07/09/17 - 2200
For: 07/10/17 - 0600
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/10/17 - 1400
For: 07/10/17 - 2200
For: 07/11/17 - 0600
For: 07/11/17 - 1400
For: 07/11/17 - 2200
For: 07/12/17 - 0600
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/12/17 - 1400
For: 07/12/17 - 2200
For: 07/13/17 - 0600
For: 07/13/17 - 1400
For: 07/13/17 - 2200
For: 07/14/17 - 0600
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 07/14/17 - 1400
For: 07/14/17 - 2200
For: 07/15/17 - 0600
For: 07/15/17 - 1400
For: 07/15/17 - 2200
For: 07/16/17 - 0600
For: 07/16/17 - 1400
For: 07/16/17 - 2200
For: 07/17/17 - 0600
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/17/17 - 1400
For: 07/17/17 - 2200
For: 07/18/17 - 0600
For: 07/18/17 - 1400
For: 07/18/17 - 2200
For: 07/19/17 - 0600
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/19/17 - 1400
For: 07/19/17 - 2200
For: 07/20/17 - 0600
For: 07/20/17 - 1400
For: 07/20/17 - 2200
For: 07/21/17 - 0600
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 07/21/17 - 1400
For: 07/21/17 - 2200
For: 07/22/17 - 0600
For: 07/22/17 - 1400
For: 07/22/17 - 2200
For: 07/23/17 - 0600
For: 07/23/17 - 1400
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

For: 07/23/17 - 2200

For: 07/24/17 - 0600
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 1400
For: 07/24/17 - 2200
For: 07/25/17 - 0600
For: 07/25/17 - 1400
For: 07/25/17 - 2200
For: 07/26/17 - 0600
07/24/17 0829 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 1400
For: 07/26/17 - 2200
For: 07/27/17 - 0600
For: 07/27/17 - 1400
For: 07/27/17 - 2200
For: 07/28/17 - 0600
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 9 Doses Auto Credited: 9
For: 07/25/17 - 1400
For: 07/25/17 - 2200
For: 07/26/17 - 0600
For: 07/26/17 - 1400
For: 07/26/17 - 2200
For: 07/27/17 - 0600
For: 07/27/17 - 1400
For: 07/27/17 - 2200
For: 07/28/17 - 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DEXT100058 - DEXTROSE 1,000 ML BAG

Dose 1,000 ML (1 BAG)

Dose Instructions 50cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 07/22/17-1815 Stop Date 07/22/17 1816 DC: 07/22/17-1816
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530722

History
07/22/17 1804 - POM ORDER by HAZIZI
07/22/17 1816 - DISCONTINUE by AADEGBAMIG Eff: 07/22/17 1816
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/22/17 1816 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 06/26/17-1700 Stop Date 07/26/17 1659 DC: 07/14/17-1646
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $3.75
Rx Number 01523837

History
06/26/17 1635 - POM ORDER by MELASHVI
06/26/17 1656 - VERIFIED by AMACCA
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 06/30/17 - 1700
For: 07/01/17 - 1700
For: 07/02/17 - 1700
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/03/17 - 1700
For: 07/04/17 - 1700
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/05/17 - 1700
For: 07/06/17 - 1700
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 07/07/17 - 1700
For: 07/08/17 - 1700
For: 07/09/17 - 1700
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/10/17 - 1700
For: 07/11/17 - 1700
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/12/17 - 1700
For: 07/13/17 - 1700
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 07/14/17 - 1700
For: 07/15/17 - 1700
For: 07/16/17 - 1700
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/17/17 - 1700
For: 07/18/17 - 1700
07/14/17 1648 - DISCONTINUE by SONUOHA Eff: 07/14/17 1646
EDIT DOCTOR: ONUOHA,SOMECHUKWU MD PGY-3
07/14/17 1704 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SONUOHA Eff: 07/14/17 1648
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 07/14/17-2200 Stop Date 08/13/17 2159 DC: 07/25/17-1300
Ordering Doctor ONUOHA,SOMECHUKWU MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $6.50
Rx Number 01528918

Discontinued Comments DC'd by Discharge

History
07/14/17 1650 - POM ORDER by SONUOHA
07/14/17 1704 - VERIFIED by MHAIMOWITZ
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/19/17 - 1400
For: 07/19/17 - 2200
For: 07/20/17 - 0600
For: 07/20/17 - 1400
For: 07/20/17 - 2200
For: 07/21/17 - 0600
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 07/21/17 - 1400
For: 07/21/17 - 2200
For: 07/22/17 - 0600
For: 07/22/17 - 1400
For: 07/22/17 - 2200
For: 07/23/17 - 0600
For: 07/23/17 - 1400
For: 07/23/17 - 2200
For: 07/24/17 - 0600
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 1400
For: 07/24/17 - 2200
For: 07/25/17 - 0600
For: 07/25/17 - 1400
For: 07/25/17 - 2200
For: 07/26/17 - 0600
07/24/17 0829 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 1400
For: 07/26/17 - 2200
For: 07/27/17 - 0600
For: 07/27/17 - 1400
For: 07/27/17 - 2200
For: 07/28/17 - 0600
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 06/27/17-0900 Stop Date 07/27/17 0859 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 29 Total Costs $0.00 Total Charges $2471.67
Rx Number 01523851

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.62
MG/KG/DAY is below the Low Daily Dose.

Discontinued Comments DC'd by Discharge

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1657 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 06/27/17 - 0900
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0837 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0828 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 07/26/17 - 0900
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 1 Doses Auto Credited: 1
For: 07/26/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/05/17-2100 Stop Date 08/04/17 2059 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $4.75
Rx Number 01526176

Discontinued Comments DC'd by Discharge

History
07/05/17 1629 - POM ORDER by MELASHVI
07/05/17 1630 - VERIFIED by EBALILO
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 2100
For: 07/11/17 - 2100
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 2100
For: 07/13/17 - 2100
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 2100
For: 07/15/17 - 2100
For: 07/16/17 - 2100
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 2100
For: 07/18/17 - 2100
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 2100
For: 07/20/17 - 2100
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
07/24/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 2100
For: 07/27/17 - 2100
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DC'd by Discharge

FLUO20SO3 - FLUOXETINE HCL 20 MG/5 ML UNIT DOSE CUP

Dose 10 MG (2.5 ML)

Admin Route ORAL
Frequency DAILY@1700 (SCH)
Start Date 07/03/17-1700 Stop Date 08/02/17 1659 DC: 07/03/17-1700
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01525718

History
07/03/17 1511 - POM ORDER by MELASHVI
07/03/17 1521 - DISCONTINUE by AADEGBAMIG Eff: 07/03/17 1700
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/03/17 1521 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

FLX10C - FLUOXETINE HCL 10 MG CAP

Dose 10 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/25/17-1800 Stop Date 09/24/17 1759 DC: 08/28/17-1249
Ordering Doctor ELASHVILI, MERY
Total Dispensed 3 Total Costs $0.00 Total Charges $1.05
Rx Number 01540090

History
08/25/17 1434 - POM ORDER by MELASHVI
08/25/17 1440 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 1800
For: 08/26/17 - 1800
For: 08/27/17 - 1800
For: 08/28/17 - 1800
For: 08/29/17 - 1800
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1800
For: 08/31/17 - 1800
08/28/17 1250 - DISCONTINUE by YCHO Eff: 08/28/17 1249
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/28/17 - 1800
For: 08/29/17 - 1800
For: 08/30/17 - 1800
For: 08/31/17 - 1800
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 1250 - POM COPY AND EDIT by YCHO
TO: Rx #U01426810
08/28/17 1256 - REVIEW PROVIDER ACTIVITY by YLEE
Discontinue by YCHO Eff: 08/28/17 1250
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@0700,1200,1600 (SCH)
Start Date 07/03/17-1200 Stop Date 08/02/17 1159 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 67 Total Costs $0.00 Total Charges $9.75
Rx Number 01525626

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

Discontinued Comments DC'd by Discharge

History
07/03/17 1158 - POM ORDER by MELASHVI
07/03/17 1200 - VERIFIED by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 12
For: 07/03/17 - 1200
For: 07/03/17 - 1600
For: 07/04/17 - 0700
For: 07/04/17 - 1200
For: 07/04/17 - 1600
For: 07/05/17 - 0700
For: 07/05/17 - 1200
For: 07/05/17 - 1600
For: 07/06/17 - 0700
For: 07/06/17 - 1200
For: 07/06/17 - 1600
For: 07/07/17 - 0700
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 07/07/17 - 1200
For: 07/07/17 - 1600
For: 07/08/17 - 0700
For: 07/08/17 - 1200
For: 07/08/17 - 1600
For: 07/09/17 - 0700
For: 07/09/17 - 1200
For: 07/09/17 - 1600
For: 07/10/17 - 0700
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/10/17 - 1200
For: 07/10/17 - 1600
For: 07/11/17 - 0700
For: 07/11/17 - 1200
For: 07/11/17 - 1600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

For: 07/12/17 - 0700

07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/12/17 - 1200
For: 07/12/17 - 1600
For: 07/13/17 - 0700
For: 07/13/17 - 1200
For: 07/13/17 - 1600
For: 07/14/17 - 0700
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 07/14/17 - 1200
For: 07/14/17 - 1600
For: 07/15/17 - 0700
For: 07/15/17 - 1200
For: 07/15/17 - 1600
For: 07/16/17 - 0700
For: 07/16/17 - 1200
For: 07/16/17 - 1600
For: 07/17/17 - 0700
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/17/17 - 1200
For: 07/17/17 - 1600
For: 07/18/17 - 0700
For: 07/18/17 - 1200
For: 07/18/17 - 1600
For: 07/19/17 - 0700
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/19/17 - 1200
For: 07/19/17 - 1600
For: 07/20/17 - 0700
For: 07/20/17 - 1200
For: 07/20/17 - 1600
For: 07/21/17 - 0700
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 07/21/17 - 1200
For: 07/21/17 - 1600
For: 07/22/17 - 0700
For: 07/22/17 - 1200
For: 07/22/17 - 1600
For: 07/23/17 - 0700
For: 07/23/17 - 1200
For: 07/23/17 - 1600
For: 07/24/17 - 0700
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 1200
For: 07/24/17 - 1600
For: 07/25/17 - 0700
For: 07/25/17 - 1200
For: 07/25/17 - 1600
For: 07/26/17 - 0700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 83
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

07/24/17 0829 - FILL by BGIRLING

Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 1200
For: 07/26/17 - 1600
For: 07/27/17 - 0700
For: 07/27/17 - 1200
For: 07/27/17 - 1600
For: 07/28/17 - 0700
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 8 Doses Auto Credited: 8
For: 07/25/17 - 1600
For: 07/26/17 - 0700
For: 07/26/17 - 1200
For: 07/26/17 - 1600
For: 07/27/17 - 0700
For: 07/27/17 - 1200
For: 07/27/17 - 1600
For: 07/28/17 - 0700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 84
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

LVF250T - LEVOFLOXACIN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/16/17-0900 Stop Date 08/23/17 0859 DC: 08/23/17-0859
Ordering Doctor ELASHVILI, MERY
Clinical Indication COMPLICATED UTI
Total Dispensed 7 Total Costs $0.00 Total Charges $458.71
Rx Number 01536998

Discontinued Comments Reached Stop Date

History
08/15/17 1501 - POM ORDER by MELASHVI
08/15/17 1518 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/23/17 0859 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 85
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 06/26/17-1645 Stop Date 07/26/17 1644 DC: 07/24/17-1154
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01523843

History
06/26/17 1635 - POM ORDER by MELASHVI
06/26/17 1656 - VERIFIED by AMACCA
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 1155 - DISCONTINUE by YCHO Eff: 07/24/17 1154
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/24/17 1155 - POM COPY AND EDIT by YCHO
TO: Rx #U01417346
07/24/17 1235 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 07/24/17 1155
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 86
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 07/24/17-1200 Stop Date 08/23/17 1159 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530876

Discontinued Comments DC'd by Discharge

History
07/24/17 1155 - POM COPY AND EDIT by YCHO
FROM: Rx #01523843
07/24/17 1233 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-1200 STOP: 08/23/17 SOFT STOP:
TO:
START: 07/24/17-1200 STOP: 08/23/17-1159 SOFT STOP: 0
07/24/17 1233 - VERIFIED by MHAIMOWITZ
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 87
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 06/26/17-1645 Stop Date 07/26/17 1644 DC: 07/24/17-1154
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01523842

History
06/26/17 1635 - POM ORDER by MELASHVI
06/26/17 1656 - VERIFIED by AMACCA
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 1155 - DISCONTINUE by YCHO Eff: 07/24/17 1154
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/24/17 1155 - POM COPY AND EDIT by YCHO
TO: Rx #U01417347
07/24/17 1235 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 07/24/17 1155
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 88
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/24/17-1200 Stop Date 08/23/17 1159 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530877

Discontinued Comments DC'd by Discharge

History
07/24/17 1155 - POM COPY AND EDIT by YCHO
FROM: Rx #01523842
07/24/17 1233 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-1200 STOP: 08/23/17 SOFT STOP:
TO:
START: 07/24/17-1200 STOP: 08/23/17-1159 SOFT STOP: 0
07/24/17 1233 - VERIFIED by MHAIMOWITZ
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 89
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MEMA5TAB2 - MEMANTINE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/21/17-0900 Stop Date 08/20/17 0859 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $65.15
Rx Number 01530294

Discontinued Comments DC'd by Discharge

History
07/21/17 0754 - POM ORDER by YCHO
07/21/17 0805 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 90
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MTHL5T - METHYLPHENIDATE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@0800,1200 (SCH)
Start Date 08/16/17-0800 Stop Date 08/23/17 0759 DC: 08/21/17-1153
Ordering Doctor ELASHVILI, MERY
Total Dispensed 10 Total Costs $0.00 Total Charges $3.00
Rx Number 01537002

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1520 - VERIFIED by EBALILO
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0800
For: 08/18/17 - 1200
For: 08/19/17 - 0800
For: 08/19/17 - 1200
For: 08/20/17 - 0800
For: 08/20/17 - 1200
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0800
For: 08/21/17 - 1200
For: 08/22/17 - 0800
For: 08/22/17 - 1200
08/21/17 1153 - DISCONTINUE by YCHO Eff: 08/21/17 1153
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/21/17 1153 - POM COPY AND EDIT by YCHO
TO: Rx #U01424767
08/21/17 1158 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/21/17 1153
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 91
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MTHL5T - METHYLPHENIDATE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@0800,1200 (SCH)
Start Date 08/21/17-1200 Stop Date 08/28/17 1159 DC: 08/25/17-0844
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $1.50
Rx Number 01538499

History
08/21/17 1153 - POM COPY AND EDIT by YCHO
FROM: Rx #01537002
08/21/17 1158 - EDIT by AMOLINARI
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/21/17-1200 STOP: 08/28/17 SOFT STOP:
TO:
START: 08/21/17-1200 STOP: 08/28/17-1159 SOFT STOP: 0
08/21/17 1158 - VERIFIED by AMOLINARI
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0800
For: 08/25/17 - 1200
For: 08/26/17 - 0800
For: 08/26/17 - 1200
For: 08/27/17 - 0800
For: 08/27/17 - 1200
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 0800
08/25/17 0845 - DISCONTINUE by YCHO Eff: 08/25/17 0844
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/25/17 0845 - POM COPY AND EDIT by YCHO
TO: Rx #U01426055
08/25/17 1246 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/25/17 0845
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 92
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MTHL5T - METHYLPHENIDATE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@0800,1200 (SCH)
Start Date 08/25/17-1200 Stop Date 09/01/17 1159 DC: 08/29/17-1318
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $2.25
Rx Number 01540003

History
08/25/17 0845 - POM COPY AND EDIT by YCHO
FROM: Rx #01538499
08/25/17 1245 - EDIT by AMOLINARI
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1200 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1200 STOP: 09/01/17-1159 SOFT STOP: 0
08/25/17 1245 - VERIFIED by AMOLINARI
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0800
For: 08/30/17 - 1200
For: 08/31/17 - 0800
For: 08/31/17 - 1200
08/29/17 1319 - DISCONTINUE by YCHO Eff: 08/29/17 1318
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/29/17 1319 - POM COPY AND EDIT by YCHO
TO: Rx #U01427082
08/29/17 1346 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/29/17 1319
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 93
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MTHL5T - METHYLPHENIDATE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@0800,1200 (SCH)
Start Date 08/30/17-0800 Stop Date 09/05/17 0759 DC: 08/30/17-0800
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540986

History
08/29/17 1319 - POM COPY AND EDIT by YCHO
FROM: Rx #01540003
08/29/17 1346 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/30/17-0800 STOP: 09/05/17 SOFT STOP:
TO:
START: 08/30/17-0800 STOP: 09/05/17-0759 SOFT STOP: 0
08/29/17 1346 - VERIFIED by MHAIMOWITZ
08/29/17 1456 - DISCONTINUE by MELASHVI Eff: 08/30/17 0800
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: ELASHVILI, MERY
08/29/17 1456 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01427130
08/29/17 1459 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by MELASHVI Eff: 08/29/17 1456
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 94
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MNTL10T - MONTELUKAST SODIUM 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 06/26/17-2100 Stop Date 07/26/17 2059 DC: 07/24/17-1154
Ordering Doctor ELASHVILI, MERY
Total Dispensed 28 Total Costs $0.00 Total Charges $263.25
Rx Number 01523855

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1659 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 06/26/17 - 2100
For: 06/27/17 - 2100
For: 06/28/17 - 2100
For: 06/29/17 - 2100
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 2100
For: 07/01/17 - 2100
For: 07/02/17 - 2100
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 2100
For: 07/04/17 - 2100
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 2100
For: 07/06/17 - 2100
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 2100
For: 07/08/17 - 2100
For: 07/09/17 - 2100
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 2100
For: 07/11/17 - 2100
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 2100
For: 07/13/17 - 2100
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 2100
For: 07/15/17 - 2100
For: 07/16/17 - 2100
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 2100
For: 07/18/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 95
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

07/17/17 0817 - FILL by BGIRLING

Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 2100
For: 07/20/17 - 2100
07/19/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
07/24/17 1155 - DISCONTINUE by YCHO Eff: 07/24/17 1154
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
07/24/17 1155 - POM COPY AND EDIT by YCHO
TO: Rx #U01417348
07/24/17 1236 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 07/24/17 1155
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 96
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

MNTL10T - MONTELUKAST SODIUM 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/24/17-2100 Stop Date 08/23/17 2059 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $9.75
Rx Number 01530878

Discontinued Comments DC'd by Discharge

History
07/24/17 1155 - POM COPY AND EDIT by YCHO
FROM: Rx #01523855
07/24/17 1234 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-2100 STOP: 08/23/17 SOFT STOP:
TO:
START: 07/24/17-2100 STOP: 08/23/17-2059 SOFT STOP: 0
07/24/17 1234 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 2100
For: 07/25/17 - 2100
For: 07/26/17 - 2100
For: 07/27/17 - 2100
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 3 Doses Auto Credited: 3
For: 07/25/17 - 2100
For: 07/26/17 - 2100
For: 07/27/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 97
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 25 EA (0 EACHS)
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 06/26/17-2200 Stop Date 07/26/17 2159 DC: 06/26/17-2200
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01523859

History
06/26/17 1648 - POM ORDER by MELASHVI
06/26/17 1700 - DISCONTINUE by AMACCA Eff: 06/26/17 2200
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
06/26/17 1700 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 98
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/21/17-0900 Stop Date 08/20/17 0859 DC: 07/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $4.40
Rx Number 01530233

Discontinued Comments DC'd by Discharge

History
07/20/17 1611 - POM ORDER by YCHO
07/20/17 1613 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 99
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/16/17-0800 Stop Date 08/29/17 1750 DC: 08/29/17-1750
Ordering Doctor ELASHVILI, MERY
Total Dispensed 16 Total Costs $0.00 Total Charges $12.32
Rx Number 01537000

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1518 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0800
For: 08/17/17 - 0800
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0800
For: 08/19/17 - 0800
For: 08/20/17 - 0800
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0800
For: 08/22/17 - 0800
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0800
For: 08/24/17 - 0800
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/29/17 1751 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/16/17-0800 STOP: 09/15/17 0759 SOFT STOP: 0
DISPENSE: 2
TO:
START: 08/16/17-0800 STOP: 08/29/17-1750 SOFT STOP:
DISPENSE: 14
08/29/17 1751 - DISCONTINUE by YCHO Eff: 08/29/17 1750
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/29/17 1751 - POM COPY AND EDIT by YCHO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 100
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

TO: Rx #U01427284
08/29/17 1752 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by YCHO Eff: 08/29/17 1751
Discontinue by YCHO Eff: 08/29/17 1751
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 101
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-0900 Stop Date 09/15/17 0759 DC: 08/30/17-0900
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541204

History
08/29/17 1751 - POM COPY AND EDIT by YCHO
FROM: Rx #01537000
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/29/17 - 0800
Last Actual Administration Time: 08/29/17 - 0812
Old Freq/Sch: DAILY@08 (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/29/17 - 1750
New Order Start: 08/30/17 - 0900
New Order Stop: 09/15/17 - 0759
08/29/17 1751 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by YCHO Eff: 08/29/17 1751
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/29/17 - 0800
Last Actual Administration Time: 08/29/17 - 0812
Old Freq/Sch: DAILY@08 (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/29/17 - 1750
New Order Start: 08/30/17 - 0900
New Order Stop: 09/15/17 - 0759
08/29/17 1751 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/29/17 1812 - DISCONTINUE by YCHO Eff: 08/30/17 0900
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/29/17 1812 - POM COPY AND EDIT by YCHO
TO: Rx #U01427288
08/29/17 1817 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/29/17 1812
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 102
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 06/26/17-2100 Stop Date 07/28/17 2059 DC: 07/25/17-1300
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $5.75
Rx Number 01523844

Discontinued Comments DC'd by Discharge

History
06/26/17 1635 - POM ORDER by MELASHVI
06/26/17 1656 - VERIFIED by AMACCA
06/28/17 0816 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 2100
For: 07/01/17 - 2100
For: 07/02/17 - 2100
06/30/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 2100
For: 07/04/17 - 2100
07/03/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 2100
For: 07/06/17 - 2100
07/05/17 0832 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 2100
For: 07/08/17 - 2100
For: 07/09/17 - 2100
07/07/17 0825 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 2100
For: 07/11/17 - 2100
07/10/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 2100
For: 07/13/17 - 2100
07/12/17 0837 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 2100
For: 07/15/17 - 2100
For: 07/16/17 - 2100
07/14/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 2100
For: 07/18/17 - 2100
07/17/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 2100
For: 07/20/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 103
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

07/19/17 0814 - FILL by BGIRLING

Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
07/21/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
07/24/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 2100
For: 07/27/17 - 2100
07/25/17 1314 - DISCONTINUE by DISCHARGE Eff: 07/25/17 1300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

KCL20PK - POTASSIUM CHLORIDE PWD 20 MEQ/PKT PACK

Dose 20 MEQ (1 PKT)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/18/17-1700 Stop Date 07/20/17 0901 DC: 07/20/17-0901
Ordering Doctor ELASHVILI, MERY
Total Dispensed 4 Total Costs $0.00 Total Charges $72.39
Rx Number 01529582

Discontinued Comments Reached Stop Date

History
07/18/17 1100 - POM ORDER by MELASHVI
07/18/17 1113 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 07/18/17 - 1700
For: 07/19/17 - 0900
For: 07/19/17 - 1700
For: 07/20/17 - 0900
07/20/17 0901 - DISCONTINUE by PHABKGJOB Eff: 07/20/17 0901
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 104
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

KCL20PK - POTASSIUM CHLORIDE PWD 20 MEQ/PKT PACK

Dose 20 MEQ (1 PKT)

Admin Route ORAL
Frequency 1058 (ONE)
Start Date 07/18/17-1058 Stop Date 07/18/17 1059 DC: 07/18/17-1059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $24.13
Rx Number 01529583

Discontinued Comments Reached Stop Date

History
07/18/17 1100 - POM ORDER by MELASHVI
07/18/17 1114 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 07/18/17 - 1058
07/18/17 1114 - DISCONTINUE by PHABKGJOB Eff: 07/18/17 1059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 105
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/15/17-1700 Stop Date 08/18/17 1217 DC: 08/18/17-1217
Ordering Doctor ELASHVILI, MERY
Total Dispensed 15 Total Costs $0.00 Total Charges $48.65
Rx Number 01537001

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1519 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/15/17 - 1700
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/18/17 1219 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/15/17-1700 STOP: 09/14/17 1659 SOFT STOP: 0
DISPENSE: 4
TO:
START: 08/15/17-1700 STOP: 08/18/17-1217 SOFT STOP:
DISPENSE: 6
08/18/17 1219 - DISCONTINUE by YCHO Eff: 08/18/17 1217
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/18/17 1219 - POM COPY AND EDIT by YCHO
TO: Rx #U01424232
08/18/17 1221 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by YCHO Eff: 08/18/17 1219
Discontinue by YCHO Eff: 08/18/17 1219
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 106
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/15/17-2100 Stop Date 08/18/17 1217 DC: 08/18/17-1217
Ordering Doctor ELASHVILI, MERY
Total Dispensed 16 Total Costs $0.00 Total Charges $19.45
Rx Number 01537003

History
08/15/17 1522 - ENTER by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0828 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/18/17 1219 - DISCONTINUE by YCHO Eff: 08/18/17 1217
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/18/17 1219 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/15/17-2100 STOP: 09/14/17 2059 SOFT STOP: 0
DISPENSE: 4
TO:
START: 08/15/17-2100 STOP: 08/18/17-1217 SOFT STOP:
DISPENSE: 6
08/18/17 1219 - POM COPY AND EDIT by YCHO
TO: Rx #U01424231
08/18/17 1220 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by YCHO Eff: 08/18/17 1219
Discontinue by YCHO Eff: 08/18/17 1219
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 107
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/14/17 1659 DC: 08/29/17-1454
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $107.03
Rx Number 01537984

History
08/18/17 1219 - POM COPY AND EDIT by YCHO
FROM: Rx #01537001
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/18/17 - 0900
Last Actual Administration Time: 08/18/17 - 0857
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/18/17 - 1217
New Order Start: 08/19/17 - 0900
New Order Stop: 09/14/17 - 1659
08/18/17 1221 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by YCHO Eff: 08/18/17 1219
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/18/17 - 0900
Last Actual Administration Time: 08/18/17 - 0857
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/18/17 - 1217
New Order Start: 08/19/17 - 0900
New Order Stop: 09/14/17 - 1659
08/18/17 1221 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 108
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

For: 08/30/17 - 0900

For: 08/31/17 - 0900
08/29/17 1456 - DISCONTINUE by MELASHVI Eff: 08/29/17 1454
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: ELASHVILI, MERY
08/29/17 1752 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by MELASHVI Eff: 08/29/17 1456

MV120B - MULTIVITAMINS LIQ 118 ML BTL

Dose 5 ML (0.0423729 BOTTLES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/16/17-0900 Stop Date 09/15/17 0859 CAN: 08/15/17-1528
Ordering Doctor ELASHVILI, MERY
Total Dispensed Total Costs $ Total Charges $
Rx Number U01423312

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1528 - CANCEL by EBALILO
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO TABLET FORM PER MD
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 109
Run Time 1513 PHA Profile

CAMINITI,JOSEPH S W00001219115 (Continued)

DEXT100058 - DEXTROSE 1,000 ML BAG

Dose 1,000 ML (1 BAG)

Dose Instructions 50cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 07/21/17-1545 Stop Date 07/21/17 1546 CAN: 07/21/17-1557
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01416949

History
07/21/17 1545 - POM ORDER by YCHO
07/21/17 1557 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
change to LVP

QTP100T - QUETIAPINE FUMARATE 100 MG TAB

Dose 50 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/15/17-2100 Stop Date 09/14/17 2059 CAN: 08/15/17-1520
Ordering Doctor ELASHVILI, MERY
Total Dispensed Total Costs $ Total Charges $
Rx Number U01423314

History
08/15/17 1500 - POM ORDER by MELASHVI
08/15/17 1520 - CANCEL by EBALILO
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 25MG STRENGTH TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CAPUANO,JOHN J Responsible Doctor VALLES,JENNIE MD

Account Number W00001219380 Location B1NN Unit Number M000209230
Age/Sex 71/M Room 135 Registered Date 08/22/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.99 in 172.7 cm Body Surface Area 2.00 m2

Weight 190 lb oz 86.183 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/23/17-1220 RENAL DOSING COMPLETE
08/23/17-1603 RENAL DOSING COMPLETE
08/25/17-0831 DRUG - DRUG INTERACTION COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: LAMI C4-6 POSTERIOR INSTRUMENTED FUSION
Secondary Diagnosis:

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions please apply to facial lacerations. thank you
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541941

History
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540686
09/01/17 1313 - EDIT by AADEGBAMIG
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP:
09/01/17 1315 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
09/01/17 1315 - CREDIT by AADEGBAMIG
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

BENZ1LOZ9 - CETYLPYRIDINIUM/BENZOCAINE 1 EA LOZG

Dose 1 EA (1 LOZENGE)
Dose Instructions PRN COUGH/SORE THROAT
Admin Route MTH/THROAT
Frequency EVERY 2 HOURS (PRN) PRN REASON: COUGH - FOR COUGH
Start Date 08/22/17-1715 Stop Date 09/21/17 1714
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 36 Total Costs $0.00 Total Charges $14.04
Rx Number 01539092

History
08/22/17 1723 - POM ORDER by RSHARMA
08/22/17 1726 - VERIFIED by MHAIMOWITZ
Items Dispensed: 18 Doses Dispensed: 1
For: 08/22/17 - 1715
08/31/17 1056 - DEBIT by AMACCA
ITEMS: 1

FLT05NA16 - FLUTICASONE PROPIONATE 0.05% NA SPR 16 GM BTL

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Dose Instructions 2 sprays into each nostril. BID.
Admin Route NASAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541943

History
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540690
09/01/17 1313 - EDIT by AADEGBAMIG
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP:
09/01/17 1315 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
09/01/17 1316 - CREDIT by AADEGBAMIG
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions please apply to sacrum.
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541946

History
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540685
09/01/17 1314 - EDIT by AADEGBAMIG
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP:
09/01/17 1315 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
09/01/17 1316 - CREDIT by AADEGBAMIG
ITEMS: 1

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/22/17-1630 Stop Date 09/21/17 1629
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01539037

History
08/22/17 1620 - POM ORDER by RSHARMA
08/22/17 1622 - VERIFIED by MHAIMOWITZ
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

CLNZ.5T - CLONAZEPAM 0.5 MG TAB

Dose 0.25 MG (0.5 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 09/01/17-1315 Stop Date 09/08/17 1314
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541942

History
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540687
09/01/17 1313 - EDIT by AADEGBAMIG
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1315 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1315 STOP: 09/08/17-1314 SOFT STOP:
09/01/17 1315 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/22/17-1700 Stop Date 09/21/17 1659
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $8.75
Rx Number 01539040

History
08/22/17 1620 - POM ORDER by RSHARMA
08/22/17 1623 - VERIFIED by MHAIMOWITZ
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

For: 09/04/17 - 0900

For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700

DOCU283E4 - DOCUSATE SODIUM 283 MG/5ML (ENEMEEZ) ENEMA

Dose 283 MG (1 ENEMA)

Admin Route RC
Frequency DAILY@2000 (SCH)
Start Date 08/22/17-2000 Stop Date 09/21/17 1959
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $0.00
Rx Number 01539136

History
08/22/17 1921 - ENTER by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 2000
For: 08/23/17 - 2000
For: 08/24/17 - 2000
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2000
For: 08/26/17 - 2000
For: 08/27/17 - 2000
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2000
For: 08/29/17 - 2000
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2000
For: 08/31/17 - 2000
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2000
For: 09/02/17 - 2000
For: 09/03/17 - 2000
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2000
For: 09/05/17 - 2000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

DULO30CA2 - DULOXETINE HCL 30 MG CPDR

Dose 60 MG (2 CAPSULE DELAYED RELEASES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 28 Total Costs $0.00 Total Charges $436.20
Rx Number 01539091

History
08/22/17 1723 - POM ORDER by RSHARMA
08/22/17 1725 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

ENXP30I.3 - ENOXAPARIN 30 MG/0.3 ML SYR

Dose 30 MG (0.3 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 29 Total Costs $0.00 Total Charges $1534.32
Rx Number 01539088

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.7
MG/KG/DAY is below the Low Daily Dose.

History
08/22/17 1724 - POM ORDER by RSHARMA
08/22/17 1724 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
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CAPUANO,JOHN J W00001219380 (Continued)

For: 09/03/17 - 0900

For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 29 Total Costs $0.00 Total Charges $8.40
Rx Number 01539093

History
08/22/17 1724 - POM ORDER by RSHARMA
08/22/17 1726 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/23/17-1400 Stop Date 09/22/17 1359
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 84 Total Costs $0.00 Total Charges $13.20
Rx Number 01539257

History
08/23/17 1308 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539094
08/23/17 1310 - VERIFIED by AADEGBAMIG
Items Dispensed: 30 Doses Dispensed: 15
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

For: 09/03/17 - 0600

For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/22/17-1630 Stop Date 09/21/17 1629
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539038

History
08/22/17 1620 - POM ORDER by RSHARMA
08/22/17 1622 - VERIFIED by MHAIMOWITZ
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 09/04/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01541944

History
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01541819
09/01/17 1313 - EDIT by AADEGBAMIG
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/04/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 09/04/17-2059 SOFT STOP:
09/01/17 1315 - VERIFIED by AADEGBAMIG

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/22/17-1630 Stop Date 09/21/17 1629
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01539041

History
08/22/17 1620 - POM ORDER by RSHARMA
08/22/17 1623 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 2
For: 08/22/17 - 1630
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: FOR MODERATE PAIN
Start Date 08/30/17-0945 Stop Date 09/06/17 0944
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01541291

History
08/30/17 0945 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540300
08/30/17 1055 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/30/17-0945 STOP: 09/06/17 SOFT STOP:
TO:
START: 08/30/17-0945 STOP: 09/06/17-0944 SOFT STOP: 0
08/30/17 1251 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
PRN REASON: FOR MODERATE to severe PAIN
TO:
PRN REASON: FOR MODERATE PAIN
08/30/17 1251 - VERIFIED by AMOLINARI
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency AFTER DINNER (SCH)
Start Date 08/22/17-1800 Stop Date 09/23/17 1759
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.75
Rx Number 01539044

History
08/22/17 1620 - POM ORDER by RSHARMA
08/22/17 1623 - VERIFIED by MHAIMOWITZ
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1800
For: 08/26/17 - 1800
For: 08/27/17 - 1800
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1800
For: 08/29/17 - 1800
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1800
For: 08/31/17 - 1800
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1800
For: 09/02/17 - 1800
For: 09/03/17 - 1800
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1800
For: 09/05/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

PRD1T - PREDNISONE 1 MG TAB

Dose 2 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 09/07/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 8 Total Costs $0.00 Total Charges $0.20
Rx Number 01541945

History
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540689
09/01/17 1314 - EDIT by AADEGBAMIG
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/02/17-0900 STOP: 09/07/17 SOFT STOP:
TO:
START: 09/02/17-0900 STOP: 09/07/17-0859 SOFT STOP:
09/01/17 1315 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 08/23/17-1200 Stop Date 09/22/17 1159
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 28 Total Costs $0.00 Total Charges $2.00
Rx Number 01539042

History
08/22/17 1620 - POM ORDER by RSHARMA
08/22/17 1623 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1200
For: 08/24/17 - 1200
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1200
For: 08/26/17 - 1200
For: 08/27/17 - 1200
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1200
For: 08/29/17 - 1200
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1200
For: 08/31/17 - 1200
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1200
For: 09/05/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions please apply to facial lacerations. thank you
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-2100 Stop Date 08/29/17 2059 DC: 08/28/17-1146
Ordering Doctor SHARMA,RAMAN MD PGY-3
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01539089

History
08/22/17 1724 - POM ORDER by RSHARMA
08/22/17 1724 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 2100
08/28/17 1147 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1146
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1147 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426762
08/28/17 1336 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EALEXEEV Eff: 08/28/17 1147
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions please apply to facial lacerations. thank you
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-1311
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01540686

History
08/28/17 1147 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539089
08/28/17 1334 - EDIT by AADEGBAMIG
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/04/17-2059 SOFT STOP:
08/28/17 1335 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
08/28/17 1336 - CREDIT by AADEGBAMIG
ITEMS: 1
08/31/17 0731 - DEBIT by AMOLINARI
ITEMS: 1
09/01/17 1311 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 1311
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427986
09/01/17 1315 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 09/01/17 1311
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

FLT05NA16 - FLUTICASONE PROPIONATE 0.05% NA SPR 16 GM BTL

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Dose Instructions 2 sprays into each nostril. BID.
Admin Route NASAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 08/31/17 2059 DC: 08/28/17-1236
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $255.78
Rx Number 01539605

History
08/24/17 1344 - POM ORDER by RSHARMA
08/24/17 1345 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 2100
08/28/17 1237 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1236
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1237 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426804
08/28/17 1336 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EALEXEEV Eff: 08/28/17 1237

FLT05NA16 - FLUTICASONE PROPIONATE 0.05% NA SPR 16 GM BTL

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Dose Instructions 2 sprays into each nostril. BID.
Admin Route NASAL
Frequency 1338 (ONE)
Start Date 08/24/17-1338 Stop Date 08/24/17 1339 DC: 08/24/17-1339
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01539604

Discontinued Comments Reached Stop Date

History
08/24/17 1344 - POM ORDER by RSHARMA
08/24/17 1345 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 1338
08/24/17 1345 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 1339
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/24/17 1346 - CREDIT by EBALILO
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

FLT05NA16 - FLUTICASONE PROPIONATE 0.05% NA SPR 16 GM BTL

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Dose Instructions 2 sprays into each nostril. BID.
Admin Route NASAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-1311
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01540690

History
08/28/17 1237 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539605
08/28/17 1334 - EDIT by AADEGBAMIG
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/04/17-2059 SOFT STOP:
08/28/17 1336 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
08/28/17 1336 - CREDIT by AADEGBAMIG
ITEMS: 1
09/01/17 1311 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 1311
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427988
09/01/17 1315 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 09/01/17 1311
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions please apply to sacrum.
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/22/17-2100 Stop Date 08/29/17 2059 DC: 08/28/17-1145
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01539112

History
08/22/17 1812 - POM ORDER by RSHARMA
08/22/17 1816 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 2100
08/28/17 1146 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1145
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1146 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426761
08/28/17 1336 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EALEXEEV Eff: 08/28/17 1146
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions please apply to sacrum.
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-1311
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01540685

History
08/28/17 1146 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539112
08/28/17 1335 - EDIT by AADEGBAMIG
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/04/17-2059 SOFT STOP:
08/28/17 1335 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
08/28/17 1336 - CREDIT by AADEGBAMIG
ITEMS: 1
09/01/17 1311 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 1311
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427991
09/01/17 1315 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 09/01/17 1311
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 08/29/17-2100 Stop Date 08/30/17 0659 DC: 08/30/17-0659
Ordering Doctor VALLES,JENNIE MD
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $15.75
Rx Number 01541095

Discontinued Comments Reached Stop Date

History
08/29/17 1552 - POM ORDER by JVALLES
08/29/17 1555 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 2100
08/30/17 0659 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 0659
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 08/30/17-2100 Stop Date 08/31/17 0659 DC: 08/31/17-0659
Ordering Doctor VALLES,JENNIE MD
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $15.75
Rx Number 01541367

Discontinued Comments Reached Stop Date

History
08/30/17 1601 - POM ORDER by JVALLES
08/30/17 1611 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 2100
08/31/17 0659 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 0659
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/22/17-2000 Stop Date 09/21/17 1959 DC: 08/23/17-1422
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539039

History
08/22/17 1620 - POM ORDER by RSHARMA
08/22/17 1622 - VERIFIED by MHAIMOWITZ
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2000
For: 08/26/17 - 2000
For: 08/27/17 - 2000
08/23/17 1424 - DISCONTINUE by EALEXEEV Eff: 08/23/17 1422
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/23/17 1436 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/23/17 1424
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

CLNZ.5T - CLONAZEPAM 0.5 MG TAB

Dose 0.25 MG (0.5 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/22/17-1715 Stop Date 08/29/17 1714 DC: 08/28/17-1146
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539090

History
08/22/17 1723 - POM ORDER by RSHARMA
08/22/17 1725 - VERIFIED by MHAIMOWITZ
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 1147 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1146
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1147 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426763
08/28/17 1336 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EALEXEEV Eff: 08/28/17 1147
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

CLNZ.5T - CLONAZEPAM 0.5 MG TAB

Dose 0.25 MG (0.5 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/28/17-1200 Stop Date 09/04/17 1159 DC: 09/01/17-1311
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540687

History
08/28/17 1147 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539090
08/28/17 1334 - EDIT by AADEGBAMIG
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1200 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-1200 STOP: 09/04/17-1159 SOFT STOP:
08/28/17 1335 - VERIFIED by AADEGBAMIG
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 1311 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 1311
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427987
09/01/17 1315 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 09/01/17 1311

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 08/22/17-1630 Stop Date 09/21/17 1629 DC: 08/22/17-1824
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539043

History
08/22/17 1620 - POM ORDER by RSHARMA
08/22/17 1623 - VERIFIED by MHAIMOWITZ
08/22/17 1825 - DISCONTINUE by RSHARMA Eff: 08/22/17 1824
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/22/17 1828 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RSHARMA Eff: 08/22/17 1825
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/22/17-2200 Stop Date 09/21/17 2159 DC: 08/23/17-1307
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $0.40
Rx Number 01539094

History
08/22/17 1724 - POM ORDER by RSHARMA
08/22/17 1726 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 8
For: 08/22/17 - 2200
For: 08/23/17 - 0600
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/23/17 1308 - DISCONTINUE by EALEXEEV Eff: 08/23/17 1307
Items Auto Credited: 15 Doses Auto Credited: 15
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/23/17 1308 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01425434
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

08/23/17 1310 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG

Discontinue by EALEXEEV Eff: 08/23/17 1308

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859 DC: 08/28/17-1524
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $0.90
Rx Number 01539095

History
08/22/17 1724 - POM ORDER by RSHARMA
08/22/17 1727 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/28/17 1526 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1524
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1526 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426871
08/28/17 1534 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EALEXEEV Eff: 08/28/17 1526
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859 DC: 08/30/17-1601
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01540754

History
08/28/17 1535 - ENTER by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/30/17 1602 - DISCONTINUE by JVALLES Eff: 08/30/17 1601
Items Auto Credited: 8 Doses Auto Credited: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: VALLES,JENNIE MD
08/31/17 0731 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JVALLES Eff: 08/30/17 1602
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY@0800 (SCH)
Start Date 08/25/17-0800 Stop Date 08/28/17 1146 DC: 08/28/17-1146
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01539718

History
08/24/17 1602 - POM ORDER by EALEXEEV
08/24/17 1604 - VERIFIED by EBALILO
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/28/17 1150 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/25/17-0800 STOP: 09/01/17 0759 SOFT STOP: 0
TO:
START: 08/25/17-0800 STOP: 08/28/17-1146 SOFT STOP:
08/28/17 1150 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1146
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/28/17 1150 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426764
08/28/17 1336 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by EALEXEEV Eff: 08/28/17 1150
Discontinue by EALEXEEV Eff: 08/28/17 1150
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/01/17 0759 DC: 08/29/17-0939
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540688

History
08/28/17 1150 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539718
Result of Frequency/Schedule Edit
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 08/28/17 - 0800
Last Actual Administration Time: 08/28/17 - 0824
Old Freq/Sch: DAILY@0800 (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/28/17 - 1146
New Order Start: 08/28/17 - 2100
New Order Stop: 09/01/17 - 0759
08/28/17 1335 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by EALEXEEV Eff: 08/28/17 1150
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 08/28/17 - 0800
Last Actual Administration Time: 08/28/17 - 0824
Old Freq/Sch: DAILY@0800 (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/28/17 - 1146
New Order Start: 08/28/17 - 2100
New Order Stop: 09/01/17 - 0759
08/28/17 1335 - VERIFIED by AADEGBAMIG
08/29/17 0940 - DISCONTINUE by EALEXEEV Eff: 08/29/17 0939
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/29/17 0940 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427011
08/29/17 0942 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/29/17 0940
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/29/17-2100 Stop Date 09/01/17 2059 DC: 08/30/17-0944
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540907

History
08/29/17 0940 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540688
08/29/17 0942 - EDIT by AMACCA
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-2100 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/29/17-2100 STOP: 09/01/17-2059 SOFT STOP:
08/29/17 0942 - VERIFIED by AMACCA
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0900
08/30/17 0945 - DISCONTINUE by EALEXEEV Eff: 08/30/17 0944
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/30/17 0945 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427337
08/30/17 1056 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/30/17 0945
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/30/17-2100 Stop Date 09/02/17 2059 DC: 08/31/17-1722
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541244

History
08/30/17 0945 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540907
08/30/17 1055 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/30/17-2100 STOP: 09/02/17 SOFT STOP:
TO:
START: 08/30/17-2100 STOP: 09/02/17-2059 SOFT STOP: 0
08/30/17 1055 - VERIFIED by AMOLINARI
08/31/17 1722 - DISCONTINUE by EALEXEEV Eff: 08/31/17 1722
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/31/17 1722 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427866
08/31/17 1723 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/31/17 1722
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/31/17-2100 Stop Date 09/03/17 2059 DC: 09/01/17-1311
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541819

History
08/31/17 1722 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01541244
08/31/17 1725 - EDIT by AMACCA
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-2100 STOP: 09/03/17 SOFT STOP:
TO:
START: 08/31/17-2100 STOP: 09/03/17-2059 SOFT STOP:
08/31/17 1725 - VERIFIED by AMACCA
09/01/17 1311 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 1311
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427989
09/01/17 1315 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 09/01/17 1311
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/23/17-2100 Stop Date 08/30/17 2059 DC: 08/25/17-0751
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 3 Total Costs $0.00 Total Charges $24.09
Rx Number 01539250

History
08/23/17 1120 - POM ORDER by EALEXEEV
08/23/17 1220 - VERIFIED by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0752 - DISCONTINUE by EALEXEEV Eff: 08/25/17 0751
Items Auto Credited: 6 Doses Auto Credited: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/25/17 0830 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/25/17 0752
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
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CAPUANO,JOHN J W00001219380 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 1116 (ONE)
Start Date 08/23/17-1116 Stop Date 08/23/17 1117 DC: 08/23/17-1117
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 1 Total Costs $0.00 Total Charges $8.03
Rx Number 01539251

Discontinued Comments Reached Stop Date

History
08/23/17 1120 - POM ORDER by EALEXEEV
08/23/17 1220 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 1116
08/23/17 1220 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 1117
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

NF-MED - NON FORMULARY MEDICATION

Dose Instructions enemeez. qhs.

Admin Route XX
Frequency DAILY@2000 (SCH)
Start Date 08/22/17-2000 Stop Date 09/21/17 1959 DC: 08/22/17-2000
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539135

History
08/22/17 1825 - POM ORDER by RSHARMA
08/22/17 1920 - DISCONTINUE by AMACCA Eff: 08/22/17 2000
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/22/17 1920 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/22/17-1715 Stop Date 08/24/17 1559 DC: 08/24/17-1559
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01539096

History
08/22/17 1724 - POM ORDER by RSHARMA
08/22/17 1727 - VERIFIED by MHAIMOWITZ
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/24/17 1601 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/22/17-1715 STOP: 08/29/17 1714 SOFT STOP: 0
TO:
START: 08/22/17-1715 STOP: 08/24/17-1559 SOFT STOP:
08/24/17 1602 - DISCONTINUE by EALEXEEV Eff: 08/24/17 1559
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/24/17 1602 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01425902
08/24/17 1603 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by EALEXEEV Eff: 08/24/17 1601
Discontinue by EALEXEEV Eff: 08/24/17 1602
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/24/17-1700 Stop Date 08/29/17 1714 DC: 08/26/17-1006
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01539717

History
08/24/17 1602 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539096
Result of Frequency/Schedule Edit
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/24/17 - 1148
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: 4 TIMES A DAY (PRN)
Old Order Stop: 08/24/17 - 1559
New Order Start: 08/24/17 - 1700
New Order Stop: 08/29/17 - 1714
08/24/17 1603 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by EALEXEEV Eff: 08/24/17 1602
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/24/17 - 1148
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: 4 TIMES A DAY (PRN)
Old Order Stop: 08/24/17 - 1559
New Order Start: 08/24/17 - 1700
New Order Stop: 08/29/17 - 1714
08/24/17 1603 - VERIFIED by EBALILO
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/26/17 1007 - DISCONTINUE by HAZIZI Eff: 08/26/17 1006
EDIT DOCTOR: AZIZI,HANA MD
08/26/17 1007 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01426450
08/28/17 1336 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HAZIZI Eff: 08/26/17 1007
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: FOR MODERATE to severe PAIN
Start Date 08/26/17-1015 Stop Date 09/02/17 1014 DC: 08/30/17-0944
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01540300

History
08/26/17 1007 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01539717
08/26/17 1009 - VERIFIED by AADEGBAMIG
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0945 - DISCONTINUE by EALEXEEV Eff: 08/30/17 0944
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/30/17 0945 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427338
08/30/17 1251 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/30/17 0945

OXYC-441 - OXYCODONE HCL/ACETAMINOPHEN 10/325MG TABLET

Dose 1 TAB (1 TABLET)

Admin Route ORAL
Frequency NOW (ONE)
Start Date 08/23/17-1315 Stop Date 08/23/17 1316 DC: 08/23/17-1316
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539265

Discontinued Comments Reached Stop Date

History
08/23/17 1311 - POM ORDER by EALEXEEV
08/23/17 1347 - VERIFIED by MHAIMOWITZ
08/23/17 1347 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 1316
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

PRD1T - PREDNISONE 1 MG TAB

Dose 2 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 08/30/17 0859 DC: 08/28/17-1215
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $0.60
Rx Number 01539097

History
08/22/17 1724 - POM ORDER by RSHARMA
08/22/17 1728 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 1216 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1215
Items Auto Credited: 2 Doses Auto Credited: 1
For: 08/29/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1216 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426775
08/28/17 1336 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EALEXEEV Eff: 08/28/17 1216
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

PRD1T - PREDNISONE 1 MG TAB

Dose 2 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/04/17 0859 DC: 09/01/17-1311
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 8 Total Costs $0.00 Total Charges $0.40
Rx Number 01540689

History
08/28/17 1216 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539097
08/28/17 1335 - EDIT by AADEGBAMIG
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0900 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/29/17-0900 STOP: 09/04/17-0859 SOFT STOP:
08/28/17 1335 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 1311 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 1311
Items Auto Credited: 4 Doses Auto Credited: 2
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1311 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427990
09/01/17 1315 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 09/01/17 1311
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

TS160800 - TRIMETHOPRIM/SULFAMETHOXAZOLE 160-800 MG TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-0900 Stop Date 09/01/17 0859 DC: 09/01/17-0859
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 14 Total Costs $0.00 Total Charges $6.72
Rx Number 01539858

Discontinued Comments Reached Stop Date

History
08/25/17 0754 - POM ORDER by EALEXEEV
08/25/17 0829 - VERIFIED by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
09/01/17 0859 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

CAPUANO,JOHN J W00001219380 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 10 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859 CAN: 08/28/17-1533
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01426871

History
08/28/17 1526 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539095
08/28/17 1533 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
new strength
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CARPENTER,JAMES Responsible Doctor NOVITCH, RICHARD MD.

Account Number W00001219547 Location B1WE Unit Number M000209367
Age/Sex 70/M Room 141 Registered Date 08/29/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 9.02 in 175.3 cm Body Surface Area 2.18 m2

Weight 226 lb 11.2 oz 102.829 kg
Hem-Onc No

Drug Allergies No Known Drug Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

NS.65NA45 - SODIUM CHLORIDE 0.65% NA SOLN 45 ML BTL

Dose 1 SPRAY (1 NASAL APPLICATION)

Admin Route NASAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $7.23
Rx Number 01541063

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1700

TIOT18CA6 - TIOTROPIUM BROMIDE 18 MCG BOX

Dose 18 MCG (1 BOX)

Admin Route INHALATION
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $243.09
Rx Number 01541064

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/29/17-1530 Stop Date 09/28/17 1529
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541065

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Dose Instructions PRN WHEEZING
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (PRN) PRN REASON: WHEEZE - for Wheezing
Start Date 08/29/17-1530 Stop Date 09/28/17 1529
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541059

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 7 Total Costs $0.00 Total Charges $0.15
Rx Number 01541122

History
08/29/17 1639 - POM ORDER by RNOVITCH
08/29/17 1639 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 8 Total Costs $0.00 Total Charges $3.75
Rx Number 01541066

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 7 Total Costs $0.00 Total Charges $80.65
Rx Number 01541067

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1530 Stop Date 09/28/17 1529
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541060

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 15 Total Costs $0.00 Total Charges $2.80
Rx Number 01541061

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

GMFB600T - GEMFIBROZIL 600 MG TAB

Dose 600 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 15 Total Costs $0.00 Total Charges $6.80
Rx Number 01541069

History
08/29/17 1538 - ENTER by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 90
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 7 Total Costs $0.00 Total Charges $1.50
Rx Number 01541068

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 90 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 15 Total Costs $0.00 Total Charges $2.50
Rx Number 01541062

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/29/17-1530 Stop Date 09/05/17 1529
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541057

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/29/17-1530 Stop Date 09/05/17 1529
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541058

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1536 - VERIFIED by AADEGBAMIG
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 10/02/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541492

History
08/30/17 2125 - POM ORDER by SDAS
08/30/17 2204 - VERIFIED by MHAIMOWITZ
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/30/17-2130 Stop Date 08/30/17 2131 DC: 08/30/17-2131
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541491

Discontinued Comments Reached Stop Date

History
08/30/17 2125 - POM ORDER by SDAS
08/30/17 2204 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by MPAULOSE Eff: 08/30/17 2136
08/30/17 2204 - VERIFIED by MHAIMOWITZ
08/30/17 2205 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2131
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

CARPENTER,JAMES W00001219547 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 600 EA (0 EACHS)

Admin Route NF
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659 DC: 08/29/17-1700
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541070

History
08/29/17 1532 - POM ORDER by RNOVITCH
08/29/17 1538 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 1700
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1538 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CARTY,CHRISTELL Responsible Doctor AMBROSE,ANNE MD

Account Number W00001219284 Location B2WEII Unit Number M000209145
Age/Sex 77/F Room 245 Registered Date 08/18/17
Status ADM IN Bed 01 Discharged Date

Height 4 ft 11.02 in 149.9 cm Body Surface Area 1.35 m2

Weight 95 lb 11.2 oz 43.409 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 30 UNIT (0.3 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541219

History
08/29/17 1846 - POM COPY AND EDIT by SDAS
FROM: Rx #01540815
08/29/17 1930 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 2100
08/29/17 2028 - CREDIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 30 UNIT (0.3 ML)

Admin Route SUBCUTAN.
Frequency DAILY @ BREAKFAST (SCH)
Start Date 08/30/17-0800 Stop Date 09/29/17 0759
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541220

History
08/29/17 1846 - POM COPY AND EDIT by SDAS
FROM: Rx #01540814
08/29/17 1930 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0800
08/29/17 2028 - CREDIT by MHAIMOWITZ
ITEMS: 1

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 08/19/17-0800 Stop Date 09/18/17 0759
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $494.46
Rx Number 01538230

History
08/18/17 1851 - POM ORDER by SDAS
08/18/17 1856 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 0800
08/31/17 1301 - DEBIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/18/17-1630 Stop Date 09/17/17 1629
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538148

History
08/18/17 1621 - POM ORDER by SDAS
08/18/17 1626 - VERIFIED by AMACCA
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $0.48
Rx Number 01538225

History
08/18/17 1851 - POM ORDER by SDAS
08/18/17 1855 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 09/17/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 19 Total Costs $0.00 Total Charges $12.00
Rx Number 01538235

History
08/18/17 1901 - ENTER by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/18/17-1630 Stop Date 09/17/17 1629
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01538151

History
08/18/17 1621 - POM ORDER by SDAS
08/18/17 1627 - VERIFIED by AMACCA
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 2,000 UNIT (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 36 Total Costs $0.00 Total Charges $4.00
Rx Number 01538232

History
08/18/17 1852 - POM ORDER by SDAS
08/18/17 1856 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/18/17-1700 Stop Date 09/17/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $11.75
Rx Number 01538147

History
08/18/17 1621 - POM ORDER by SDAS
08/18/17 1626 - VERIFIED by AMACCA
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

For: 09/02/17 - 0900

For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

FESO4TAB2 - FESOTERODINE FUMARATE 4 MG TABSR 24H

Dose 8 MG (2 TAB.SR.24HS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 36 Total Costs $0.00 Total Charges $794.40
Rx Number 01538237

History
08/18/17 1903 - ENTER by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $2.40
Rx Number 01538233

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 100 MG/DAY
is below the Low Daily Dose.

History
08/18/17 1852 - POM ORDER by SDAS
08/18/17 1856 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 09/17/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 38 Total Costs $0.00 Total Charges $4.80
Rx Number 01538234

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 200 MG/DAY
is below the Low Daily Dose.

History
08/18/17 1852 - POM ORDER by SDAS
08/18/17 1856 - VERIFIED by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 08/18/17-2100 Stop Date 09/17/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 37 Total Costs $0.00 Total Charges $296.96
Rx Number 01538226

History
08/18/17 1851 - POM ORDER by SDAS
08/18/17 1855 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

For: 09/02/17 - 0900

For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $1.60
Rx Number 01538228

History
08/18/17 1851 - POM ORDER by SDAS
08/18/17 1856 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/18/17-1630 Stop Date 09/17/17 1629
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538150

History
08/18/17 1621 - POM ORDER by SDAS
08/18/17 1626 - VERIFIED by AMACCA
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/18/17-1630 Stop Date 09/17/17 1629
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538149

History
08/18/17 1621 - POM ORDER by SDAS
08/18/17 1626 - VERIFIED by AMACCA
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $1.60
Rx Number 01538231

History
08/18/17 1852 - POM ORDER by SDAS
08/18/17 1856 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 25 UNIT (0.25 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 09/17/17 2059 DC: 08/21/17-1509
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $322.41
Rx Number 01538229

History
08/18/17 1851 - POM ORDER by SDAS
08/18/17 1856 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 2100
08/21/17 1514 - DISCONTINUE by SDAS Eff: 08/21/17 1509
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/21/17 1514 - POM COPY AND EDIT by SDAS
TO: Rx #U01424871
08/21/17 1543 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SDAS Eff: 08/21/17 1514

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 30 UNIT (0.3 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 DC: 08/22/17-1651
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538665

History
08/21/17 1514 - POM COPY AND EDIT by SDAS
FROM: Rx #01538229
08/21/17 1542 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 2100
08/21/17 1543 - CREDIT by EBALILO
ITEMS: 1
08/22/17 1741 - DISCONTINUE by SDAS Eff: 08/22/17 1651
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/22/17 1742 - POM COPY AND EDIT by SDAS
TO: Rx #U01425299
08/22/17 1746 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SDAS Eff: 08/22/17 1741
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 35 UNIT (0.35 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059 DC: 08/23/17-1844
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01539108

History
08/22/17 1742 - POM COPY AND EDIT by SDAS
FROM: Rx #01538665
08/22/17 1746 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 2100
08/22/17 1747 - CREDIT by AMACCA
ITEMS: 1
08/23/17 1847 - DISCONTINUE by SDAS Eff: 08/23/17 1844
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/23/17 1847 - POM COPY AND EDIT by SDAS
TO: Rx #U01425657
08/23/17 1852 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 08/23/17 1847

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 40 UNIT (0.4 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 09/22/17 2059 DC: 08/24/17-1708
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01539482

History
08/23/17 1847 - POM COPY AND EDIT by SDAS
FROM: Rx #01539108
08/23/17 1851 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 2100
08/23/17 1851 - CREDIT by AADEGBAMIG
ITEMS: 1
08/24/17 1812 - DISCONTINUE by SDAS Eff: 08/24/17 1708
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/24/17 1812 - POM COPY AND EDIT by SDAS
TO: Rx #U01425960
08/24/17 1832 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SDAS Eff: 08/24/17 1812
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 45 UNIT (0.45 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059 DC: 08/28/17-1630
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01539803

History
08/24/17 1812 - POM COPY AND EDIT by SDAS
FROM: Rx #01539482
08/24/17 1832 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 2100
08/24/17 1832 - CREDIT by EBALILO
ITEMS: 1
08/28/17 1633 - DISCONTINUE by SDAS Eff: 08/28/17 1630
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/28/17 1633 - POM COPY AND EDIT by SDAS
TO: Rx #U01426923
08/28/17 1650 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SDAS Eff: 08/28/17 1633

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 25 UNIT (0.25 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059 DC: 08/29/17-1842
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01540815

History
08/28/17 1633 - POM COPY AND EDIT by SDAS
FROM: Rx #01539803
08/28/17 1647 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
08/28/17 1651 - CREDIT by MHAIMOWITZ
ITEMS: 1
08/29/17 1846 - DISCONTINUE by SDAS Eff: 08/29/17 1842
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/29/17 1846 - POM COPY AND EDIT by SDAS
TO: Rx #U01427295
08/29/17 2027 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SDAS Eff: 08/29/17 1846
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 25 UNIT (0.25 ML)

Admin Route SUBCUTAN.
Frequency DAILY @ BREAKFAST (SCH)
Start Date 08/29/17-0800 Stop Date 09/28/17 0759 DC: 08/29/17-1842
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01540814

History
08/28/17 1633 - POM ORDER by SDAS
08/28/17 1646 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 0800
08/28/17 1651 - CREDIT by MHAIMOWITZ
ITEMS: 1
08/29/17 1846 - DISCONTINUE by SDAS Eff: 08/29/17 1842
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/29/17 1846 - POM COPY AND EDIT by SDAS
TO: Rx #U01427296
08/29/17 2027 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SDAS Eff: 08/29/17 1846

INSU100V26 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose 8 UNIT (0.08 ML)

Admin Route SUBCUTAN.
Frequency ONETIME (ONE)
Start Date 08/18/17-1915 Stop Date 08/18/17 1916 DC: 08/18/17-1916
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01538239

Discontinued Comments Reached Stop Date

History
08/18/17 1907 - POM ORDER by SDAS
08/18/17 1921 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by LWAUCHOPE Eff: 08/18/17 1912
08/18/17 1921 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 1915
08/18/17 1921 - DISCONTINUE by PHABKGJOB Eff: 08/18/17 1916
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 09/17/17 2059 DC: 08/18/17-2100
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538236

History
08/18/17 1851 - POM ORDER by SDAS
08/18/17 1902 - VERIFIED by SYSTEM
Verified in order to DC
08/18/17 1902 - DISCONTINUE by AADEGBAMIG Eff: 08/18/17 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 DC: 08/19/17-0900
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538227

History
08/18/17 1851 - POM ORDER by SDAS
08/18/17 1856 - VERIFIED by AADEGBAMIG
08/18/17 1923 - DISCONTINUE by AADEGBAMIG Eff: 08/19/17 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

CARTY,CHRISTELL W00001219284 (Continued)

FESO8TAB2 - FESOTERODINE FUMARATE 8 MG TABSR 24H

Dose 8 MG (1 TAB SUSTAINED RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 DC: 08/19/17-0900
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538238

History
08/18/17 1852 - POM ORDER by SDAS
08/18/17 1903 - VERIFIED by SYSTEM
Verified in order to DC
08/18/17 1903 - DISCONTINUE by AADEGBAMIG Eff: 08/19/17 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE

MTC5T - METOCLOPRAMIDE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/28/17-1630 Stop Date 08/28/17 1631 DC: 08/28/17-1631
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $0.48
Rx Number 01540803

Discontinued Comments Reached Stop Date

History
08/28/17 1628 - POM ORDER by SDAS
08/28/17 1629 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1630
08/28/17 1631 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 1631
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CASSAMAJOR,MARIE Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001218923 Location B2EA Unit Number M000208979
Age/Sex 69/F Room 205 Registered Date 08/10/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 5 in 165.1 cm Body Surface Area 1.97 m2

Weight 198 lb 9.6 oz 90.083 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/10/17-1717 ALLERGY VERIFICATION CALL COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

LEVA0.63 - LEVALBUTEROL HCL 0.63 MG/3 ML VIAL

Dose 0.63 MG (3 ML)

Admin Route NEBULIZER
Frequency EVERY 8 HOURS (SCH)
Start Date 08/14/17-2200 Stop Date 09/13/17 2159
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 48 Total Costs $0.00 Total Charges $889.92
Rx Number 01536700

History
08/14/17 1637 - POM ORDER by RMINASSIAN
08/14/17 1643 - VERIFIED by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 1
For: 08/14/17 - 2200
08/21/17 1023 - DEBIT by EBALILO
ITEMS: 1
08/25/17 0729 - DEBIT by AMOLINARI
ITEMS: 1
08/30/17 1022 - DEBIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 2 EA (2 PATCHS)
Dose Instructions one patch on the left low back / posterior hip, one patch
on the right low back / posterior hip area
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 30 Total Costs $0.00 Total Charges $661.50
Rx Number 01538552

History
08/21/17 1301 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01536883
08/21/17 1310 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 1
For: 08/22/17 - 0900
08/21/17 1312 - CREDIT by MHAIMOWITZ
ITEMS: 1
08/23/17 0812 - DEBIT by AMOLINARI
ITEMS: 2
08/30/17 0919 - DEBIT by BGIRLING
ITEMS: 2
DEBIT COMMENTS:
sent up 8/30/17
09/02/17 1738 - DEBIT by MHAIMOWITZ
ITEMS: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/10/17-1815 Stop Date 09/09/17 1814
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.50
Rx Number 01535859

History
08/10/17 1817 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01535819
08/10/17 1818 - VERIFIED by EBALILO
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 26 Total Costs $0.00 Total Charges $14.49
Rx Number 01535827

History
08/10/17 1713 - POM ORDER by CDOHLE
08/10/17 1721 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 26 Total Costs $0.00 Total Charges $2.40
Rx Number 01535826

History
08/10/17 1713 - POM ORDER by CDOHLE
08/10/17 1721 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

For: 09/01/17 - 0900

For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/10/17-1715 Stop Date 09/09/17 1714
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01535820

History
08/10/17 1709 - POM ORDER by RMINASSIAN
08/10/17 1720 - VERIFIED by AMOLINARI
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $11.75
Rx Number 01538194

History
08/18/17 1710 - POM ORDER by CDOHLE
08/18/17 1737 - VERIFIED by AMACCA
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

For: 09/02/17 - 0900

For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

ESOM40CAP - ESOMEPRAZOLE MAGNESIUM 40 MG CPDR

Dose 40 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/19/17-0800 Stop Date 09/18/17 0759
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 18 Total Costs $0.00 Total Charges $315.68
Rx Number 01538193

History
08/18/17 1710 - POM ORDER by CDOHLE
08/18/17 1737 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0800
For: 08/20/17 - 0800
For: 08/21/17 - 0800
For: 08/22/17 - 0800
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0800
For: 08/24/17 - 0800
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/17/17-2100 Stop Date 09/16/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $3.40
Rx Number 01537550

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/17/17 1104 - POM ORDER by RMINASSIAN
08/17/17 1119 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 2100
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 09/04/17 - 2100
For: 09/05/17 - 2100

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@0900,1500 (SCH)
Start Date 08/28/17-1500 Stop Date 09/27/17 1459
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 17 Total Costs $0.00 Total Charges $1.95
Rx Number 01540623

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 200 MG/DAY
is below the Low Daily Dose.

History
08/28/17 1028 - POM ORDER by CDOHLE
08/28/17 1216 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/28/17 - 1500
For: 08/29/17 - 0900
For: 08/29/17 - 1500
For: 08/30/17 - 0900
For: 08/30/17 - 1500
For: 08/31/17 - 0900
For: 08/31/17 - 1500
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1500
For: 09/02/17 - 0900
For: 09/02/17 - 1500
For: 09/03/17 - 0900
For: 09/03/17 - 1500
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1500
For: 09/05/17 - 0900
For: 09/05/17 - 1500
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/10/17-2200 Stop Date 09/09/17 2159
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 80 Total Costs $0.00 Total Charges $668.16
Rx Number 01535857

History
08/10/17 1807 - POM ORDER by RMINASSIAN
08/10/17 1810 - VERIFIED by EBALILO
Items Dispensed: 11 Doses Dispensed: 11
For: 08/10/17 - 2200
For: 08/11/17 - 0600
For: 08/11/17 - 1400
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 1400
For: 08/18/17 - 2200
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
For: 08/21/17 - 0600
08/18/17 0819 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 08/21/17 - 1400
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

For: 09/04/17 - 1400

For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/16/17-0900 Stop Date 09/15/17 0859
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 21 Total Costs $0.00 Total Charges $0.54
Rx Number 01537055

History
08/15/17 1645 - POM ORDER by CDOHLE
08/15/17 1658 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/10/17-1715 Stop Date 09/09/17 1714
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535822

History
08/10/17 1709 - POM ORDER by RMINASSIAN
08/10/17 1720 - VERIFIED by AMOLINARI
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/10/17-1715 Stop Date 09/09/17 1714
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01535821

History
08/10/17 1709 - POM ORDER by RMINASSIAN
08/10/17 1720 - VERIFIED by AMOLINARI
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

ROSU10TA - ROSUVASTATIN CALCIUM 10 MG TAB

Dose 40 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/10/17-2100 Stop Date 09/09/17 2059
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 108 Total Costs $0.00 Total Charges $2088.00
Rx Number 01535825

History
08/10/17 1713 - POM ORDER by CDOHLE
08/10/17 1720 - VERIFIED by AMOLINARI
Items Dispensed: 16 Doses Dispensed: 4
For: 08/10/17 - 2100
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

Items Dispensed: 12 Doses Dispensed: 3

For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 52 Total Costs $0.00 Total Charges $4.70
Rx Number 01535824

History
08/10/17 1713 - POM ORDER by CDOHLE
08/10/17 1720 - VERIFIED by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0823 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

ACT20V10 - ACETYLCYSTEINE 20% INHAL SOLN 10 ML VIAL

Dose 2 ML (0.2 VIALS)

Admin Route NEBULIZER
Frequency EVERY 8 HOURS (SCH)
Start Date 08/14/17-2200 Stop Date 09/13/17 2159 DC: 08/22/17-2249
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $171.15
Rx Number 01536710

History
08/14/17 1636 - POM ORDER by RMINASSIAN
08/14/17 1646 - EDIT by AADEGBAMIG
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE: 0 ML None
TO:
DOSE: 2 ML (0.2 VIALS)
08/14/17 1647 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/14/17 - 2200
08/16/17 0824 - DEBIT by BGIRLING
ITEMS: 3
DEBIT COMMENTS:
sent up 8/16/17
08/21/17 1215 - DEBIT by MHAIMOWITZ
ITEMS: 3
08/22/17 2250 - DISCONTINUE by CDOHLE Eff: 08/22/17 2249
EDIT DOCTOR: DOHLE,CAROLIN MD
08/23/17 0812 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/22/17 2250
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions to left low back / posterior left hip area
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/16/17-0900 Stop Date 09/15/17 0859 DC: 08/21/17-1255
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $330.75
Rx Number 01536883

History
08/15/17 1029 - POM ORDER by RMINASSIAN
08/15/17 1038 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 1
For: 08/16/17 - 0900
08/16/17 0832 - DEBIT by AMOLINARI
ITEMS: 1
08/19/17 1027 - DEBIT by AADEGBAMIG
ITEMS: 1
08/21/17 1301 - DISCONTINUE by RMINASSIAN Eff: 08/21/17 1255
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/21/17 1301 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01424791
08/21/17 1310 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RMINASSIAN Eff: 08/21/17 1301
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions to left low back / posterior left hip area
Admin Route TOPICALLY
Frequency 1026 (ONE)
Start Date 08/15/17-1026 Stop Date 08/15/17 1027 DC: 08/15/17-1027
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01536882

Discontinued Comments Reached Stop Date

History
08/15/17 1029 - POM ORDER by RMINASSIAN
08/15/17 1038 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 1
For: 08/15/17 - 1026
08/15/17 1038 - DISCONTINUE by PHABKGJOB Eff: 08/15/17 1027
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/15/17 1039 - CREDIT by EBALILO
ITEMS: 1

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY@1600 (SCH)
Start Date 08/13/17-1600 Stop Date 08/14/17 1601 DC: 08/14/17-1601
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536395

Discontinued Comments Reached Stop Date

History
08/13/17 1337 - POM ORDER by NCHANDEL
08/13/17 1341 - VERIFIED by AMACCA
08/14/17 1601 - DISCONTINUE by PHABKGJOB Eff: 08/14/17 1601
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/14/17-1400 Stop Date 08/14/17 1401 DC: 08/14/17-1401
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01536568

Warnings
Type: MAINTENANCE
Range: SODIUM POLYSTYRENE SULFONATE (15 GM/60 ML)
Condition: ALL COMMON INDICATIONS
Warnings SODI15OR2: Unable to check dose ranges for G/DAY (Dose Units).

Discontinued Comments Reached Stop Date

History
08/14/17 1402 - POM ORDER by TKOUTZEVA
08/14/17 1403 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/14/17 - 1400
08/14/17 1406 - DISCONTINUE by PHABKGJOB Eff: 08/14/17 1401
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/28/17-1715 Stop Date 08/28/17 1716 DC: 08/28/17-1716
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01540824

Discontinued Comments Reached Stop Date

History
08/28/17 1723 - POM ORDER by CDOHLE
08/28/17 1727 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1715
08/28/17 1728 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 1716
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/10/17-1715 Stop Date 09/09/17 1714 DC: 08/10/17-1814
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535819

History
08/10/17 1709 - POM ORDER by RMINASSIAN
08/10/17 1720 - VERIFIED by AMOLINARI
08/10/17 1817 - DISCONTINUE by RMINASSIAN Eff: 08/10/17 1814
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/10/17 1817 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01422205
08/10/17 1818 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by RMINASSIAN Eff: 08/10/17 1817
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

CLCX200C - CELECOXIB 200 MG CAP

Dose 200 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 08/29/17 0859 DC: 08/29/17-0859
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $137.75
Rx Number 01539240

Discontinued Comments Reached Stop Date

History
08/23/17 1024 - POM ORDER by CDOHLE
08/23/17 1215 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 0900
08/29/17 0859 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859 DC: 08/18/17-1709
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $5.75
Rx Number 01535828

History
08/10/17 1713 - POM ORDER by CDOHLE
08/10/17 1721 - VERIFIED by AMOLINARI
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 0900
For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/18/17 1710 - DISCONTINUE by CDOHLE Eff: 08/18/17 1709
EDIT DOCTOR: DOHLE,CAROLIN MD
08/18/17 1736 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by CDOHLE Eff: 08/18/17 1710
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

ESOM40SU - ESOMEPRAZOLE MAG TRIHYDRATE 40 MG PKT

Dose 40 MG (1 PACKET)
Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/11/17-0800 Stop Date 09/10/17 0759 DC: 08/18/17-1709
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 8 Total Costs $0.00 Total Charges $180.64
Rx Number 01535829

History
08/10/17 1713 - POM ORDER by CDOHLE
08/10/17 1721 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0800
For: 08/12/17 - 0800
For: 08/13/17 - 0800
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0800
For: 08/15/17 - 0800
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0800
For: 08/17/17 - 0800
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0800
For: 08/19/17 - 0800
For: 08/20/17 - 0800
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0800
For: 08/22/17 - 0800
08/18/17 1710 - DISCONTINUE by CDOHLE Eff: 08/18/17 1709
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 0800
For: 08/20/17 - 0800
For: 08/21/17 - 0800
For: 08/22/17 - 0800
EDIT DOCTOR: DOHLE,CAROLIN MD
08/18/17 1736 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by CDOHLE Eff: 08/18/17 1710
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/12/17-2130 Stop Date 08/12/17 2131 DC: 08/12/17-2131
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $0.28
Rx Number 01536375

Discontinued Comments Reached Stop Date

History
08/12/17 2136 - POM ORDER by EGITLER
08/13/17 0951 - REVIEW PROVIDER ACTIVITY by AMACCA
Administration of Unverified Order by ACABELLO Eff: 08/12/17 2149
08/13/17 0951 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/12/17 - 2130
08/13/17 0953 - DISCONTINUE by PHABKGJOB Eff: 08/12/17 2131
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

CASSAMAJOR,MARIE W00001218923 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/10/17-1715 Stop Date 09/09/17 1714 DC: 08/30/17-0955
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $0.40
Rx Number 01535823

History
08/10/17 1710 - POM ORDER by RMINASSIAN
08/10/17 1720 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 1
For: 08/10/17 - 1715
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0956 - DISCONTINUE by CDOHLE Eff: 08/30/17 0955
EDIT DOCTOR: DOHLE,CAROLIN MD
08/30/17 1022 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/30/17 0956
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CHUNG,SOOKZA Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001219255 Location B2EA Unit Number M000208695
Age/Sex 73/F Room 212 Registered Date 08/16/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 2.99 in 160 cm Body Surface Area 1.68 m2

Weight 143 lb oz 64.864 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions to back of head / neck
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/16/17-2100 Stop Date 09/15/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01537437

History
08/16/17 1814 - POM ORDER by RMINASSIAN
08/16/17 1826 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 08/16/17 - 2100

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions apply to left wrist at night
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01541904

History
09/01/17 1219 - POM ORDER by SDAS
09/01/17 1225 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 09/01/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/16/17-1345 Stop Date 09/15/17 1344
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537232

History
08/16/17 1347 - POM ORDER by RMINASSIAN
08/16/17 1355 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $10.71
Rx Number 01537239

History
08/16/17 1353 - POM ORDER by RMINASSIAN
08/16/17 1357 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $1.80
Rx Number 01537240

History
08/16/17 1353 - POM ORDER by RMINASSIAN
08/16/17 1357 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/16/17-2100 Stop Date 09/15/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 42 Total Costs $0.00 Total Charges $1229.40
Rx Number 01537241

History
08/16/17 1353 - POM ORDER by RMINASSIAN
08/16/17 1357 - VERIFIED by EBALILO
Items Dispensed: 10 Doses Dispensed: 5
For: 08/16/17 - 2100
For: 08/17/17 - 2100
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1345 Stop Date 09/15/17 1344
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01537233

History
08/16/17 1347 - POM ORDER by RMINASSIAN
08/16/17 1355 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $290.34
Rx Number 01537242

History
08/16/17 1353 - POM ORDER by RMINASSIAN
08/16/17 1357 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/16/17-1700 Stop Date 09/15/17 1659
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01537234

History
08/16/17 1353 - POM ORDER by RMINASSIAN
08/16/17 1356 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

For: 08/31/17 - 0900

For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $1534.14
Rx Number 01537243

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.62
MG/KG/DAY is below the Low Daily Dose.

History
08/16/17 1353 - POM ORDER by RMINASSIAN
08/16/17 1358 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 09/04/17 - 0900
For: 09/05/17 - 0900

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/16/17-1345 Stop Date 09/15/17 1344
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537236

History
08/16/17 1347 - POM ORDER by RMINASSIAN
08/16/17 1356 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1345 Stop Date 09/15/17 1344
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537235

History
08/16/17 1347 - POM ORDER by RMINASSIAN
08/16/17 1356 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/18/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01537238

History
08/16/17 1353 - POM ORDER by RMINASSIAN
08/16/17 1356 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1345 Stop Date 09/15/17 1344
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01537237

History
08/16/17 1347 - POM ORDER by RMINASSIAN
08/16/17 1356 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 1345
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

AMN50480 - AMANTADINE SYRUP 50 MG/5 ML 480 ML ML

Dose 5 ML (5 MLS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 DC: 08/23/17-1035
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 30 Total Costs $0.00 Total Charges $5.40
Rx Number 01538679

History
08/21/17 1556 - ENTER by MHAIMOWITZ
Items Dispensed: 30 Doses Dispensed: 6
For: 08/22/17 - 0900
08/23/17 1036 - DISCONTINUE by CDOHLE Eff: 08/23/17 1035
EDIT DOCTOR: DOHLE,CAROLIN MD
08/28/17 1453 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/23/17 1036
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

ENOX300V2 - ENOXAPARIN SODIUM 100 MG/ML MDV

Dose 70 MG (0.7 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 07/27/17-2100 Stop Date 08/26/17 2059 DC: 08/09/17-0500
Ordering Doctor DOHLE,CAROLIN
Total Dispensed 6 Total Costs $0.00 Total Charges $3721.20
Rx Number 01532283

Discontinued Comments DC'd by Discharge

Activity Needing Review

RA - Hold/Resume by RMINASSIAN Eff: 08/08/17 1320

History
07/27/17 1725 - ENTER by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/27/17 - 2100
07/29/17 1124 - DEBIT by EBALILO
ITEMS: 1
08/01/17 1033 - DEBIT by BGIRLING
ITEMS: 1
08/03/17 0928 - DEBIT by AMOLINARI
ITEMS: 1
08/05/17 1137 - DEBIT by MHAIMOWITZ
ITEMS: 1
08/07/17 0743 - DEBIT by JDIMARCO
ITEMS: 1
08/08/17 1320 - HOLD by RMINASSIAN Eff: 08/08/17 1319
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 07/27/17-1715 Stop Date 08/26/17 1714 DC: 08/09/17-0500
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532273

Discontinued Comments DC'd by Discharge

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1718 - VERIFIED by AMACCA
07/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/09/17-0500
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 12 Total Costs $0.00 Total Charges $7.56
Rx Number 01532278

Discontinued Comments DC'd by Discharge

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1720 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/09/17-0500
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 12 Total Costs $0.00 Total Charges $1.10
Rx Number 01532280

Discontinued Comments DC'd by Discharge

Activity Needing Review

RA - Hold/Resume by RMINASSIAN Eff: 08/08/17 0913

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1722 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/08/17 0913 - HOLD by RMINASSIAN Eff: 08/08/17 0912
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/02/17-2100 Stop Date 09/01/17 2059 DC: 08/09/17-0500
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 14 Total Costs $0.00 Total Charges $460.40
Rx Number 01533619

Discontinued Comments DC'd by Discharge

History
08/02/17 1137 - ENTER by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 08/02/17 - 2100
For: 08/03/17 - 2100
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/27/17-2100 Stop Date 08/26/17 2059 DC: 08/02/17-1020
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 4 Total Costs $0.00 Total Charges $3.00
Rx Number 01532279

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1720 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 07/27/17 - 2100
For: 07/28/17 - 2100
For: 07/29/17 - 2100
For: 07/30/17 - 2100
07/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 2100
For: 08/01/17 - 2100
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 2100
For: 08/03/17 - 2100
07/31/17 1036 - HOLD by RMINASSIAN Eff: 07/31/17 1035
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
Items Auto Credited: 4 Doses Auto Credited: 4
For: 07/31/17 - 2100
For: 08/01/17 - 2100
For: 08/02/17 - 2100
For: 08/03/17 - 2100
08/01/17 1033 - REVIEW PROVIDER ACTIVITY by BGIRLING
Hold/Resume by RMINASSIAN Eff: 07/31/17 1036
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 1020 - RESUME by RMINASSIAN Eff: 08/02/17 1000
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
Items Auto Debited: 5 Doses Auto Debited: 5
For: 08/02/17 - 2100
For: 08/03/17 - 2100
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/02/17 1027 - DISCONTINUE by RMINASSIAN Eff: 08/02/17 1020
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/02/17 - 2100
For: 08/03/17 - 2100
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

08/02/17 1027 - POM COPY AND EDIT by RMINASSIAN

TO: Rx #U01420004
08/03/17 0927 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by RMINASSIAN Eff: 08/02/17 1020
Discontinue by RMINASSIAN Eff: 08/02/17 1027

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 40 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/02/17-2100 Stop Date 09/01/17 2059 DC: 08/02/17-2100
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533620

History
08/02/17 1027 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01532279
08/02/17 1137 - DISCONTINUE by AADEGBAMIG Eff: 08/02/17 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/02/17 1137 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/27/17-1715 Stop Date 08/26/17 1714 DC: 08/09/17-0500
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01532274

Discontinued Comments DC'd by Discharge

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1719 - VERIFIED by AMACCA
07/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/04/17-1700 Stop Date 09/03/17 1659 DC: 08/09/17-0500
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534389

Discontinued Comments DC'd by Discharge

History
08/04/17 1647 - POM ORDER by RMINASSIAN
08/04/17 1648 - VERIFIED by MHAIMOWITZ
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
For: 08/09/17 - 2100
For: 08/10/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 08/04/17-2100 Stop Date 08/04/17 2101 DC: 08/04/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534405

Discontinued Comments Reached Stop Date

History
08/04/17 1653 - POM ORDER by RMINASSIAN
08/04/17 1654 - VERIFIED by AADEGBAMIG
08/04/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/04/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency 1700 (ONE)
Start Date 08/17/17-1700 Stop Date 08/17/17 1701 DC: 08/17/17-1701
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537565

Discontinued Comments Reached Stop Date

History
08/17/17 1155 - POM ORDER by RMINASSIAN
08/17/17 1157 - VERIFIED by AMOLINARI
08/17/17 1702 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 1701
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 09/01/17-2100 Stop Date 09/01/17 2101 DC: 09/01/17-2101
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541903

Discontinued Comments Reached Stop Date

History
09/01/17 1216 - POM ORDER by SDAS
09/01/17 1217 - VERIFIED by AMOLINARI
09/01/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/09/17-0500
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 10 Total Costs $0.00 Total Charges $161.30
Rx Number 01532281

Discontinued Comments DC'd by Discharge

Activity Needing Review

RA - Hold/Resume by RMINASSIAN Eff: 08/07/17 0737

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1723 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0737 - HOLD by RMINASSIAN Eff: 08/07/17 0737
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

CCLB10T - CYCLOBENZAPRINE HCL 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 07/31/17-2045 Stop Date 07/31/17 2046 DC: 07/31/17-2046
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $0.25
Rx Number 01533290

Discontinued Comments Reached Stop Date

History
07/31/17 2039 - POM ORDER by SDAS
07/31/17 2042 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 2045
07/31/17 2046 - DISCONTINUE by PHABKGJOB Eff: 07/31/17 2046
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

ENXP80I.8 - ENOXAPARIN INJ 80 MG/0.8 ML SYR

Dose 70 MG (0.7 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 07/27/17-2100 Stop Date 08/26/17 2059 DC: 07/27/17-2100
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532282

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Warnings ENXP80I.8: Unable to check dose ranges for MG/KG/DAY (No Weight).

Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Warnings ENXP80I.8: Unable to check dose ranges for MG/KG/DOSE (No Weight).

Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Warnings ENXP80I.8: Unable to check dose ranges for MG/KG/DAY (No Weight).

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1724 - VERIFIED by SYSTEM
Verified in order to DC
07/27/17 1724 - DISCONTINUE by AMACCA Eff: 07/27/17 2100
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/01/17-1300 Stop Date 08/03/17 1225 DC: 08/03/17-1225
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 17 Total Costs $0.00 Total Charges $0.75
Rx Number 01533384

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/01/17 1303 - POM ORDER by RMINASSIAN
08/01/17 1304 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 8
For: 08/01/17 - 1300
For: 08/01/17 - 1700
For: 08/02/17 - 0900
For: 08/02/17 - 1300
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1300
For: 08/03/17 - 1700
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/04/17 - 0900
For: 08/04/17 - 1300
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
08/03/17 1227 - EDIT by RMINASSIAN
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
FROM:
START: 08/01/17-1300 STOP: 08/31/17 1259 SOFT STOP: 0
DISPENSE: 9
TO:
START: 08/01/17-1300 STOP: 08/03/17-1225 SOFT STOP:
DISPENSE: 6
08/03/17 1227 - DISCONTINUE by RMINASSIAN Eff: 08/03/17 1225
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
FROM:
RX COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

Order filed UNV:

Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
08/03/17 1227 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01420331
08/03/17 1228 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by RMINASSIAN Eff: 08/03/17 1227
Discontinue by RMINASSIAN Eff: 08/03/17 1227
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/03/17-1700 Stop Date 08/31/17 1259 DC: 08/04/17-0830
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $0.15
Rx Number 01533954

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 200 MG/DAY
is below the Low Daily Dose.

History
08/03/17 1227 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01533384
Result of Frequency/Schedule Edit
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: 08/03/17 - 0900
Last Actual Administration Time: 08/03/17 - 0918
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/03/17 - 1225
New Order Start: 08/03/17 - 1700
New Order Stop: 08/31/17 - 1259
08/03/17 1228 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by RMINASSIAN Eff: 08/03/17 1227
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: 08/03/17 - 0900
Last Actual Administration Time: 08/03/17 - 0918
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/03/17 - 1225
New Order Start: 08/03/17 - 1700
New Order Stop: 08/31/17 - 1259
08/03/17 1228 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/03/17 - 1700
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

For: 08/08/17 - 0900

For: 08/08/17 - 1700
08/04/17 0831 - DISCONTINUE by RMINASSIAN Eff: 08/04/17 0830
Items Auto Credited: 10 Doses Auto Credited: 10
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/04/17 1654 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RMINASSIAN Eff: 08/04/17 0831
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/03/17-2100 Stop Date 09/02/17 2059 DC: 08/04/17-0830
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01533955

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/03/17 1227 - POM ORDER by RMINASSIAN
08/03/17 1229 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/03/17 - 2100
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/04/17 0831 - DISCONTINUE by RMINASSIAN Eff: 08/04/17 0830
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/04/17 1654 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RMINASSIAN Eff: 08/04/17 0831
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

GUAI100S17 - GUAIFENESIN 100 MG/5 ML UDC

Dose 100 MG (5 ML)

Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/17/17-1300 Stop Date 09/16/17 1259 DC: 08/29/17-2038
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $6.00
Rx Number 01537566

History
08/17/17 1153 - POM ORDER by RMINASSIAN
08/17/17 1159 - VERIFIED by AMOLINARI
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 12
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/28/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

For: 08/29/17 - 0900

For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 08/31/17 - 2100
08/29/17 2039 - DISCONTINUE by RMINASSIAN Eff: 08/29/17 2038
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/30/17 1521 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/29/17 2039

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 07/27/17-1715 Stop Date 08/26/17 1714 DC: 08/09/17-0500
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532276

Discontinued Comments DC'd by Discharge

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1719 - VERIFIED by AMACCA
07/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/27/17-1715 Stop Date 08/26/17 1714 DC: 08/09/17-0500
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532275

Discontinued Comments DC'd by Discharge

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1719 - VERIFIED by AMACCA
07/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions water 350cc, 4 times per day

Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 07/28/17-1700 Stop Date 08/27/17 1659 DC: 08/09/17-0500
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01532570

Discontinued Comments DC'd by Discharge

History
07/28/17 1629 - POM ORDER by RMINASSIAN
07/28/17 1648 - VERIFIED by AADEGBAMIG
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/27/17-1715 Stop Date 08/26/17 1714 DC: 08/09/17-0500
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.20
Rx Number 01532277

Discontinued Comments DC'd by Discharge

History
07/27/17 1718 - POM ORDER by CDOHLE
07/27/17 1719 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 07/27/17 - 1715
07/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0617 - DISCONTINUE by DISCHARGE Eff: 08/09/17 0500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

CHUNG,SOOKZA W00001219255 (Continued)

AMAN100C9 - AMANTADINE HCL 100 MG CAP

Dose 50 MG (0.5 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 CAN: 08/21/17-1555
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424769

History
08/21/17 1203 - POM ORDER by CDOHLE
08/21/17 1555 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO ORAL SOL.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient COLBERT,JACK Responsible Doctor NOVITCH, RICHARD MD.

Account Number W00001219323 Location B1WE Unit Number M000209190
Age/Sex 65/M Room 143 Registered Date 08/18/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 10.98 in 180.3 cm Body Surface Area 2.45 m2

Weight 285 lb 14.4 oz 129.682 kg
Hem-Onc No

Drug Allergies ACE Inhibitors, strawberry, cheese

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Dose Instructions BS <150 give 20 units

BS <200 give 25 units
BS >201 give 30 units
Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 08/22/17-0800 Stop Date 09/21/17 0759
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538746

History
08/21/17 1808 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01538739
08/21/17 1814 - REVIEW PROVIDER ACTIVITY by EBALILO
Administration of Unverified Order by MGRANGE Eff: 08/21/17 1812
08/21/17 1814 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 0800
08/21/17 1814 - CREDIT by EBALILO
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 25 UNIT (0.25 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/19/17-2100 Stop Date 09/18/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $322.41
Rx Number 01538290

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1013 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 2100

KETO30CR - KETOCONAZOLE 2% CREAM 30 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions apply topically BID. mix with hydrocortisone, use over
face, chest, groin for rashes. thankyou
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $83.04
Rx Number 01538291

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1013 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

OLOP5DRO - OLOPATADINE HCL 0.1% 5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions please apply to both eyes, thank you
Admin Route OPHTHALMIC
Frequency 2 TIMES A DAY (PRN) PRN REASON: ITCH - Itching
Start Date 08/21/17-1345 Stop Date 09/20/17 1344
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538581

History
08/21/17 1345 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01538293
08/21/17 1349 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 1345
08/21/17 1349 - CREDIT by AADEGBAMIG
ITEMS: 1

SLN1SH120 - SELENIUM SULFIDE 1% SHAMPOO 120 ML BTL

Dose 1 APPLIC (1 SHAMPOO APPLICATION)

Dose Instructions rotate with other antidandruff shampoos if possible
Admin Route TOPICALLY
Frequency MoWeFr (SCH)
Start Date 08/18/17-2315 Stop Date 09/17/17 2314
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $13.83
Rx Number 01538298

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by SKEMAL Eff: 08/19/17 0509
08/19/17 1015 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 2315
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/18/17-2315 Stop Date 09/17/17 2314
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538276

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1011 - VERIFIED by AADEGBAMIG
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: FEVER - Fever
Start Date 08/18/17-2315 Stop Date 09/17/17 2314
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538279

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1012 - VERIFIED by AADEGBAMIG
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

ALLP100T - ALLOPURINOL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $11.20
Rx Number 01538283

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1012 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

C500T - ASCORBIC ACID 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $4.00
Rx Number 01538284

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1012 - VERIFIED by AADEGBAMIG
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $0.48
Rx Number 01538285

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1012 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

CLD1500T - CALCIUM/VITAMIN D 1 EA (CITRACAL + D)

Dose 2 EA (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 36 Total Costs $0.00 Total Charges $6.40
Rx Number 01538287

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1012 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

CLNZ.5T - CLONAZEPAM 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/31/17-1045 Stop Date 09/07/17 1044
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541541

History
08/31/17 1046 - POM ORDER by RNOVITCH
08/31/17 1047 - VERIFIED by AMOLINARI
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $11.00
Rx Number 01538277

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1011 - VERIFIED by AADEGBAMIG
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

For: 09/01/17 - 0900

For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $4.00
Rx Number 01538278

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1012 - VERIFIED by AADEGBAMIG
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $4.80
Rx Number 01538288

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1012 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 54 Total Costs $0.00 Total Charges $9.40
Rx Number 01538289

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1012 - VERIFIED by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 12
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

08/28/17 0813 - FILL by BGIRLING

Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/18/17-2315 Stop Date 09/17/17 2314
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538274

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1011 - VERIFIED by AADEGBAMIG
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

MGX400T - MAGNESIUM OXIDE 400 MG TAB

Dose 400 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $2.08
Rx Number 01538292

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1013 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/31/17-1045 Stop Date 09/07/17 1044
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01541543

History
08/31/17 1046 - POM ORDER by RNOVITCH
08/31/17 1048 - VERIFIED by AMOLINARI
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/19/17-0800 Stop Date 09/18/17 0759
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $334.08
Rx Number 01538304

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1034 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0800
For: 08/20/17 - 0800
For: 08/21/17 - 0800
For: 08/22/17 - 0800
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0800
For: 08/24/17 - 0800
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

PRV20T - PRAVASTATIN SOD 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/19/17-2100 Stop Date 09/18/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 36 Total Costs $0.00 Total Charges $51.00
Rx Number 01538294

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1013 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/19/17 - 2100
For: 08/20/17 - 2100
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

PRD5T - PREDNISONE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $5.50
Rx Number 01539361

History
08/23/17 1623 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538295
08/23/17 1624 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions Constipation
374mg=2 tablets
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/18/17-2315 Stop Date 09/17/17 2314
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01538275

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1011 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 08/18/17 - 2315
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

TCRL1C - TACROLIMUS 1 MG CAP

Dose 1 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/31/17-2100 Stop Date 09/18/17 2059
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 11 Total Costs $0.00 Total Charges $82.20
Rx Number 01541767

History
08/31/17 1626 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01539358
Result of Frequency/Schedule Edit
Ordering Doctor: NOVITCH, RICHARD MD.
Last Scheduled Administration Time: 08/31/17 - 0900
Last Actual Administration Time: 08/31/17 - 0900 (Not Given)
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/31/17 - 1625
New Order Start: 08/31/17 - 2100
New Order Stop: 09/18/17 - 2059
08/31/17 1629 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by RNOVITCH Eff: 08/31/17 1626
Ordering Doctor: NOVITCH, RICHARD MD.
Last Scheduled Administration Time: 08/31/17 - 0900
Last Actual Administration Time: 08/31/17 - 0900 (Not Given)
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/31/17 - 1625
New Order Start: 08/31/17 - 2100
New Order Stop: 09/18/17 - 2059
08/31/17 1629 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

TRS20T - TORSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 36 Total Costs $0.00 Total Charges $63.55
Rx Number 01538296

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1013 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 8
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

For: 09/01/17 - 1700

For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

VITA1CAP19 - VITAMIN B COMPLEX W/VIT B-12 1 EA TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $1.28
Rx Number 01538286

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1012 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Dose Instructions BS <150 give 20 units

BS <200 give 25 units
BS >251 give 30 units
Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 08/22/17-0800 Stop Date 09/21/17 0759 DC: 08/22/17-0800
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $134.43
Rx Number 01538739

History
08/21/17 1752 - POM ORDER by RNOVITCH
08/21/17 1758 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 0800
08/21/17 1808 - DISCONTINUE by RNOVITCH Eff: 08/22/17 0800
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/21/17 1808 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01424953
08/21/17 1814 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by RNOVITCH Eff: 08/21/17 1808

INSU100V26 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose 8 UNIT (0.08 ML)

Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 08/19/17-0800 Stop Date 09/18/17 0759 DC: 08/21/17-1741
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01538281

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1012 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 0800
08/21/17 1749 - DISCONTINUE by RNOVITCH Eff: 08/21/17 1741
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/21/17 1749 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01424946
08/21/17 1751 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by RNOVITCH Eff: 08/21/17 1749
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

INSU100V26 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 20 units BS less than 200

30 units before meals BS >=201
Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 08/22/17-0800 Stop Date 08/22/17 0800 DC: 08/22/17-0800
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538736

History
08/21/17 1749 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01538281
08/21/17 1751 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 0800
08/21/17 1751 - EDIT by RNOVITCH
EDIT DOCTOR: NOVITCH, RICHARD MD.
FROM:
START: 08/22/17-0800 STOP: 09/21/17 0759 SOFT STOP: 0
TO:
START: 08/22/17-0800 STOP: 08/22/17-0800 SOFT STOP:
08/21/17 1751 - DISCONTINUE by RNOVITCH Eff: 08/22/17 0800
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/21/17 1759 - CREDIT by EBALILO
ITEMS: 1
08/21/17 1805 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by RNOVITCH Eff: 08/21/17 1751
Discontinue by RNOVITCH Eff: 08/21/17 1751
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

OLOP5DRO - OLOPATADINE HCL 0.1% 5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions please apply to both eyes, thank you
Admin Route OPHTHALMIC
Frequency 2 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 DC: 08/21/17-1344
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $394.20
Rx Number 01538293

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1013 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 0900
08/21/17 1345 - DISCONTINUE by RNOVITCH Eff: 08/21/17 1344
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/21/17 1345 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01424814
08/21/17 1349 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RNOVITCH Eff: 08/21/17 1345
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/19/17-0600 Stop Date 08/22/17 1838 DC: 08/22/17-1838
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 19 Total Costs $0.00 Total Charges $83.52
Rx Number 01538280

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by SKEMAL Eff: 08/19/17 0621
08/19/17 1012 - VERIFIED by AADEGBAMIG
Items Dispensed: 13 Doses Dispensed: 13
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
For: 08/21/17 - 0600
For: 08/21/17 - 1400
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/22/17 1839 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/19/17-0600 STOP: 09/18/17 0559 SOFT STOP: 0
DISPENSE: 6
TO:
START: 08/19/17-0600 STOP: 08/22/17-1838 SOFT STOP:
DISPENSE: 11
08/22/17 1839 - DISCONTINUE by NBALCETIS Eff: 08/22/17 1838
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/22/17 1839 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425321
08/22/17 1927 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by NBALCETIS Eff: 08/22/17 1839
Discontinue by NBALCETIS Eff: 08/22/17 1839
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Dose Instructions refused Q8H
Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-2100 Stop Date 09/18/17 0559 DC: 08/31/17-1044
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 18 Total Costs $0.00 Total Charges $167.04
Rx Number 01539138

History
08/22/17 1839 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538280
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/22/17 - 1400
Last Actual Administration Time: 08/22/17 - 1259 (Not Given)
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/22/17 - 1838
New Order Start: 08/22/17 - 2100
New Order Stop: 09/18/17 - 0559
08/22/17 1928 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by NBALCETIS Eff: 08/22/17 1839
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/22/17 - 1400
Last Actual Administration Time: 08/22/17 - 1259 (Not Given)
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/22/17 - 1838
New Order Start: 08/22/17 - 2100
New Order Stop: 09/18/17 - 0559
08/22/17 1928 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

For: 08/29/17 - 2100

08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
08/31/17 1046 - DISCONTINUE by RNOVITCH Eff: 08/31/17 1044
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/31/17 1048 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RNOVITCH Eff: 08/31/17 1046

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency BEFORE BREAKFAST (SCH)
Start Date 08/19/17-0800 Stop Date 09/18/17 0759 DC: 08/19/17-1034
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.88
Rx Number 01538303

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1034 - DISCONTINUE by AADEGBAMIG Eff: 08/19/17 1034
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/19/17 1034 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: FOR MODERATE to severe PAIN
Start Date 08/19/17-1700 Stop Date 08/26/17 1659 DC: 08/23/17-1622
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01538341

History
08/19/17 1648 - POM ORDER by HAZIZI
08/19/17 1650 - VERIFIED by AADEGBAMIG
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 1623 - DISCONTINUE by NBALCETIS Eff: 08/23/17 1622
For: 08/24/17 - 0900
For: 08/25/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/23/17 1623 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425554
08/23/17 1623 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/23/17 1623
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: FOR MODERATE to severe PAIN
Start Date 08/23/17-1630 Stop Date 08/30/17 1629 DC: 08/30/17-1629
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01539362

Discontinued Comments Reached Stop Date

History
08/23/17 1623 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538341
08/23/17 1624 - EDIT by AMACCA
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/23/17-1630 STOP: 08/30/17 SOFT STOP:
TO:
START: 08/23/17-1630 STOP: 08/30/17-1629 SOFT STOP:
08/23/17 1624 - VERIFIED by AMACCA
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 1629 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 1629
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

PRD5T - PREDNISONE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 08/26/17 0859 DC: 08/23/17-1622
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $2.50
Rx Number 01538295

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1008 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MNEWELL Eff: 08/19/17 0859
08/19/17 1013 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 0900
08/23/17 1623 - DISCONTINUE by NBALCETIS Eff: 08/23/17 1622
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/24/17 - 0900
For: 08/25/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/23/17 1623 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425555
08/23/17 1623 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/23/17 1623
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

TACR0.5C2 - TACROLIMUS 0.5 MG CAP

Dose 0.5 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 DC: 08/21/17-1741
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $20.55
Rx Number 01538282

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1012 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/21/17 1749 - DISCONTINUE by RNOVITCH Eff: 08/21/17 1741
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/21/17 1805 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by RNOVITCH Eff: 08/21/17 1749
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

TCRL1C - TACROLIMUS 1 MG CAP

Dose 1 MG (1 CAPSULE)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/19/17-2100 Stop Date 08/21/17 1741 DC: 08/21/17-1741
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $27.40
Rx Number 01538297

History
08/18/17 2350 - POM ORDER by RSHARMA
08/19/17 1013 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 2100
For: 08/20/17 - 2100
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/19/17 1649 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 08/19/17 1242
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/21/17 1749 - EDIT by RNOVITCH
EDIT DOCTOR: NOVITCH, RICHARD MD.
FROM:
START: 08/19/17-2100 STOP: 09/18/17 2059 SOFT STOP: 0
TO:
START: 08/19/17-2100 STOP: 08/21/17-1741 SOFT STOP:
08/21/17 1749 - DISCONTINUE by RNOVITCH Eff: 08/21/17 1741
EDIT DOCTOR: NOVITCH, RICHARD MD.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/21/17 1749 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01424947
08/21/17 1805 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by RNOVITCH Eff: 08/21/17 1749
Discontinue by RNOVITCH Eff: 08/21/17 1749
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

TCRL1C - TACROLIMUS 1 MG CAP

Dose 1 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/21/17-2100 Stop Date 08/23/17 1614 DC: 08/23/17-1614
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 13 Total Costs $0.00 Total Charges $54.80
Rx Number 01538738

History
08/21/17 1749 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01538297
Result of Frequency/Schedule Edit
Ordering Doctor: NOVITCH, RICHARD MD.
Last Scheduled Administration Time: 08/20/17 - 2100
Last Actual Administration Time: 08/20/17 - 2108
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/21/17 - 1741
New Order Start: 08/21/17 - 2100
New Order Stop: 09/18/17 - 2059
08/21/17 1753 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by RNOVITCH Eff: 08/21/17 1749
Ordering Doctor: NOVITCH, RICHARD MD.
Last Scheduled Administration Time: 08/20/17 - 2100
Last Actual Administration Time: 08/20/17 - 2108
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/21/17 - 1741
New Order Start: 08/21/17 - 2100
New Order Stop: 09/18/17 - 2059
08/21/17 1753 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/23/17 1617 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/21/17-2100 STOP: 09/18/17 2059 SOFT STOP:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

DISPENSE: 6
TO:
START: 08/21/17-2100 STOP: 08/23/17-1614 SOFT STOP:
DISPENSE: 4
08/23/17 1617 - DISCONTINUE by NBALCETIS Eff: 08/23/17 1614
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/23/17 1617 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425531
08/23/17 1618 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by NBALCETIS Eff: 08/23/17 1617
Discontinue by NBALCETIS Eff: 08/23/17 1617
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

TCRL1C - TACROLIMUS 1 MG CAP

Dose 1 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 08/31/17 1625 DC: 08/31/17-1625
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 11 Total Costs $0.00 Total Charges $95.90
Rx Number 01539358

History
08/23/17 1617 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538738
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/23/17 - 0900
Last Actual Administration Time: 08/23/17 - 0831
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/23/17 - 1614
New Order Start: 08/24/17 - 0900
New Order Stop: 09/18/17 - 2059
08/23/17 1618 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by NBALCETIS Eff: 08/23/17 1617
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/23/17 - 0900
Last Actual Administration Time: 08/23/17 - 0831
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/23/17 - 1614
New Order Start: 08/24/17 - 0900
New Order Stop: 09/18/17 - 2059
08/23/17 1618 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/30/17 1751 - CONVERTED by MHAIMOWITZ
TO: Rx #000300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

08/31/17 1626 - EDIT by RNOVITCH

EDIT DOCTOR: NOVITCH, RICHARD MD.
FROM:
START: 08/24/17-0900 STOP: 09/18/17 2059 SOFT STOP:
DISPENSE: 3
TO:
START: 08/24/17-0900 STOP: 08/31/17-1625 SOFT STOP:
DISPENSE: 8
08/31/17 1626 - DISCONTINUE by RNOVITCH Eff: 08/31/17 1625
EDIT DOCTOR: NOVITCH, RICHARD MD.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/31/17 1626 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01427825
08/31/17 1629 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by RNOVITCH Eff: 08/31/17 1626
Discontinue by RNOVITCH Eff: 08/31/17 1626
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

TACR0.5C2 - TACROLIMUS 0.5 MG CAP

Dose 0.5 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 09/22/17 2059 DC: 08/31/17-1625
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $54.80
Rx Number 01539357

History
08/23/17 1617 - POM ORDER by NBALCETIS
08/23/17 1617 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/23/17 - 2100
For: 08/24/17 - 2100
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/31/17 1626 - DISCONTINUE by RNOVITCH Eff: 08/31/17 1625
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/31/17 1629 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/31/17 1626
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

COLBERT,JACK W00001219323 (Continued)

TCRL1C - TACROLIMUS 1 MG CAP

Dose 1 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-1800 Stop Date 08/31/17 1800 DC: 09/01/17-0000
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $0.00
Rx Number 000300

Discontinued Comments Reached Stop Date

History
08/30/17 1751 - ENTER by MHAIMOWITZ
08/30/17 1751 - CONVERTED by MHAIMOWITZ
FROM: Rx #01539358
09/01/17 0003 - DISCONTINUE by AUTO-DC Eff: 09/01/17 0000
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient COLLINS,JAMES F Responsible Doctor VAIDYA, SUDHIR M.D.

Account Number W00001219160 Location B1NN Unit Number M000196715
Age/Sex 72/M Room 128 Registered Date 08/16/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 10.51 in 179.1 cm Body Surface Area 2.27 m2

Weight 240 lb oz 108.862 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/17/17-1621 DRUG REGIMEN REVIEW COMPLETE
08/17/17-1832 DRUG REGIMEN REVIEW COMPLETE
08/28/17-0726 RENAL DOSING COMPLETE
08/29/17-1046 DRUG REGIMEN REVIEW COMPLETE
08/30/17-1442 ANTIBIOTIC CONSULT COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

ENOX300V2 - ENOXAPARIN SODIUM 100 MG/ML MDV

Dose 110 MG (1.1 ML)

Admin Route SUBCUTAN.
Frequency ONETIME (ONE)
Start Date 09/04/17-2100 Stop Date 09/04/17 2101
Ordering Doctor VALLES,JENNIE MD
Total Dispensed 1 Total Costs $0.00 Total Charges $620.20
Rx Number 01542018

History
09/01/17 1600 - ENTER by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

HPF10V10 - HEPARIN SOD (PORCINE) LK FLSH 10 UNIT/ML VIAL

Dose 30 UNIT (3 ML)

Dose Instructions please use 3 cc of Heparin flush with blood draw from the
PICC lines
Admin Route IV FLUSH
Frequency DAILY (PRN) PRN REASON: blood draw from PICC
Start Date 08/17/17-1515 Stop Date 09/16/17 1514
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $5.40
Rx Number 01537661

History
08/17/17 1515 - POM ORDER by SMOHAMED
08/17/17 1517 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 1515

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 20 Total Costs $0.00 Total Charges $441.00
Rx Number 01537249

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1403 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 08/17/17 - 0900
08/20/17 1141 - DEBIT by AADEGBAMIG
ITEMS: 1
08/27/17 1139 - DEBIT by AADEGBAMIG
ITEMS: 1
08/31/17 1023 - DEBIT by AMACCA
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions TO BACK
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01540921

History
08/29/17 1043 - POM ORDER by SMOHAMED
08/29/17 1045 - EDIT by AMACCA
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
TO:
DOSE INSTRUCTIONS:
TO BACK
08/29/17 1046 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 1
For: 08/30/17 - 0900
08/31/17 1023 - DEBIT by AMACCA
ITEMS: 1

NYST15CR2 - NYSTATIN CR 15 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions Please apply to the skin surrounding back decubitus wound
(Do not put into the wound)
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/16/17-1700 Stop Date 09/15/17 1659
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $210.60
Rx Number 01537259

History
08/16/17 1454 - POM ORDER by EALEXEEV
08/16/17 1456 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 1700
08/21/17 1031 - DEBIT by AMOLINARI
ITEMS: 1
08/26/17 1653 - DEBIT by AADEGBAMIG
ITEMS: 1
08/30/17 0952 - DEBIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SLFL50250 - SALMETEROL XINAF/FLUTICASONE 50-250 MCG/DOSE DISKUS

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 08/16/17-1700 Stop Date 09/15/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $557.34
Rx Number 01537250

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1403 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 1700
08/24/17 0916 - DEBIT by AMOLINARI
ITEMS: 1

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 09/04/17-1800 Stop Date 09/04/17 1801
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541598

History
08/31/17 1401 - POM ORDER by SMOHAMED
08/31/17 1403 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SODI473S26 - SODIUM HYPOCHLORITE 473 ML 0.25%

Dose 1 ML (0.0021142 SOLUTIONS)

Dose Instructions 1 APPLICATION TO AFFECTED AREA TWICE DAILY
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $0.00
Rx Number 01537393

History
08/16/17 1716 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/17/17 - 0900
08/21/17 0750 - DEBIT by AMOLINARI
ITEMS: 1 DOSES: 1
08/25/17 1502 - DEBIT by AMACCA
ITEMS: 1 DOSES: 1

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 975 MG (3 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: FEVER - Fever
Start Date 08/16/17-1245 Stop Date 09/15/17 1244
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01537252

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1403 - VERIFIED by AADEGBAMIG
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/16/17-1830 Stop Date 09/15/17 1829
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01537465

History
08/16/17 1833 - POM ORDER by SMOHAMED
08/16/17 1903 - VERIFIED by AADEGBAMIG
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 08/16/17-1830 Stop Date 09/15/17 1829
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537468

History
08/16/17 1833 - POM ORDER by SMOHAMED
08/16/17 1903 - VERIFIED by AADEGBAMIG
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $5.00
Rx Number 01537463

History
08/16/17 1833 - POM ORDER by SMOHAMED
08/16/17 1903 - VERIFIED by AADEGBAMIG
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

For: 08/31/17 - 0900

For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700

FLC100T - FLUCONAZOLE 100 MG TAB

Dose 200 MG (2 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/13/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 14 Total Costs $0.00 Total Charges $14.50
Rx Number 01541012

History
08/29/17 1450 - POM ORDER by SMOHAMED
08/29/17 1452 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 20 Total Costs $0.00 Total Charges $5.40
Rx Number 01537246

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1403 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/16/17-1830 Stop Date 09/15/17 1829
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537466

History
08/16/17 1833 - POM ORDER by SMOHAMED
08/16/17 1903 - VERIFIED by AADEGBAMIG
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1830 Stop Date 09/15/17 1829
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537467

History
08/16/17 1833 - POM ORDER by SMOHAMED
08/16/17 1903 - VERIFIED by AADEGBAMIG
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $4.25
Rx Number 01537612

History
08/17/17 1303 - POM ORDER by EALEXEEV
08/17/17 1304 - VERIFIED by AMACCA
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NAPR250T20 - NAPROXEN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/16/17-1730 Stop Date 09/15/17 1729
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $3.60
Rx Number 01537400

History
08/16/17 1720 - ENTER by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/16/17 - 1730
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/02/17-2100 Stop Date 09/09/17 2059
Ordering Doctor AZIZI,HANA MD
Clinical Indication COMPLICATED UTI
Total Dispensed 7 Total Costs $0.00 Total Charges $16.06
Rx Number 01542265

History
09/02/17 1722 - POM ORDER by HAZIZI
09/02/17 1730 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/16/17-1830 Stop Date 09/15/17 1829
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 01537464

History
08/16/17 1833 - POM ORDER by SMOHAMED
08/16/17 1903 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/16/17 - 1830
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 20 Total Costs $0.00 Total Charges $375.84
Rx Number 01537245

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1403 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 20 Total Costs $0.00 Total Charges $0.20
Rx Number 01537244

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1403 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/03/17-2100 Stop Date 09/03/17 2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537670

History
08/17/17 1618 - POM ORDER by SMOHAMED
08/17/17 1623 - VERIFIED by AMACCA
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/03/17 - 2100

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/04/17-2100 Stop Date 09/04/17 2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537671

History
08/17/17 1618 - POM ORDER by SMOHAMED
08/17/17 1623 - VERIFIED by AMACCA
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

ARGI1POW17 - ARGININE/GLUTAMINE/CALCIUM HMB (JUVEN) POWDER PACKET

Dose 1 EACH (1 POWD.PACK)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/20/17-1300 Stop Date 08/17/17 1259 DC: 07/20/17-1300
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 30 Total Costs $0.00 Total Charges $0.00
Rx Number 01530064

History
07/20/17 1123 - ENTER by AMOLINARI
Items Dispensed: 30 Doses Dispensed: 1
For: 07/20/17 - 1300
07/20/17 1123 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/20/17-1300 STOP: 08/19/17 1259 SOFT STOP: 0
TO:
START: 07/20/17-1300 STOP: 08/17/17-1259 SOFT STOP: 0
07/20/17 1124 - COPY AND EDIT by AMOLINARI
TO: Rx #01530065
07/20/17 1124 - DISCONTINUE by AMOLINARI Eff: 07/20/17 1300
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

ARGI1POW17 - ARGININE/GLUTAMINE/CALCIUM HMB (JUVEN) POWDER PACKET

Dose 1 EACH (1 POWD.PACK)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/20/17-1300 Stop Date 08/17/17 1259 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 30 Total Costs $0.00 Total Charges $0.00
Rx Number 01530065

Discontinued Comments DC'd by Discharge

History
07/20/17 1124 - COPY AND EDIT by AMOLINARI
FROM: Rx #01530064
07/20/17 1124 - ENTER by AMOLINARI
Items Dispensed: 30 Doses Dispensed: 1
For: 07/20/17 - 1300
07/20/17 1124 - SYSTEM COPY AND EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
LABEL COMMENTS:
CHARGE ON BLUE SLIP
TO:
LABEL COMMENTS:
SENT BOX OF 30 PACKETS TO FLOOR
CHARGE ON BLUE SLIP
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

BISM262O - BISMUTH SUBSALICYLATE BTL (KAOPECTATE)

Dose 30 ML (0.1271186 MLS)

Dose Instructions PRN DIARRHEA
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: DIARRHEA - FOR DIARRHEA
Start Date 07/20/17-1430 Stop Date 08/19/17 1429 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530167

Discontinued Comments DC'd by Discharge

History
07/20/17 1429 - POM ORDER by SMOHAMED
07/20/17 1437 - VERIFIED by AMACCA
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

COLL30OI - COLLAGENASE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions Sacral wound
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 06/20/17-0900 Stop Date 07/20/17 0859 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 1 Total Costs $0.00 Total Charges $308.97
Rx Number 01522110

Discontinued Comments DC'd by Discharge

History
06/19/17 1629 - POM ORDER by NCHANDEL
06/19/17 1633 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 06/20/17 - 0900
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 07/26/17-0900 Stop Date 08/25/17 0859 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01531630

Discontinued Comments DC'd by Discharge

History
07/26/17 0840 - POM ORDER by SMOHAMED
07/26/17 0859 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 07/26/17 - 0900
08/02/17 0821 - DEBIT by AMOLINARI
ITEMS: 1
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NYST15CR2 - NYSTATIN CR 15 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions to groin
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 07/20/17-2100 Stop Date 08/19/17 2059 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $157.95
Rx Number 01530055

Discontinued Comments DC'd by Discharge

History
07/20/17 1110 - POM ORDER by SMOHAMED
07/20/17 1113 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/20/17 - 2100
07/25/17 1645 - DEBIT by MHAIMOWITZ
ITEMS: 1
07/28/17 1226 - DEBIT by MHAIMOWITZ
ITEMS: 1
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

SLFL50250 - SALMETEROL XINAF/FLUTICASONE 50-250 MCG/DOSE DISKUS

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 07/18/17-1700 Stop Date 08/17/17 1659 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $278.67
Rx Number 01529793

Discontinued Comments DC'd by Discharge

History
07/18/17 1705 - POM ORDER by SMOHAMED
07/18/17 1738 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/18/17 - 1700
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SODI473S26 - SODIUM HYPOCHLORITE 473 ML 0.25%

Dose 1 ML (0.0021142 SOLUTIONS)

Dose Instructions 1 APPLICATION TOPICALLY
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 07/18/17-1800 Stop Date 07/19/17 2051 DC: 07/19/17-2051
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.00
Rx Number 01529788

History
07/18/17 1737 - ENTER by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/18/17 - 1800
07/18/17 1737 - NOW DOSE by AADEGBAMIG
Now Dose: 07/18/17 1800
07/18/17 1737 - KEEP NEXT DOSE by AADEGBAMIG
Keep Next Dose: 07/19/17 0900
07/19/17 2053 - EDIT by YIVANOV
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
FROM:
START: 07/18/17-1800 STOP: 08/17/17 1759 SOFT STOP: 0
DISPENSE: 1
TO:
START: 07/18/17-1800 STOP: 07/19/17-2051 SOFT STOP:
DISPENSE: 3
07/19/17 2053 - DISCONTINUE by YIVANOV Eff: 07/19/17 2051
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
07/19/17 2053 - POM COPY AND EDIT by YIVANOV
TO: Rx #U01416560
07/20/17 0745 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YIVANOV Eff: 07/19/17 2053
Discontinue by YIVANOV Eff: 07/19/17 2053
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SODI473S26 - SODIUM HYPOCHLORITE 473 ML 0.25%

Dose 1 ML (0.0021142 SOLUTIONS)

Dose Instructions 1 APPLICATION TOPICALLY
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 07/20/17-0900 Stop Date 08/17/17 1759 DC: 08/06/17-1730
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $0.00
Rx Number 01530038

Discontinued Comments DC'd by Discharge

History
07/20/17 0745 - ENTER by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/20/17 - 0900
07/20/17 0745 - SYSTEM COPY AND EDIT by AMOLINARI
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
START: 07/19/17-2100 STOP: 08/17/17 1759 SOFT STOP:
DISPENSE: 9
TO:
ORDER TYPE: BULK - BULK ORDER
START: 07/20/17-0900 STOP: 08/17/17-1759 SOFT STOP:
DISPENSE: 2
07/20/17 0745 - COPY AND EDIT by AMOLINARI
FROM: Rx #01530037
07/25/17 0747 - DEBIT by AMACCA
ITEMS: 1 DOSES: 1
08/03/17 2002 - DEBIT by EBALILO
ITEMS: 2 DOSES: 2
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SODI500L2 - SODIUM HYPOCHLORITE 500 ML ML

Dose 500 ML (500 MLS)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/16/17-1700 Stop Date 08/16/17 1700 DC: 08/16/17-1700
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537258

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1453 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/16/17-1700 STOP: 09/15/17 1659 SOFT STOP: 0
TO:
START: 08/16/17-1700 STOP: 08/16/17-1700 SOFT STOP:
08/16/17 1453 - VERIFIED by SYSTEM
Verified in order to DC
08/16/17 1453 - DISCONTINUE by EALEXEEV Eff: 08/16/17 1700
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/16/17 1459 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by EALEXEEV Eff: 08/16/17 1453
Edit by SYSTEM Eff: 08/16/17 1453
Discontinue by EALEXEEV Eff: 08/16/17 1453

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 3 TIMES A DAY (SCH)
Start Date 08/06/17-0900 Stop Date 08/13/17 0859 DC: 08/06/17-1730
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01534655

Discontinued Comments DC'd by Discharge

History
08/05/17 1807 - POM ORDER by HAZIZI
08/05/17 1854 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/06/17 - 0900
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,250 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency DAILY (SCH)
Start Date 06/20/17-0900 Stop Date 07/31/17 2300 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Clinical Indication OTHER
Last Bag 3
Total Dispensed 3 Total Costs $0.00 Total Charges $448.95
Rx Number 01522128

Discontinued Comments DC'd by Discharge

History
06/19/17 1629 - POM ORDER by NCHANDEL
06/19/17 1649 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 06/20/17 - 0900
06/20/17 1105 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 06/21/17 - 0900
06/21/17 1007 - FILL by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 06/22/17 - 0900
06/22/17 1637 - FILL by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 06/23/17 - 0900
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
Items Auto Credited: 1 Doses Auto Credited: 1
For: 06/23/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,500 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency DAILY (SCH)
Start Date 07/19/17-0900 Stop Date 07/26/17 0859 DC: 07/19/17-1051
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $149.65
Rx Number 01529797

History
07/18/17 1737 - POM ORDER by SMOHAMED
07/18/17 1746 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/19/17 - 0900
07/19/17 0943 - FILL by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/20/17 - 0900
07/19/17 1052 - DISCONTINUE by SMOHAMED Eff: 07/19/17 1051
Items Auto Credited: 1 Doses Auto Credited: 1
For: 07/20/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
07/19/17 1052 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01416386
07/19/17 1106 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 07/19/17 1052
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,500 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency DAILY (SCH)
Start Date 07/19/17-0900 Stop Date 07/26/17 0859 DC: 07/19/17-1121
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 1
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01529847

History
07/19/17 1052 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529797
07/19/17 1106 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 1127 - DISCONTINUE by SMOHAMED Eff: 07/19/17 1121
Items Auto Credited: 1 Doses Auto Credited: 1
For: 07/20/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
07/19/17 1127 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01416391
07/19/17 1143 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 07/19/17 1127
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,500 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency DAILY (SCH)
Start Date 07/20/17-0600 Stop Date 07/22/17 1112 DC: 07/22/17-1112
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 5
Total Dispensed 5 Total Costs $0.00 Total Charges $448.95
Rx Number 01529860

History
07/19/17 1127 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529847
07/19/17 1127 - NOW DOSE by SMOHAMED
Now Dose: 07/20/17 0600
07/19/17 1127 - KEEP NEXT DOSE by System
Keep Next Dose: 07/20/17 0900
07/19/17 1146 - REVIEW PROVIDER ACTIVITY by AMACCA
Now Dose by SMOHAMED Eff: 07/19/17 1127
Now Dose 07/20/17 - 0600
Keep Next Dose 07/20/17 - 0900
07/19/17 1146 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 07/20/17 - 0600
For: 07/20/17 - 0900
07/20/17 1000 - FILL by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/21/17 - 0900
07/21/17 1005 - FILL by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 07/22/17 - 0900
07/22/17 1007 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/23/17 - 0900
07/22/17 1113 - EDIT by HAZIZI
EDIT DOCTOR: AZIZI,HANA MD
FROM:
START: 07/20/17-0600 STOP: 07/27/17 0559 SOFT STOP: 0
DISPENSE: 1
TO:
START: 07/20/17-0600 STOP: 07/22/17-1112 SOFT STOP:
DISPENSE: 4
07/22/17 1113 - DISCONTINUE by HAZIZI Eff: 07/22/17 1112
EDIT DOCTOR: AZIZI,HANA MD
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

Order filed UNV:

Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
07/22/17 1113 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01417124
07/22/17 1203 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by HAZIZI Eff: 07/22/17 1113
Discontinue by HAZIZI Eff: 07/22/17 1113
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,500 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency DAILY@0600 (SCH)
Start Date 07/23/17-0600 Stop Date 07/27/17 0559 DC: 07/26/17-1000
Ordering Doctor AZIZI,HANA MD
Clinical Indication BACTEREMIA
Last Bag 4
Total Dispensed 4 Total Costs $0.00 Total Charges $598.60
Rx Number 01530620

History
07/22/17 1113 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01529860
Result of Frequency/Schedule Edit
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 07/22/17 - 0900
Last Actual Administration Time: 07/22/17 - 0600
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@0600 (SCH)
Old Order Stop: 07/22/17 - 1112
New Order Start: 07/23/17 - 0600
New Order Stop: 07/27/17 - 0559
07/22/17 1120 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by HAZIZI Eff: 07/22/17 1113
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 07/22/17 - 0900
Last Actual Administration Time: 07/22/17 - 0600
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@0600 (SCH)
Old Order Stop: 07/22/17 - 1112
New Order Start: 07/23/17 - 0600
New Order Stop: 07/27/17 - 0559
07/22/17 1120 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/23/17 - 0600
07/23/17 0958 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/24/17 - 0600
07/24/17 1010 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/25/17 - 0600
07/25/17 1010 - FILL by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 07/26/17 - 0600
07/26/17 1001 - DISCONTINUE by SMOHAMED Eff: 07/26/17 1000
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
07/26/17 1001 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01418129
07/26/17 1025 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SMOHAMED Eff: 07/26/17 1001
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,500 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency DAILY@0600 (SCH)
Start Date 07/27/17-0600 Stop Date 07/31/17 0900 DC: 07/31/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 5
Total Dispensed 5 Total Costs $0.00 Total Charges $748.25
Rx Number 01531643

Discontinued Comments Reached Stop Date

History
07/26/17 1001 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01530620
07/26/17 1019 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 07/27/17 - 0600
07/27/17 1012 - FILL by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 07/28/17 - 0600
07/28/17 0957 - FILL by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 07/29/17 - 0600
07/29/17 1251 - FILL by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 07/30/17 - 0600
07/30/17 1153 - FILL by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 0600
07/31/17 0900 - DISCONTINUE by PHABKGJOB Eff: 07/31/17 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,500 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency NIGHTLY (SCH)
Start Date 08/05/17-2100 Stop Date 08/12/17 2059 DC: 08/05/17-2244
Ordering Doctor AZIZI,HANA MD
Clinical Indication OTHER
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534659

History
08/05/17 2101 - POM ORDER by HAZIZI
08/05/17 2245 - VERIFIED by SYSTEM
Verified in order to DC
08/05/17 2245 - DISCONTINUE by HAZIZI Eff: 08/05/17 2244
EDIT DOCTOR: AZIZI,HANA MD
08/05/17 2245 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01421024
08/06/17 1022 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SYSTEM Eff: 08/05/17 2245
Discontinue by HAZIZI Eff: 08/05/17 2245

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,000 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency NOW (ONE)
Start Date 08/05/17-2245 Stop Date 08/05/17 2344 DC: 08/05/17-2247
Ordering Doctor AZIZI,HANA MD
Clinical Indication OTHER
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534660

History
08/05/17 2244 - POM ORDER by HAZIZI
08/05/17 2247 - DISCONTINUE by HAZIZI Eff: 08/05/17 2247
EDIT DOCTOR: AZIZI,HANA MD
08/05/17 2247 - VERIFIED by SYSTEM
Verified in order to DC
08/06/17 1023 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SYSTEM Eff: 08/05/17 2247
Discontinue by HAZIZI Eff: 08/05/17 2247
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,000 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency NOW (ONE)
Start Date 08/05/17-2245 Stop Date 08/05/17 2344 DC: 08/05/17-2247
Ordering Doctor AZIZI,HANA MD
Clinical Indication OTHER
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534661

Protocol
Text
please give 1500 mg total.

History
08/05/17 2244 - POM ORDER by HAZIZI
08/05/17 2247 - VERIFIED by SYSTEM
Verified in order to DC
08/05/17 2247 - DISCONTINUE by HAZIZI Eff: 08/05/17 2247
EDIT DOCTOR: AZIZI,HANA MD
08/06/17 1024 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SYSTEM Eff: 08/05/17 2247
Discontinue by HAZIZI Eff: 08/05/17 2247
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,500 MG

in D5500 - DEXTROSE 5% 500 ML BAG - 500 ML

Site
Total Volume 500 MLS Rate 250 MLS/HR Duration 2 HR
Frequency NIGHTLY (SCH)
Start Date 08/06/17-2100 Stop Date 08/13/17 2059 DC: 08/06/17-2100
Ordering Doctor AZIZI,HANA MD
Clinical Indication OTHER
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534693

Discontinued Comments DC'd by Discharge

History
08/05/17 2245 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01534659
08/06/17 1151 - EDIT by MHAIMOWITZ
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
RX ID: VANCOMYCIN HCL 1,500 MG in DEXTROSE 5% 375 ML
CHARGE: $165.40
IV FLUIDS:
D5250 - DEXTROSE 5% 250 ML BAG - 375 ML
ORDERED VOLUME: 375
TOTAL VOLUME: 375
DURATION: 1 HR 30 MIN
TO:
RX ID: VANCOMYCIN HCL 1,500 MG in DEXTROSE 5% 500 ML
CHARGE: $149.65
IV FLUIDS:
D5500 - DEXTROSE 5% 500 ML BAG - 500 ML
ORDERED VOLUME: 500
TOTAL VOLUME: 500
DURATION: 2 HR
08/06/17 1151 - VERIFIED by MHAIMOWITZ
08/06/17 1250 - FILL by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/06/17 - 2100
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 2100
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/06/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC1KV - VANCOMYCIN HCL 1,000 MG VIAL - 1,000 MG

in D5250 - DEXTROSE 5% 250 ML BAG - 250 ML

Site
Total Volume 250 MLS Rate 250 MLS/HR Duration 1 HR
Frequency ONETIME (ONE)
Start Date 08/05/17-2300 Stop Date 08/05/17 2359 DC: 08/05/17-2359
Ordering Doctor AZIZI,HANA MD
Clinical Indication OTHER
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $87.70
Rx Number 01534691

Discontinued Comments Reached Stop Date

History
08/05/17 2250 - POM ORDER by HAZIZI
08/06/17 1025 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by SKEMAL Eff: 08/05/17 2306
08/06/17 1125 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/05/17 - 2300
08/06/17 1125 - DISCONTINUE by PHABKGJOB Eff: 08/05/17 2359
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

VNC500V - VANCOMYCIN HCL 500 MG VIAL - 500 MG

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 100 MLS/HR Duration 1 HR
Frequency ONETIME (ONE)
Start Date 08/05/17-2300 Stop Date 08/05/17 2359 DC: 08/05/17-2359
Ordering Doctor AZIZI,HANA MD
Clinical Indication OTHER
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $40.42
Rx Number 01534663

Discontinued Comments Reached Stop Date

History
08/05/17 2250 - POM ORDER by HAZIZI
08/06/17 1022 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by SKEMAL Eff: 08/05/17 2359
08/06/17 1022 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/05/17 - 2300
08/06/17 1023 - DISCONTINUE by PHABKGJOB Eff: 08/05/17 2359
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

UNS3AV - AMPICILLIN SOD/SULBACTAM SOD 3 GM VIAL - 3 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency EVERY 6 HOURS (SCH)
Start Date 08/16/17-1800 Stop Date 08/23/17 1759 DC: 08/16/17-1800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537255

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1413 - VERIFIED by SYSTEM
Verified in order to DC
08/16/17 1413 - DISCONTINUE by AADEGBAMIG Eff: 08/16/17 1800
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CFTR2V - CEFTRIAXONE SOD 2 GM VIAL - 2 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 08/24/17 0859 DC: 08/24/17-0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication OSTEOMYELITIS
Last Bag 7
Total Dispensed 7 Total Costs $0.00 Total Charges $264.88
Rx Number 01537253

Discontinued Comments Reached Stop Date

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1406 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 0900
08/17/17 1002 - FILL by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 0900
08/18/17 0932 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 0900
08/19/17 1000 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/20/17 - 0900
08/20/17 1012 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 0900
08/21/17 1004 - FILL by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 0900
08/22/17 1006 - FILL by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 0900
08/24/17 0859 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

UNS3AV - AMPICILLIN SOD/SULBACTAM SOD 3 GM VIAL - 3 GM

in NS.9100 - SODIUM CHLORIDE 0.9% IV SOLN 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency EVERY 6 HOURS (SCH)
Start Date 08/16/17-1800 Stop Date 08/23/17 1759 DC: 08/16/17-1800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537254

History
08/16/17 1413 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 1800
For: 08/17/17 - 0000
For: 08/17/17 - 0600
For: 08/17/17 - 1200
08/16/17 1414 - DISCONTINUE by AADEGBAMIG Eff: 08/16/17 1800
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/16/17 - 1800
For: 08/17/17 - 0000
For: 08/17/17 - 0600
For: 08/17/17 - 1200
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

UNS3AV - AMPICILLIN SOD/SULBACTAM SOD 3 GM VIAL - 3 GM

in NS.9100 - SODIUM CHLORIDE 0.9% IV SOLN 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency EVERY 6 HOURS (SCH)
Start Date 08/16/17-1800 Stop Date 08/23/17 1759 DC: 08/16/17-1800
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication BACTEREMIA
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537256

History
08/16/17 1415 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 1800
For: 08/17/17 - 0000
For: 08/17/17 - 0600
For: 08/17/17 - 1200
08/16/17 1541 - DISCONTINUE by EALEXEEV Eff: 08/16/17 1800
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/16/17 - 1800
For: 08/17/17 - 0000
For: 08/17/17 - 0600
For: 08/17/17 - 1200
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/16/17 1541 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01423543
08/16/17 1714 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EALEXEEV Eff: 08/16/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

UNS3AV - AMPICILLIN SOD/SULBACTAM SOD 3 GM VIAL - 3 GM

in NS.9100 - SODIUM CHLORIDE 0.9% IV SOLN 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 100 MLS/HR Duration 1 HR
Frequency EVERY 6 HOURS (SCH)
Start Date 08/16/17-1800 Stop Date 08/23/17 1759 DC: 08/23/17-1759
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication BACTEREMIA
Last Bag 28
Total Dispensed 28 Total Costs $0.00 Total Charges $983.08
Rx Number 01537356

Discontinued Comments Reached Stop Date

History
08/16/17 1541 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01537256
08/16/17 1658 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 1800
For: 08/17/17 - 0000
For: 08/17/17 - 0600
For: 08/17/17 - 1200
08/17/17 1002 - FILL by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 1800
For: 08/18/17 - 0000
For: 08/18/17 - 0600
For: 08/18/17 - 1200
08/18/17 0932 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/18/17 - 1800
For: 08/19/17 - 0000
For: 08/19/17 - 0600
For: 08/19/17 - 1200
08/19/17 1000 - FILL by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 1800
For: 08/20/17 - 0000
For: 08/20/17 - 0600
For: 08/20/17 - 1200
08/20/17 1012 - FILL by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/20/17 - 1800
For: 08/21/17 - 0000
For: 08/21/17 - 0600
For: 08/21/17 - 1200
08/21/17 1004 - FILL by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 1800
For: 08/22/17 - 0000
For: 08/22/17 - 0600
For: 08/22/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

08/22/17 1006 - FILL by MHAIMOWITZ

Items Dispensed: 4 Doses Dispensed: 4
For: 08/22/17 - 1800
For: 08/23/17 - 0000
For: 08/23/17 - 0600
For: 08/23/17 - 1200
08/23/17 1759 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 1759
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 07/31/17-1130 Stop Date 08/01/17 0729 DC: 08/01/17-0729
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Last Bag 2
Total Dispensed 2 Total Costs $0.00 Total Charges $31.50
Rx Number 01532915

Discontinued Comments Reached Stop Date

History
07/31/17 1122 - ENTER by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 1130
For: 07/31/17 - 2130
08/01/17 0729 - DISCONTINUE by PHABKGJOB Eff: 08/01/17 0729
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 1,000 ML

Site
Total Volume 1,000 MLS Rate 50 MLS/HR Duration 20 HR
Frequency .Q20H (SCH)
Start Date 08/01/17-1145 Stop Date 08/02/17 1144 DC: 08/02/17-1144
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Last Bag 2
Total Dispensed 2 Total Costs $0.00 Total Charges $63.00
Rx Number 01533366

Discontinued Comments Reached Stop Date

History
08/01/17 1138 - ENTER by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/01/17 - 1145
For: 08/02/17 - 0745
08/02/17 1144 - DISCONTINUE by PHABKGJOB Eff: 08/02/17 1144
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 1,000 ML

Site
Total Volume 1,000 MLS Rate 50 MLS/HR Duration 20 HR
Frequency .Q20H (SCH)
Start Date 08/02/17-1730 Stop Date 08/03/17 1729 DC: 08/03/17-0713
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $31.50
Rx Number 01533688

History
08/02/17 1343 - ENTER by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 1730
For: 08/03/17 - 1330
08/03/17 0714 - DISCONTINUE by SMOHAMED Eff: 08/03/17 0713
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/03/17 - 1330
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/03/17 0714 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01420219
08/03/17 0740 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/03/17 0714
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 1,000 ML

Site
Total Volume 1,000 MLS Rate 50 MLS/HR Duration 20 HR
Frequency .Q20H (SCH)
Start Date 08/03/17-0713 Stop Date 08/04/17 0312 DC: 08/04/17-0312
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $31.50
Rx Number 01533828

Discontinued Comments Reached Stop Date

History
08/03/17 0714 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01533688
08/03/17 0740 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/03/17-0713 STOP: 08/04/17 SOFT STOP:
TO:
START: 08/03/17-0713 STOP: 08/04/17-0312 SOFT STOP:
TOTAL BAGS: 1
VOLUME TO INFUSE: 1,000 mls
08/03/17 0740 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/03/17 - 0713
08/04/17 0312 - DISCONTINUE by PHABKGJOB Eff: 08/04/17 0312
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 1,000 ML (6.6666667 BAGS)

Dose Instructions 50cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/01/17-1700 Stop Date 08/01/17 1701 DC: 08/01/17-1700
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533365

History
08/01/17 1117 - POM ORDER by SMOHAMED
08/01/17 1137 - DISCONTINUE by AMACCA Eff: 08/01/17 1700
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/01/17 1137 - VERIFIED by SYSTEM
Verified in order to DC

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 1,000 ML (6.6666667 BAGS)

Dose Instructions 50cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/02/17-1730 Stop Date 08/02/17 1731 DC: 08/02/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533687

History
08/02/17 1226 - POM ORDER by SMOHAMED
08/02/17 1340 - DISCONTINUE by AMACCA Eff: 08/02/17 1730
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/02/17 1340 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 06/19/17-1630 Stop Date 07/19/17 1629 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01522098

Discontinued Comments DC'd by Discharge

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1629 - VERIFIED by EBALILO
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
For: 06/23/17 - 1200
For: 06/24/17 - 1200
For: 06/25/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 325 MG (1 TABLET)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: FEVER - Fever
Start Date 07/18/17-1700 Stop Date 08/17/17 1659 DC: 07/24/17-1151
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01529789

History
07/18/17 1705 - POM ORDER by SMOHAMED
07/18/17 1738 - VERIFIED by AADEGBAMIG
07/19/17 0805 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0807 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 1153 - DISCONTINUE by RSHARMA Eff: 07/24/17 1151
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
07/24/17 1153 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01417338
07/24/17 1159 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RSHARMA Eff: 07/24/17 1153
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: FEVER - Fever
Start Date 07/24/17-1200 Stop Date 08/23/17 1159 DC: 08/06/17-1730
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01530831

Discontinued Comments DC'd by Discharge

History
07/24/17 1153 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01529789
07/24/17 1159 - VERIFIED by MHAIMOWITZ
07/26/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0812 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: pain
Start Date 08/16/17-1245 Stop Date 09/15/17 1244 DC: 08/16/17-1903
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537251

Discontinued Comments DUPLICATE ORDER

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1403 - VERIFIED by AADEGBAMIG
08/16/17 1903 - DISCONTINUE by AADEGBAMIG Eff: 08/16/17 1903
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DUPLICATE ORDER

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 06/19/17-1700 Stop Date 06/19/17 1700 DC: 06/19/17-1700
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01522100

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1629 - VERIFIED by EBALILO
06/19/17 1647 - DISCONTINUE by NCHANDEL Eff: 06/19/17 1700
EDIT DOCTOR: CHANDEL,NEEL MD
06/19/17 1647 - EDIT by NCHANDEL
EDIT DOCTOR: CHANDEL,NEEL MD
FROM:
START: 06/19/17-1700 STOP: 07/19/17 1659 SOFT STOP: 0
TO:
START: 06/19/17-1700 STOP: 06/19/17-1700 SOFT STOP:
06/19/17 1648 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by NCHANDEL Eff: 06/19/17 1647
Discontinue by NCHANDEL Eff: 06/19/17 1647
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 06/19/17-2000 Stop Date 07/19/17 1959 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01522101

Discontinued Comments DC'd by Discharge

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1629 - VERIFIED by EBALILO
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 2000
For: 06/24/17 - 2000
For: 06/25/17 - 2000
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
For: 06/23/17 - 1200
For: 06/24/17 - 1200
For: 06/25/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CYAN100019 - CYANOCOBALAMIN 1,000 MCG/ML VIAL

Dose 1,000 MCG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 07/19/17-0900 Stop Date 07/24/17 0859 DC: 07/23/17-1056
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $0.40
Rx Number 01529790

History
07/18/17 1705 - POM ORDER by SMOHAMED
07/18/17 1738 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0805 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/23/17 1056 - DISCONTINUE by SMOHAMED Eff: 07/23/17 1056
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
07/23/17 1056 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01417279
07/24/17 1742 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 07/23/17 1056
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CYAN100019 - CYANOCOBALAMIN 1,000 MCG/ML VIAL

Dose 1,000 MCG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 07/24/17-0900 Stop Date 07/28/17 0859 DC: 07/26/17-1001
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $0.24
Rx Number 01530750

History
07/23/17 1056 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529790
07/23/17 1214 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-0900 STOP: 07/28/17 SOFT STOP:
TO:
START: 07/24/17-0900 STOP: 07/28/17-0859 SOFT STOP:
07/23/17 1214 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 1001 - DISCONTINUE by SMOHAMED Eff: 07/26/17 1001
Items Auto Credited: 1 Doses Auto Credited: 1
For: 07/27/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
07/26/17 1001 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01418130
07/26/17 1100 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SMOHAMED Eff: 07/26/17 1001
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CYAN100019 - CYANOCOBALAMIN 1,000 MCG/ML VIAL

Dose 1,000 MCG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 07/27/17-0900 Stop Date 07/30/17 0859 DC: 07/28/17-1757
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $0.16
Rx Number 01531659

History
07/26/17 1001 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01530750
07/26/17 1100 - EDIT by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/27/17-0900 STOP: 07/30/17 SOFT STOP:
TO:
START: 07/27/17-0900 STOP: 07/30/17-0859 SOFT STOP: 0
07/26/17 1100 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 07/27/17 - 0900
For: 07/28/17 - 0900
For: 07/29/17 - 0900
07/28/17 1758 - DISCONTINUE by SMOHAMED Eff: 07/28/17 1757
Items Auto Credited: 1 Doses Auto Credited: 1
For: 07/29/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
07/28/17 1758 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01419083
07/28/17 1917 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SMOHAMED Eff: 07/28/17 1758
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CYAN100019 - CYANOCOBALAMIN 1,000 MCG/ML VIAL

Dose 1,000 MCG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 07/29/17-0900 Stop Date 07/31/17 0859 DC: 07/31/17-0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $0.16
Rx Number 01532660

Discontinued Comments Reached Stop Date

History
07/28/17 1758 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01531659
07/28/17 1917 - EDIT by EBALILO
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/29/17-0900 STOP: 07/31/17 SOFT STOP:
TO:
START: 07/29/17-0900 STOP: 07/31/17-0859 SOFT STOP: 0
07/28/17 1917 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/31/17 0859 - DISCONTINUE by PHABKGJOB Eff: 07/31/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CYAN100019 - CYANOCOBALAMIN 1,000 MCG/ML VIAL

Dose 1,000 MCG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/06/17 0859 DC: 08/04/17-1111
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $0.32
Rx Number 01533099

History
07/31/17 1536 - POM ORDER by SMOHAMED
07/31/17 1538 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/04/17 - 0900
For: 08/05/17 - 0900
08/04/17 1111 - DISCONTINUE by SMOHAMED Eff: 08/04/17 1111
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/05/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/04/17 1111 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01420574
08/04/17 1537 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/04/17 1111
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CYAN100019 - CYANOCOBALAMIN 1,000 MCG/ML VIAL

Dose 1,000 MCG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 08/05/17-0900 Stop Date 08/09/17 0859 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $0.16
Rx Number 01534139

Discontinued Comments DC'd by Discharge

History
08/04/17 1111 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01533099
08/04/17 1117 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/04/17 1537 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/05/17-0900 STOP: 08/09/17 SOFT STOP:
TO:
START: 08/05/17-0900 STOP: 08/09/17-0859 SOFT STOP: 0
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CYAN100019 - CYANOCOBALAMIN 1,000 MCG/ML VIAL

Dose 1,000 MCG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 08/22/17 0859 DC: 08/20/17-0759
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $0.24
Rx Number 01537248

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1403 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 0900
08/20/17 0759 - DISCONTINUE by SMOHAMED Eff: 08/20/17 0759
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/20/17 - 0900
For: 08/21/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/20/17 0759 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424577
08/20/17 1027 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/20/17 0759
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CYAN100019 - CYANOCOBALAMIN 1,000 MCG/ML VIAL

Dose 1,000 MCG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 08/20/17-0900 Stop Date 08/25/17 0859 DC: 08/23/17-1511
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $0.32
Rx Number 01538359

History
08/20/17 0759 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01537248
08/20/17 1000 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/20/17-0900 STOP: 08/25/17 SOFT STOP:
TO:
START: 08/20/17-0900 STOP: 08/25/17-0859 SOFT STOP:
08/20/17 1000 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 1512 - DISCONTINUE by EALEXEEV Eff: 08/23/17 1511
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/24/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/23/17 1512 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01425509
08/23/17 1524 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/23/17 1512
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

CYAN100019 - CYANOCOBALAMIN 1,000 MCG/ML VIAL

Dose 1,000 MCG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 08/28/17 0859 DC: 08/28/17-0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $0.32
Rx Number 01539336

Discontinued Comments Reached Stop Date

History
08/23/17 1512 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01538359
08/23/17 1525 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 1137 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/24/17-0900 STOP: 08/28/17 SOFT STOP:
TO:
START: 08/24/17-0900 STOP: 08/28/17-0859 SOFT STOP:
08/28/17 0859 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

DIAZ5TAB34 - DIAZEPAM 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 06/19/17-1700 Stop Date 06/26/17 1659 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01522109

Discontinued Comments DC'd by Discharge

History
06/19/17 1629 - POM ORDER by NCHANDEL
06/19/17 1632 - VERIFIED by EBALILO
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 06/23/17 - 0900
For: 06/23/17 - 1300
For: 06/23/17 - 1700
For: 06/24/17 - 0900
For: 06/24/17 - 1300
For: 06/24/17 - 1700
For: 06/25/17 - 0900
For: 06/25/17 - 1300
For: 06/25/17 - 1700
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
For: 06/23/17 - 1200
For: 06/24/17 - 1200
For: 06/25/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 06/19/17-1630 Stop Date 07/19/17 1629 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01522102

Discontinued Comments DC'd by Discharge

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1630 - VERIFIED by EBALILO
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
For: 06/23/17 - 1200
For: 06/24/17 - 1200
For: 06/25/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 06/19/17-1700 Stop Date 07/19/17 1659 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01522103

Discontinued Comments DC'd by Discharge

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1630 - VERIFIED by EBALILO
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 06/23/17 - 0900
For: 06/23/17 - 1300
For: 06/23/17 - 1700
For: 06/24/17 - 0900
For: 06/24/17 - 1300
For: 06/24/17 - 1700
For: 06/25/17 - 0900
For: 06/25/17 - 1300
For: 06/25/17 - 1700
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

DOCU100T10 - DOCUSATE SODIUM TABLET 100 MG

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/19/17-0900 Stop Date 08/18/17 0859 DC: 07/19/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01529795

History
07/18/17 1738 - POM ORDER by SMOHAMED
07/18/17 1739 - VERIFIED by SYSTEM
Verified in order to DC
07/18/17 1739 - DISCONTINUE by AADEGBAMIG Eff: 07/19/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/19/17-0900 Stop Date 08/18/17 0859 DC: 07/20/17-1331
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01529796

History
07/18/17 1744 - ENTER by AADEGBAMIG
07/19/17 0805 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 1700
For: 07/22/17 - 0900
For: 07/22/17 - 1700
For: 07/23/17 - 0900
For: 07/23/17 - 1700
07/20/17 1332 - DISCONTINUE by SMOHAMED Eff: 07/20/17 1331
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
07/20/17 1336 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 07/20/17 1332
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/19/17-0900 Stop Date 08/18/17 0859 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 19 Total Costs $0.00 Total Charges $5.70
Rx Number 01529791

Discontinued Comments DC'd by Discharge

History
07/18/17 1705 - POM ORDER by SMOHAMED
07/18/17 1738 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0805 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0807 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0812 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

Items Auto Credited: 2 Doses Auto Credited: 2

For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/20/17-0900 Stop Date 07/20/17 0859 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.84
Rx Number 01522111

Discontinued Comments DC'd by Discharge

History
06/19/17 1629 - POM ORDER by NCHANDEL
06/19/17 1633 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 06/20/17 - 0900
For: 06/21/17 - 0900
For: 06/22/17 - 0900
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
Items Auto Credited: 3 Doses Auto Credited: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency 2 TIMES A DAY (SCH)
Start Date 06/19/17-1700 Stop Date 07/19/17 1659 DC: 06/19/17-1700
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01522126

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1648 - VERIFIED by SYSTEM
Verified in order to DC
06/19/17 1648 - DISCONTINUE by NCHANDEL Eff: 06/19/17 1700
EDIT DOCTOR: CHANDEL,NEEL MD
06/19/17 1648 - POM COPY AND EDIT by NCHANDEL
TO: Rx #U01408951
06/19/17 1648 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by SYSTEM Eff: 06/19/17 1648
Discontinue by NCHANDEL Eff: 06/19/17 1648
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 06/19/17-2100 Stop Date 07/19/17 1659 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 7 Total Costs $0.00 Total Charges $64.96
Rx Number 01522127

Discontinued Comments DC'd by Discharge

History
06/19/17 1648 - POM COPY AND EDIT by NCHANDEL
FROM: Rx #01522126
Result of Frequency/Schedule Edit
Ordering Doctor: CHANDEL,NEEL MD
Last Scheduled Administration Time: 06/19/17 - 1700
Last Actual Administration Time:
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 06/19/17 - 1700
New Order Start: 06/19/17 - 2100
New Order Stop: 07/19/17 - 1659
06/19/17 1648 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by NCHANDEL Eff: 06/19/17 1648
Ordering Doctor: CHANDEL,NEEL MD
Last Scheduled Administration Time: 06/19/17 - 1700
Last Actual Administration Time:
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 06/19/17 - 1700
New Order Start: 06/19/17 - 2100
New Order Stop: 07/19/17 - 1659
06/19/17 1648 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 06/19/17 - 2100
For: 06/20/17 - 0900
For: 06/20/17 - 2100
For: 06/21/17 - 0900
For: 06/21/17 - 2100
For: 06/22/17 - 0900
For: 06/22/17 - 2100
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/23/17 - 0900
For: 06/23/17 - 2100
For: 06/24/17 - 0900
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 2100
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
Items Auto Credited: 6 Doses Auto Credited: 6
For: 06/23/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

For: 06/23/17 - 2100

For: 06/24/17 - 0900
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/31/17-0800 Stop Date 08/31/17 0800 DC: 08/31/17-0800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537666

History
08/17/17 1613 - POM ORDER by SMOHAMED
08/17/17 1613 - NOW DOSE by SMOHAMED
Now Dose: 08/31/17 0800
08/17/17 1613 - KEEP NEXT DOSE by System
Keep Next Dose: 08/31/17 1400
08/17/17 1623 - REVIEW PROVIDER ACTIVITY by AMACCA
Now Dose by SMOHAMED Eff: 08/17/17 1613
Now Dose 08/31/17 - 0800
Keep Next Dose 08/31/17 - 1400
08/17/17 1623 - VERIFIED by AMACCA
08/19/17 0948 - EDIT by HAZIZI
EDIT DOCTOR: AZIZI,HANA MD
FROM:
START: 08/31/17-0800 STOP: 09/04/17 0800 SOFT STOP:
TO:
START: 08/31/17-0800 STOP: 08/31/17-0800 SOFT STOP:
08/19/17 0948 - DISCONTINUE by HAZIZI Eff: 08/31/17 0800
EDIT DOCTOR: AZIZI,HANA MD
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/20/17 1027 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by HAZIZI Eff: 08/19/17 0948
Discontinue by HAZIZI Eff: 08/19/17 0948
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 06/19/17-1700 Stop Date 07/19/17 1659 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $3.50
Rx Number 01522125

Discontinued Comments DC'd by Discharge

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1647 - VERIFIED by EBALILO
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 06/23/17 - 0900
For: 06/23/17 - 1300
For: 06/23/17 - 1700
For: 06/23/17 - 2100
For: 06/24/17 - 0900
For: 06/24/17 - 1300
For: 06/24/17 - 1700
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 1300
For: 06/25/17 - 1700
For: 06/25/17 - 2100
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
For: 06/23/17 - 1200
For: 06/24/17 - 1200
For: 06/25/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 06/19/17-1630 Stop Date 07/19/17 1629 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01522104

Discontinued Comments DC'd by Discharge

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1631 - VERIFIED by EBALILO
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
For: 06/23/17 - 1200
For: 06/24/17 - 1200
For: 06/25/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 06/19/17-1630 Stop Date 07/19/17 1629 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01522105

Discontinued Comments DC'd by Discharge

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1631 - VERIFIED by EBALILO
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
For: 06/23/17 - 1200
For: 06/24/17 - 1200
For: 06/25/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NAPR250T20 - NAPROXEN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 07/18/17-1745 Stop Date 08/17/17 1744 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $3.60
Rx Number 01529785

Discontinued Comments DC'd by Discharge

History
07/18/17 1733 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 07/18/17 - 1745
07/19/17 0805 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0807 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0812 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NAPR250T20 - NAPROXEN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/16/17-1730 Stop Date 09/15/17 1729 DC: 08/16/17-1730
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 01537396

History
08/16/17 1717 - ENTER by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/16/17 - 1730
08/16/17 1718 - DISCONTINUE by AADEGBAMIG Eff: 08/16/17 1730
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/27/17-1930 Stop Date 08/31/17 2101 DC: 08/29/17-1442
Ordering Doctor IVANOV,YURIY MD PGY-3
Clinical Indication COMPLICATED UTI
Total Dispensed 5 Total Costs $0.00 Total Charges $32.12
Rx Number 01540512

History
08/27/17 1930 - POM ORDER by YIVANOV
08/27/17 1930 - NOW DOSE by YIVANOV
Now Dose: 08/27/17 1930
08/27/17 1930 - KEEP NEXT DOSE by System
Keep Next Dose: 08/27/17 2100
08/28/17 0726 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Now Dose by YIVANOV Eff: 08/27/17 1930
Now Dose 08/27/17 - 1930
Keep Next Dose 08/27/17 - 2100
Administration of Unverified Order by NDEKIND Eff: 08/27/17 2304
Administration of Unverified Order by NDEKIND Eff: 08/28/17 0012
08/28/17 0726 - VERIFIED by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/27/17 - 1930
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/29/17 1445 - DISCONTINUE by SMOHAMED Eff: 08/29/17 1442
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/29/17 1451 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/29/17 1445
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions arginine/glutamine/calcium 7 gram-7gram-1.5 gram poed. pack

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/18/17-1700 Stop Date 08/17/17 1659 DC: 07/20/17-1122
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530063

History
07/18/17 1705 - POM ORDER by SMOHAMED
07/19/17 1050 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
LABEL COMMENTS:
TO:
LABEL COMMENTS:
PRODUCT THAT CAME IN IN NOT EQUIVALENT - ORDERED JUVEN
PRODUCT FOR THURS - DR. SHARMA AWARE AND OKAY TO WAIT.
07/20/17 1122 - DISCONTINUE by AMOLINARI Eff: 07/20/17 1122
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/20/17 1122 - REVIEW PROVIDER ACTIVITY by SYSTEM
Administration of Unverified Order by BALEXANDER Eff: 07/18/17 2312
Administration of Unverified Order by VSKEENE Eff: 07/19/17 0942
Administration of Unverified Order by VSKEENE Eff: 07/19/17 1321
Administration of Unverified Order by VSKEENE Eff: 07/19/17 1759
07/20/17 1122 - VERIFIED by SYSTEM
Verified in order to DC

NF-MED - NON FORMULARY MEDICATION

Dose 250 EA (0 EACHS)

Dose Instructions naproxen 250 mg q8hr prn for moderate pain
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/19/17-0900 Stop Date 08/18/17 0859 DC: 07/19/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01529786

History
07/18/17 1705 - POM ORDER by SMOHAMED
07/18/17 1733 - DISCONTINUE by AADEGBAMIG Eff: 07/19/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/18/17 1733 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions sodium hypochlorite 0.25% topically bid

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/18/17-1700 Stop Date 08/17/17 1659 DC: 07/18/17-1734
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01529787

History
07/18/17 1705 - POM ORDER by SMOHAMED
07/18/17 1734 - DISCONTINUE by AADEGBAMIG Eff: 07/18/17 1734
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/18/17 1734 - VERIFIED by SYSTEM
Verified in order to DC

NF-MED - NON FORMULARY MEDICATION

Dose Instructions L-argining/L-Glutamine/HMB 1.5 packet PO TID

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/16/17-1300 Stop Date 09/15/17 1259 DC: 08/16/17-1524
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537270

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1531 - VERIFIED by SYSTEM
Verified in order to DC
08/16/17 1531 - DISCONTINUE by EALEXEEV Eff: 08/16/17 1524
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/16/17 1533 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SYSTEM Eff: 08/16/17 1531
Discontinue by EALEXEEV Eff: 08/16/17 1531
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Naproxen 250mg Po q8hr PRN

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: pain
Start Date 08/16/17-1715 Stop Date 09/15/17 1714 DC: 08/16/17-1717
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537397

History
08/16/17 1708 - POM ORDER by SMOHAMED
08/16/17 1717 - DISCONTINUE by AADEGBAMIG Eff: 08/16/17 1717
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/16/17 1717 - VERIFIED by SYSTEM
Verified in order to DC

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Dakins 0.25% BID

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859 DC: 08/17/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537394

History
08/16/17 1710 - POM ORDER by SMOHAMED
08/16/17 1716 - DISCONTINUE by AADEGBAMIG Eff: 08/17/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/16/17 1716 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 07/19/17-0800 Stop Date 08/18/17 0759 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 19 Total Costs $0.00 Total Charges $16.72
Rx Number 01529792

Discontinued Comments DC'd by Discharge

History
07/18/17 1705 - POM ORDER by SMOHAMED
07/18/17 1738 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0800
For: 07/20/17 - 0800
07/19/17 0805 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0800
For: 07/22/17 - 0800
For: 07/23/17 - 0800
07/21/17 0807 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0800
For: 07/25/17 - 0800
07/24/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0800
For: 07/27/17 - 0800
07/26/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0800
For: 07/29/17 - 0800
For: 07/30/17 - 0800
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0800
For: 08/01/17 - 0800
07/31/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0800
For: 08/03/17 - 0800
08/02/17 0812 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0800
For: 08/05/17 - 0800
For: 08/06/17 - 0800
08/04/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0800
For: 08/08/17 - 0800
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

Items Auto Credited: 2 Doses Auto Credited: 2

For: 08/07/17 - 0800
For: 08/08/17 - 0800
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 06/19/17-1630 Stop Date 07/19/17 1629 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 01522108

Discontinued Comments DC'd by Discharge

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1632 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 06/19/17 - 1630
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 83
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Dose Instructions PRN NAUSEA
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 07/24/17-1200 Stop Date 08/23/17 1159 DC: 08/06/17-1730
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $1.10
Rx Number 01530832

Discontinued Comments DC'd by Discharge

History
07/24/17 1153 - POM ORDER by RSHARMA
07/24/17 1159 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 07/24/17 - 1200
07/26/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0812 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 84
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 06/19/17-1700 Stop Date 07/21/17 1659 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01522107

Discontinued Comments DC'd by Discharge

History
06/19/17 1629 - POM ORDER by NCHANDEL
06/19/17 1631 - VERIFIED by EBALILO
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/23/17 - 0900
For: 06/23/17 - 1700
For: 06/24/17 - 0900
For: 06/24/17 - 1700
For: 06/25/17 - 0900
For: 06/25/17 - 1700
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 85
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/20/17-0900 Stop Date 07/20/17 0859 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 3 Total Costs $0.00 Total Charges $4.05
Rx Number 01522117

Discontinued Comments DC'd by Discharge

History
06/19/17 1637 - ENTER by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 06/20/17 - 0900
For: 06/21/17 - 0900
For: 06/22/17 - 0900
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
Items Auto Credited: 3 Doses Auto Credited: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 86
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

KCL10TCR - POTASSIUM CHLORIDE 10 MEQ TABCR

Dose 10 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 1 HOUR (SCH)
Start Date 06/22/17-1300 Stop Date 06/22/17 1401 DC: 06/22/17-1401
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 2 Total Costs $0.00 Total Charges $3.32
Rx Number 01522844

Warnings
Type: BURKE
Range: POTASSIUM CHLORIDE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 40 MEQ/DAY - 100 MEQ/DAY. Ordered dose of 20 MEQ/DAY
is below the Low Daily Dose.

Discontinued Comments Reached Stop Date

History
06/22/17 1258 - POM ORDER by NCHANDEL
06/22/17 1301 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/22/17 - 1300
For: 06/22/17 - 1400
06/22/17 1401 - DISCONTINUE by PHABKGJOB Eff: 06/22/17 1401
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 87
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/17/17-1815 Stop Date 08/17/17 1816 DC: 08/17/17-1816
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $1.35
Rx Number 01537780

Discontinued Comments Reached Stop Date

History
08/17/17 1817 - POM ORDER by SMOHAMED
08/17/17 1825 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 1815
08/17/17 1826 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 1816
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

KCL10TCR - POTASSIUM CHLORIDE 10 MEQ TABCR

Dose 20 MEQ (2 TABLET, CONTROLLED-RELEASES)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/17/17-1815 Stop Date 08/17/17 1816 DC: 08/17/17-1816
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537779

Warnings
Type: BURKE
Range: POTASSIUM CHLORIDE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 40 MEQ/DAY - 100 MEQ/DAY. Ordered dose of 20 MEQ/DAY
is below the Low Daily Dose.

History
08/17/17 1817 - POM ORDER by SMOHAMED
08/17/17 1825 - DISCONTINUE by AMACCA Eff: 08/17/17 1816
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/17/17 1825 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 88
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 2 HOURS (SCH)
Start Date 08/17/17-2000 Stop Date 08/18/17 0100 DC: 08/18/17-0100
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $4.05
Rx Number 01537781

Discontinued Comments Reached Stop Date

History
08/17/17 1832 - ENTER by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/17/17 - 2000
For: 08/17/17 - 2200
For: 08/18/17 - 0000
08/18/17 0100 - DISCONTINUE by PHABKGJOB Eff: 08/18/17 0100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 89
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

PSYL1PAC15 - PSYLLIUM SEED 1 EA PKT

Dose 1 EA (1 PACKET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/21/17-0900 Stop Date 07/21/17 0900 DC: 07/21/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01530147

History
07/20/17 1333 - POM ORDER by SMOHAMED
07/20/17 1336 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/20/17 1426 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 07/21/17-0900 STOP: 08/20/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 07/21/17-0900 STOP: 07/21/17-0900 SOFT STOP:
DISPENSE: 0
07/20/17 1426 - DISCONTINUE by SMOHAMED Eff: 07/21/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
07/20/17 1427 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 07/20/17 1426
Discontinue by SMOHAMED Eff: 07/20/17 1426
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 90
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

PSYL1PAC15 - PSYLLIUM SEED 1 EA PKT

Dose 1 EA (1 PACKET)
Admin Route ORAL
Frequency 1332 (ONE)
Start Date 07/20/17-1332 Stop Date 07/20/17 1333 DC: 07/20/17-1333
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01530148

Discontinued Comments Reached Stop Date

History
07/20/17 1333 - POM ORDER by SMOHAMED
07/20/17 1336 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/20/17 - 1332
07/20/17 1336 - DISCONTINUE by PHABKGJOB Eff: 07/20/17 1333
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 91
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 06/20/17-1200 Stop Date 07/20/17 1159 DC: 06/22/17-2323
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 6 Total Costs $0.00 Total Charges $0.40
Rx Number 01522106

Discontinued Comments DC'd by Discharge

History
06/19/17 1628 - POM ORDER by NCHANDEL
06/19/17 1631 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 06/20/17 - 1200
For: 06/21/17 - 1200
For: 06/22/17 - 1200
06/21/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 06/23/17 - 1200
For: 06/24/17 - 1200
For: 06/25/17 - 1200
06/22/17 2357 - DISCONTINUE by DISCHARGE Eff: 06/22/17 2323
Items Auto Credited: 6 Doses Auto Credited: 3
For: 06/23/17 - 1200
For: 06/24/17 - 1200
For: 06/25/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 92
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/19/17-0900 Stop Date 08/18/17 0859 DC: 08/06/17-1730
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 19 Total Costs $0.00 Total Charges $1.10
Rx Number 01529794

Discontinued Comments DC'd by Discharge

History
07/18/17 1738 - POM ORDER by SMOHAMED
07/18/17 1738 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0805 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0807 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0812 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/06/17 2354 - DISCONTINUE by DISCHARGE Eff: 08/06/17 1730
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 93
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

Items Auto Credited: 2 Doses Auto Credited: 2

For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 94
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

SODI473S26 - SODIUM HYPOCHLORITE 473 ML 0.25%

Dose 1 ML (0.0021142 SOLUTIONS)

Dose Instructions 1 APPLICATION TOPICALLY
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 07/19/17-2100 Stop Date 08/17/17 1759 DC: 07/20/17-0745
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01530037

History
07/19/17 2053 - POM COPY AND EDIT by YIVANOV
FROM: Rx #01529788
Result of Frequency/Schedule Edit
Ordering Doctor: IVANOV,YURIY MD PGY-3
Last Scheduled Administration Time: 07/19/17 - 1700
Last Actual Administration Time: 07/19/17 - 1700 (Not Given)
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 07/19/17 - 2051
New Order Start: 07/19/17 - 2100
New Order Stop: 08/17/17 - 1759
07/20/17 0745 - EDIT by AMOLINARI
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
TO:
CHARGE TYPE: PSM - PATIENT'S SELF MEDS
CHARGE: $0.00
07/20/17 0745 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by YIVANOV Eff: 07/19/17 2053
Ordering Doctor: IVANOV,YURIY MD PGY-3
Last Scheduled Administration Time: 07/19/17 - 1700
Last Actual Administration Time: 07/19/17 - 1700 (Not Given)
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 07/19/17 - 2051
New Order Start: 07/19/17 - 2100
New Order Stop: 08/17/17 - 1759
07/20/17 0745 - VERIFIED by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 07/19/17 - 2100
For: 07/20/17 - 0900
For: 07/20/17 - 2100
For: 07/21/17 - 0900
For: 07/21/17 - 2100
For: 07/22/17 - 0900
For: 07/22/17 - 2100
For: 07/23/17 - 0900
For: 07/23/17 - 2100
07/20/17 0745 - COPY AND EDIT by AMOLINARI
TO: Rx #01530038
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 95
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

07/20/17 0745 - DISCONTINUE by AMOLINARI Eff: 07/20/17 0745

Items Auto Credited: 8 Doses Auto Credited: 8
For: 07/20/17 - 0900
For: 07/20/17 - 2100
For: 07/21/17 - 0900
For: 07/21/17 - 2100
For: 07/22/17 - 0900
For: 07/22/17 - 2100
For: 07/23/17 - 0900
For: 07/23/17 - 2100
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE

WRF3T - WARFARIN SOD 3 MG TAB

Dose 4 MG (1.33333 TABLETS)

Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 07/19/17-2100 Stop Date 07/19/17 2101 DC: 07/19/17-2100
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530017

History
07/19/17 1703 - POM ORDER by SMOHAMED
07/19/17 1739 - DISCONTINUE by AMACCA Eff: 07/19/17 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/19/17 1739 - VERIFIED by SYSTEM
Verified in order to DC

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 07/19/17-2100 Stop Date 07/19/17 2101 DC: 07/19/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01530018

Discontinued Comments Reached Stop Date

History
07/19/17 1741 - ENTER by AMACCA
07/19/17 2101 - DISCONTINUE by PHABKGJOB Eff: 07/19/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 96
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 07/20/17-2100 Stop Date 07/20/17 2101 DC: 07/20/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01530056

Discontinued Comments Reached Stop Date

History
07/20/17 1114 - ENTER by AMOLINARI
07/20/17 2101 - DISCONTINUE by PHABKGJOB Eff: 07/20/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 07/21/17-2100 Stop Date 07/21/17 2101 DC: 07/21/17-2101
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01530506

Discontinued Comments Reached Stop Date

History
07/21/17 1725 - POM ORDER by JRUSSO
07/21/17 1726 - VERIFIED by MHAIMOWITZ
07/21/17 2101 - DISCONTINUE by PHABKGJOB Eff: 07/21/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 97
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/22/17-2100 Stop Date 07/24/17 2059 DC: 07/24/17-1742
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01530716

Discontinued Comments DC ORDER WHICH WILL END 7/24 2059

History
07/22/17 1731 - POM ORDER by HAZIZI
07/22/17 1741 - VERIFIED by AADEGBAMIG
07/24/17 1743 - DISCONTINUE by AMACCA Eff: 07/24/17 1742
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC ORDER WHICH WILL END 7/24 2059

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/24/17-2100 Stop Date 07/25/17 2059 DC: 07/25/17-1644
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01531106

Discontinued Comments NEW ORDER ON FILE

History
07/24/17 1740 - POM ORDER by SMOHAMED
07/24/17 1742 - VERIFIED by AMACCA
07/25/17 1644 - DISCONTINUE by MHAIMOWITZ Eff: 07/25/17 1644
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
NEW ORDER ON FILE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 98
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/25/17-2100 Stop Date 07/26/17 2059 DC: 07/26/17-1737
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01531184

Discontinued Comments NEW ORDER ON FILE

History
07/25/17 0952 - POM ORDER by SMOHAMED
07/25/17 1004 - VERIFIED by AMACCA
07/26/17 1738 - DISCONTINUE by MHAIMOWITZ Eff: 07/26/17 1737
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
NEW ORDER ON FILE

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 07/26/17-2100 Stop Date 07/26/17 2101 DC: 07/26/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01531953

Discontinued Comments Reached Stop Date

History
07/26/17 1709 - POM ORDER by SMOHAMED
07/26/17 1738 - VERIFIED by MHAIMOWITZ
07/26/17 2101 - DISCONTINUE by PHABKGJOB Eff: 07/26/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 99
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/27/17-2100 Stop Date 07/28/17 2059 DC: 07/28/17-1213
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01532255

Discontinued Comments NEW ORDER ON FILE

History
07/27/17 1631 - POM ORDER by SMOHAMED
07/27/17 1634 - VERIFIED by AMACCA
07/28/17 1214 - DISCONTINUE by MHAIMOWITZ Eff: 07/28/17 1213
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
NEW ORDER ON FILE

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 07/28/17-2100 Stop Date 07/28/17 2101 DC: 07/28/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532403

Discontinued Comments Reached Stop Date

History
07/28/17 1154 - POM ORDER by SMOHAMED
07/28/17 1214 - VERIFIED by MHAIMOWITZ
07/28/17 2101 - DISCONTINUE by PHABKGJOB Eff: 07/28/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 100
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/30/17-2100 Stop Date 07/31/17 2101 DC: 07/30/17-2100
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532777

History
07/29/17 2136 - POM ORDER by HAZIZI
07/29/17 2139 - DISCONTINUE by HAZIZI Eff: 07/30/17 2100
EDIT DOCTOR: AZIZI,HANA MD
07/29/17 2139 - VERIFIED by SYSTEM
Verified in order to DC
07/29/17 2139 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01419205
07/30/17 1044 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by SYSTEM Eff: 07/29/17 2139
Discontinue by HAZIZI Eff: 07/29/17 2139
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 101
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/29/17-2140 Stop Date 07/30/17 2101 DC: 07/30/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01532785

Discontinued Comments Reached Stop Date

History
07/29/17 2139 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01532777
Last Scheduled Administration Time:
Last Actual Administration Time:
Old Total Doses: 2
New Total Doses: 2 (Defaulted Remaining Doses)
07/29/17 2139 - NOW DOSE by HAZIZI
Now Dose: 07/29/17 2140
07/29/17 2139 - KEEP NEXT DOSE by System
Keep Next Dose: 07/30/17 2100
07/30/17 1044 - REVIEW PROVIDER ACTIVITY by EBALILO
Total Doses Edit by HAZIZI Eff: 07/29/17 2139
Last Scheduled Administration Time:
Last Actual Administration Time:
Old Total Doses: 2
New Total Doses: 2 (Defaulted Remaining Doses)
Now Dose by HAZIZI Eff: 07/29/17 2139
Now Dose 07/29/17 - 2140
Keep Next Dose 07/30/17 - 2100
Administration of Unverified Order by CPENOL Eff: 07/29/17 2142
07/30/17 1044 - VERIFIED by EBALILO
07/30/17 2101 - DISCONTINUE by PHABKGJOB Eff: 07/30/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 102
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/31/17-2100 Stop Date 07/31/17 2101 DC: 07/31/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01532914

Discontinued Comments Reached Stop Date

History
07/31/17 1121 - ENTER by AMOLINARI
07/31/17 2101 - DISCONTINUE by PHABKGJOB Eff: 07/31/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF6T - WARFARIN SOD 6 MG TAB

Dose 6 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/01/17-2100 Stop Date 08/02/17 2059 DC: 08/02/17-2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01533364

Discontinued Comments Reached Stop Date

History
08/01/17 1116 - POM ORDER by SMOHAMED
08/01/17 1136 - VERIFIED by AMACCA
08/02/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/02/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 103
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF6T - WARFARIN SOD 6 MG TAB

Dose 6 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/02/17-2100 Stop Date 08/03/17 2059 DC: 08/03/17-2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01533686

Warnings
Type: BURKE
Range: WARFARIN SOD
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.5 MG/DAY - 15 MG/DAY. Ordered dose of 0 MG/DAY is
below the Low Daily Dose.

Discontinued Comments Reached Stop Date

History
08/02/17 1224 - POM ORDER by SMOHAMED
08/02/17 1339 - VERIFIED by AMACCA
08/03/17 2100 - DISCONTINUE by PHABKGJOB Eff: 08/03/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF3T - WARFARIN SOD 3 MG TAB

Dose 4 MG (1.33333 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/03/17-2100 Stop Date 08/04/17 2059 DC: 08/03/17-2100
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533941

History
08/03/17 1134 - POM ORDER by SMOHAMED
08/03/17 1159 - DISCONTINUE by AADEGBAMIG Eff: 08/03/17 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/03/17 1159 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 104
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/03/17-2100 Stop Date 08/04/17 2059 DC: 08/04/17-2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01533940

Discontinued Comments Reached Stop Date

History
08/03/17 1158 - ENTER by AADEGBAMIG
08/04/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/04/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/04/17-2100 Stop Date 08/05/17 2059 DC: 08/05/17-2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534138

Discontinued Comments Reached Stop Date

History
08/04/17 1113 - POM ORDER by SMOHAMED
08/04/17 1116 - VERIFIED by AADEGBAMIG
08/05/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/05/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 105
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/05/17-2100 Stop Date 08/06/17 2101 DC: 08/06/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534664

Discontinued Comments Reached Stop Date

History
08/05/17 1915 - POM ORDER by HAZIZI
08/06/17 1022 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by SKEMAL Eff: 08/05/17 2017
08/06/17 1022 - VERIFIED by MHAIMOWITZ
08/06/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/06/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/16/17-2100 Stop Date 08/16/17 2101 DC: 08/16/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537247

Discontinued Comments Reached Stop Date

History
08/16/17 1256 - POM ORDER by SMOHAMED
08/16/17 1403 - VERIFIED by AADEGBAMIG
08/16/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/16/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 106
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/31/17-2100 Stop Date 08/31/17 2101 DC: 08/31/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01537667

Discontinued Comments Reached Stop Date

History
08/17/17 1618 - POM ORDER by SMOHAMED
08/17/17 1623 - VERIFIED by AMACCA
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 2100
08/31/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 107
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/01/17-2100 Stop Date 09/01/17 2101 DC: 09/01/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537668

Discontinued Comments Reached Stop Date

History
08/17/17 1618 - POM ORDER by SMOHAMED
08/17/17 1623 - VERIFIED by AMACCA
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
09/01/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 108
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/02/17-2100 Stop Date 09/02/17 2101 DC: 09/02/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537669

Discontinued Comments Reached Stop Date

History
08/17/17 1618 - POM ORDER by SMOHAMED
08/17/17 1623 - VERIFIED by AMACCA
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 2100
09/02/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/17/17-2100 Stop Date 08/18/17 2059 DC: 08/18/17-1927
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537775

History
08/17/17 1806 - POM ORDER by SMOHAMED
08/17/17 1814 - VERIFIED by AMACCA
08/18/17 1929 - DISCONTINUE by SMOHAMED Eff: 08/18/17 1927
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/20/17 1027 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/18/17 1929
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 109
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF7.5T - WARFARIN SOD 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 08/19/17 2059 DC: 08/19/17-2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538219

Discontinued Comments Reached Stop Date

History
08/18/17 1818 - POM ORDER by SMOHAMED
08/18/17 1818 - VERIFIED by AADEGBAMIG
08/19/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/20/17-2100 Stop Date 08/21/17 2059 DC: 08/21/17-2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538357

Discontinued Comments Reached Stop Date

History
08/19/17 2207 - POM ORDER by HAZIZI
08/20/17 1000 - VERIFIED by AADEGBAMIG
08/21/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/21/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 110
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 2204 (ONE)
Start Date 08/19/17-2204 Stop Date 08/19/17 2205 DC: 08/19/17-2205
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538358

Discontinued Comments Reached Stop Date

History
08/19/17 2207 - POM ORDER by HAZIZI
08/20/17 1000 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by DCYRIAC Eff: 08/19/17 2242
08/20/17 1000 - VERIFIED by AADEGBAMIG
08/20/17 1000 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 2205
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/23/17-2100 Stop Date 08/23/17 2101 DC: 08/23/17-2100
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539157

Discontinued Comments SPOKE TO MD WANTS ONE DOSE ON 8/22/17

History
08/22/17 2153 - POM ORDER by DSPUNBERG
08/22/17 2201 - VERIFIED by SYSTEM
Verified in order to DC
08/22/17 2201 - DISCONTINUE by AMACCA Eff: 08/23/17 2100
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
SPOKE TO MD WANTS ONE DOSE ON 8/22/17
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 111
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/22/17-2100 Stop Date 08/22/17 2101 DC: 08/22/17-2101
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539158

Discontinued Comments Reached Stop Date

History
08/22/17 2202 - ENTER by AMACCA
08/22/17 2202 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 08/24/17 2059 DC: 08/24/17-2058
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539356

Warnings
Type: BURKE
Range: WARFARIN SOD
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.5 MG/DAY - 15 MG/DAY. Ordered dose of 0 MG/DAY is
below the Low Daily Dose.

Discontinued Comments D/C ORDER TO AVOID CONFUSION

History
08/23/17 1603 - POM ORDER by SMOHAMED
08/23/17 1604 - VERIFIED by AADEGBAMIG
08/24/17 2059 - DISCONTINUE by EBALILO Eff: 08/24/17 2058
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
D/C ORDER TO AVOID CONFUSION
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 112
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/24/17-2100 Stop Date 08/24/17 2101 DC: 08/24/17-2101
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539838

Discontinued Comments Reached Stop Date

History
08/24/17 2054 - POM ORDER by RSHARMA
08/24/17 2057 - VERIFIED by EBALILO
08/24/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF6T - WARFARIN SOD 6 MG TAB

Dose 6 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 08/25/17 2101 DC: 08/25/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540194

Discontinued Comments Reached Stop Date

History
08/25/17 1702 - POM ORDER by SMOHAMED
08/25/17 1709 - EDIT by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-2100 STOP: 08/26/17 2059 SOFT STOP: 0
TO:
START: 08/25/17-2100 STOP: 08/25/17-2101 SOFT STOP: 0
08/25/17 1709 - VERIFIED by MHAIMOWITZ
08/25/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 113
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/26/17-2100 Stop Date 08/28/17 2101 DC: 08/28/17-2017
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540399

History
08/26/17 1658 - POM ORDER by HAZIZI
08/26/17 1709 - VERIFIED by AADEGBAMIG
08/28/17 2019 - DISCONTINUE by HMOHAMED Eff: 08/28/17 2017
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/28/17 2021 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HMOHAMED Eff: 08/28/17 2019

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/28/17-2100 Stop Date 08/28/17 2101 DC: 08/28/17-2101
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540885

Discontinued Comments Reached Stop Date

History
08/28/17 2020 - POM ORDER by HMOHAMED
08/28/17 2021 - VERIFIED by AADEGBAMIG
08/28/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 114
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 08/30/17 2059 DC: 08/30/17-1152
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540920

History
08/29/17 1042 - POM ORDER by SMOHAMED
08/29/17 1044 - VERIFIED by AMACCA
08/30/17 1152 - DISCONTINUE by AMOLINARI Eff: 08/30/17 1152
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 08/30/17 2101 DC: 08/30/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541258

Discontinued Comments Reached Stop Date

History
08/30/17 0935 - POM ORDER by SMOHAMED
08/30/17 1152 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/30/17-2100 STOP: 08/31/17 2059 SOFT STOP: 0
TO:
START: 08/30/17-2100 STOP: 08/30/17-2101 SOFT STOP: 0
08/30/17 1152 - VERIFIED by AMOLINARI
08/30/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 115
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 1,000 ML (6.6666667 BAGS)

Dose Instructions 50cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 07/31/17-1015 Stop Date 07/31/17 1016 CAN: 07/31/17-1121
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01419368

History
07/31/17 1013 - POM ORDER by SMOHAMED
07/31/17 1121 - CANCEL by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO LVP
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 116
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

ENXP100I - ENOXAPARIN INJ 100 MG/ML SYR

Dose 110 MG (1.1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 09/04/17-2100 Stop Date 10/04/17 2059 CAN: 09/01/17-1556
Ordering Doctor VALLES,JENNIE MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01428055

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Maximum Daily Dose is 2 MG/KG/DAY. Ordered dose of 2.02 MG/KG/DAY
exceeds the Maximum Daily Dose.

Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Maximum Daily Dose is 1 MG/KG/DOSE. Ordered dose of 1.01 MG/KG/DOSE
exceeds the Maximum Daily Dose.

Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Maximum Daily Dose is 2 MG/KG/DAY. Ordered dose of 2.02 MG/KG/DAY
exceeds the Maximum Daily Dose.

History
09/01/17 1554 - POM ORDER by JVALLES
09/01/17 1556 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: VALLES,JENNIE MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
DR. VALLES ASKED ME TO D/C Q12 ORDER
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 117
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

ENXP100I - ENOXAPARIN INJ 100 MG/ML SYR

Dose 110 MG (1.1 ML)

Admin Route SUBCUTAN.
Frequency ONETIME (ONE)
Start Date 09/04/17-2100 Stop Date 09/04/17 2101 CAN: 09/01/17-1558
Ordering Doctor VALLES,JENNIE MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01428056

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Maximum Daily Dose is 1 MG/KG/DOSE. Ordered dose of 1.01 MG/KG/DOSE
exceeds the Maximum Daily Dose.

History
09/01/17 1554 - POM ORDER by JVALLES
09/01/17 1558 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: VALLES,JENNIE MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO VIAL
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 118
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

KCL10TCR - POTASSIUM CHLORIDE 10 MEQ TABCR

Dose 20 MEQ (2 TABLET, CONTROLLED-RELEASES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/20/17-0900 Stop Date 07/20/17 0859 CAN: 06/19/17-1636
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01408932

Warnings
Type: BURKE
Range: POTASSIUM CHLORIDE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 40 MEQ/DAY - 100 MEQ/DAY. Ordered dose of 20 MEQ/DAY
is below the Low Daily Dose.

History
06/19/17 1629 - POM ORDER by NCHANDEL
06/19/17 1636 - CANCEL by EBALILO
EDIT DOCTOR: CHANDEL,NEEL MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 20MEQ TAB

WRF3T - WARFARIN SOD 3 MG TAB

Dose 4 MG (1.33333 TABLETS)

Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 07/20/17-2100 Stop Date 07/20/17 2101 CAN: 07/20/17-1114
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01416581

History
07/20/17 1057 - POM ORDER by SMOHAMED
07/20/17 1114 - CANCEL by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 2MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 119
Run Time 1513 PHA Profile

COLLINS,JAMES F W00001219160 (Continued)

WRF6T - WARFARIN SOD 6 MG TAB

Dose 4 MG (0.66667 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/31/17-2100 Stop Date 08/01/17 2059 CAN: 07/31/17-1120
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01419371

History
07/31/17 1019 - POM ORDER by SMOHAMED
07/31/17 1120 - CANCEL by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 2MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient COLLINS,JAMES R Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001219465 Location B2EA Unit Number M000193393
Age/Sex 83/M Room 206 Registered Date 08/24/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 1.84 m2

Weight 159 lb 6.4 oz 72.303 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: OLD CVA, NEW DVT
Secondary Diagnosis:

NF-MED - NON FORMULARY MEDICATION

Dose Instructions water 300cc, 3 times per day

Admin Route PEG TUBE
Frequency 3 TIMES A DAY (SCH)
Start Date 08/24/17-1700 Stop Date 09/23/17 1659
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539690

History
08/24/17 1551 - POM ORDER by RMINASSIAN
08/24/17 1553 - EDIT by EBALILO
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
LABEL COMMENTS:
TO:
ORDER TYPE: BULK - BULK ORDER
LABEL COMMENTS:
water 300ml
08/24/17 1553 - VERIFIED by EBALILO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

NYST15CR2 - NYSTATIN CR 15 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions to peg site , especially in abdominal fold at peg site
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $52.65
Rx Number 01541302

History
08/30/17 1320 - POM ORDER by RMINASSIAN
08/30/17 1323 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 2100

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions to rash on buttocks and right leg/calf
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01541926

History
09/01/17 1232 - POM COPY AND EDIT by SDAS
FROM: Rx #01540454
09/01/17 1308 - EDIT by AADEGBAMIG
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP:
09/01/17 1308 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/24/17-1400 Stop Date 09/23/17 1359
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01539610

History
08/24/17 1359 - POM ORDER by RMINASSIAN
08/24/17 1401 - VERIFIED by EBALILO
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 16 Total Costs $0.00 Total Charges $177.98
Rx Number 01540702

History
08/28/17 1348 - ENTER by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $1.00
Rx Number 01539619

History
08/24/17 1404 - POM ORDER by RMINASSIAN
08/24/17 1410 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $7.50
Rx Number 01539617

History
08/24/17 1405 - POM ORDER by RMINASSIAN
08/24/17 1409 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1400 Stop Date 09/23/17 1359
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539611

History
08/24/17 1359 - POM ORDER by RMINASSIAN
08/24/17 1402 - VERIFIED by EBALILO
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 1,000 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $0.80
Rx Number 01539616

History
08/24/17 1404 - POM ORDER by RMINASSIAN
08/24/17 1409 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/24/17-1400 Stop Date 09/23/17 1359
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $7.25
Rx Number 01539615

History
08/24/17 1359 - POM ORDER by RMINASSIAN
08/24/17 1359 - NOW DOSE by RMINASSIAN
Now Dose: 08/24/17 1400
08/24/17 1359 - KEEP NEXT DOSE by System
Keep Next Dose: 08/24/17 1700
08/24/17 1403 - REVIEW PROVIDER ACTIVITY by EBALILO
Now Dose by RMINASSIAN Eff: 08/24/17 1359
Now Dose 08/24/17 - 1400
Keep Next Dose 08/24/17 - 1700
08/24/17 1403 - VERIFIED by EBALILO
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

For: 09/05/17 - 0900

For: 09/05/17 - 1300
For: 09/05/17 - 1700

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $2.80
Rx Number 01539620

History
08/24/17 1404 - POM ORDER by RMINASSIAN
08/24/17 1410 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/24/17-1400 Stop Date 09/23/17 1359
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539613

History
08/24/17 1359 - POM ORDER by RMINASSIAN
08/24/17 1402 - VERIFIED by EBALILO
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1400 Stop Date 09/23/17 1359
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539612

History
08/24/17 1359 - POM ORDER by RMINASSIAN
08/24/17 1402 - VERIFIED by EBALILO
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 25 Total Costs $0.00 Total Charges $2.75
Rx Number 01539621

History
08/24/17 1405 - POM ORDER by RMINASSIAN
08/24/17 1410 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/25/17-0800 Stop Date 09/24/17 0759
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $8.80
Rx Number 01539622

History
08/24/17 1404 - POM ORDER by RMINASSIAN
08/24/17 1411 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

OXB5T - OXYBUTYNIN CHLORIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $15.00
Rx Number 01539618

History
08/24/17 1404 - POM ORDER by RMINASSIAN
08/24/17 1409 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 26 Total Costs $0.00 Total Charges $2.00
Rx Number 01539614

History
08/24/17 1359 - POM ORDER by RMINASSIAN
08/24/17 1402 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/24/17 - 2100
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

SMV20T - SIMVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 26 Total Costs $0.00 Total Charges $6.00
Rx Number 01539629

History
08/24/17 1429 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01539628
08/24/17 1430 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/24/17 - 2100
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions to peg site
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/01/17 2059 DC: 08/29/17-1626
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Clinical Indication OTHER
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01539916

History
08/25/17 1220 - POM ORDER by RMINASSIAN
08/25/17 1221 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 2100
08/29/17 1627 - DISCONTINUE by RMINASSIAN Eff: 08/29/17 1626
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/30/17 1323 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RMINASSIAN Eff: 08/29/17 1627
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

BDS.5IN2 - BUDESONIDE INHA SUSP 0.5 MG/2 ML NEB

Dose 0.5 MG (2 ML)

Admin Route NEBULIZER
Frequency 2 TIMES A DAY (SCH)
Start Date 04/17/15-1700 Stop Date 05/17/15 1659 DC: 05/08/15-1100
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 50 Total Costs $0.00 Total Charges $1539.00
Rx Number 01329851

History
04/17/15 1510 - POM ORDER by MREDING
04/17/15 1513 - VERIFIED by GZEIARATI
Items Dispensed: 5 Doses Dispensed: 1
For: 04/17/15 - 1700
04/19/15 1027 - DEBIT by MHAIMOWITZ
ITEMS: 1
04/22/15 0736 - DEBIT by JORPHAL
ITEMS: 1
04/25/15 1810 - DEBIT by EBALILO
ITEMS: 2
05/01/15 0738 - DEBIT by AMOLINARI
ITEMS: 2
05/04/15 1921 - DEBIT by MREISS
ITEMS: 1
05/07/15 0739 - DEBIT by AMOLINARI
ITEMS: 2
05/08/15 1108 - DISCONTINUE by CDOHLE Eff: 05/08/15 1100
EDIT DOCTOR: DOHLE,CAROLIN MD
06/08/15 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by CDOHLE Eff: 05/08/15 1108)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions to peg site; cover with dry dressing
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/29/17-2100 Stop Date 09/05/17 2059 DC: 08/30/17-1317
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $7.98
Rx Number 01540948

History
08/29/17 1247 - POM ORDER by RMINASSIAN
08/29/17 1247 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 2100
08/30/17 1320 - DISCONTINUE by RMINASSIAN Eff: 08/30/17 1317
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/30/17 1323 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RMINASSIAN Eff: 08/30/17 1320

HC2.5C30 - HYDROCORTISONE 2.5% CR 30 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions apply to back
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 03/16/15-2100 Stop Date 03/23/15 2059 DC: 03/23/15-1709
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $11.88
Rx Number 01320449

History
03/16/15 1800 - POM ORDER by CDOHLE
03/16/15 1801 - VERIFIED by MREISS
Items Dispensed: 1 Doses Dispensed: 1
For: 03/16/15 - 2100
03/23/15 1710 - DISCONTINUE by CDOHLE Eff: 03/23/15 1709
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: Written
03/23/15 1710 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01213640
03/23/15 1714 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by CDOHLE Eff: 03/23/15 1710
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
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COLLINS,JAMES R W00001219465 (Continued)

HC2.5C30 - HYDROCORTISONE 2.5% CR 30 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions apply to back
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 03/23/15-2100 Stop Date 03/30/15 2059 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01322496

Discontinued Comments DC'd by Discharge

History
03/23/15 1710 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01320449
03/23/15 1713 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 03/23/15 - 2100
03/23/15 1715 - CREDIT by MHAIMOWITZ
ITEMS: 1
03/24/15 2223 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge

NTR.4SL - NITROGLYCERIN 0.4 MG SUBL

Dose 0.4 MG (1 TABLET, SUBLINGUAL)

Admin Route SUBLINGUAL
Frequency EVERY 5 MINUTES X 3 (PRN) PRN REASON: CP - Chest Pain
Start Date 03/16/15-1530 Stop Date 04/15/15 1529 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 25 Total Costs $0.00 Total Charges $22.50
Rx Number 01320395

Discontinued Comments DC'd by Discharge

History
03/16/15 1553 - POM ORDER by CDOHLE
03/16/15 1601 - VERIFIED by MHAIMOWITZ
Items Dispensed: 25 Doses Dispensed: 1
For: 03/16/15 - 1530
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

NTR.4SL - NITROGLYCERIN 0.4 MG SUBL

Dose 0.4 MG (1 TABLET, SUBLINGUAL)

Dose Instructions Notify MD if needed
Admin Route SUBLINGUAL
Frequency EVERY 5 MINUTES X 3 (PRN) PRN REASON: CP - Chest Pain
Start Date 04/17/15-1500 Stop Date 05/17/15 1459 DC: 05/08/15-1100
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 25 Total Costs $0.00 Total Charges $22.50
Rx Number 01329850

History
04/17/15 1510 - POM ORDER by MREDING
04/17/15 1512 - VERIFIED by GZEIARATI
Items Dispensed: 25 Doses Dispensed: 1
For: 04/17/15 - 1500
05/08/15 1108 - DISCONTINUE by CDOHLE Eff: 05/08/15 1100
EDIT DOCTOR: DOHLE,CAROLIN MD
06/08/15 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by CDOHLE Eff: 05/08/15 1108)
Removed by File Maintenance.

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions to rash on buttocks
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/25/17-2100 Stop Date 09/01/17 2059 DC: 08/27/17-1103
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01540118

History
08/25/17 1517 - POM ORDER by RMINASSIAN
08/25/17 1518 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 2100
08/27/17 1108 - DISCONTINUE by YIVANOV Eff: 08/27/17 1103
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
08/27/17 1108 - POM COPY AND EDIT by YIVANOV
TO: Rx #U01426596
08/27/17 1134 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by YIVANOV Eff: 08/27/17 1108
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions to rash on buttocks and right leg/calf
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/27/17-2100 Stop Date 09/03/17 2059 DC: 09/01/17-1232
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01540454

History
08/27/17 1108 - POM COPY AND EDIT by YIVANOV
FROM: Rx #01540118
08/27/17 1134 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/27/17 - 2100
08/27/17 1134 - CREDIT by AADEGBAMIG
ITEMS: 1
09/01/17 1232 - DISCONTINUE by SDAS Eff: 09/01/17 1232
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
09/01/17 1232 - POM COPY AND EDIT by SDAS
TO: Rx #U01427971
09/01/17 1308 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 09/01/17 1232

DORI500V6 - DORIPENEM 500 MG VIAL - 500 MG

in NS.9100 - SODIUM CHLORIDE 0.9% IV SOLN 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 100 MLS/HR Duration 1 HR
Frequency EVERY 8 HOURS (SCH)
Start Date 04/25/15-2200 Stop Date 05/25/15 2159 DC: 04/25/15-2315
Ordering Doctor UMAR,MOHAMMED DO
Clinical Indication SUSPECTED INFECTION
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01332117

History
04/25/15 2023 - POM ORDER by MUMAR
04/25/15 2316 - VERIFIED by SYSTEM
Verified in order to DC
04/25/15 2316 - DISCONTINUE by MUMAR Eff: 04/25/15 2315
EDIT DOCTOR: UMAR,MOHAMMED DO
EDIT SOURCE: Written
04/26/15 1124 - REVIEW PROVIDER ACTIVITY by EBALILO
by SYSTEM Eff: 04/25/15 2316
by MUMAR Eff: 04/25/15 2316
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

IMIP500V2 - IMIPENEM/CILASTATIN SODIUM 500 MG VIAL - 500 MG

in NS.9100 - SODIUM CHLORIDE 0.9% IV SOLN 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 100 MLS/HR Duration 1 HR
Frequency EVERY 8 HOURS (SCH)
Start Date 04/25/15-2200 Stop Date 05/02/15 2159 DC: 05/02/15-2159
Ordering Doctor UMAR,MOHAMMED DO
Clinical Indication SUSPECTED INFECTION
Last Bag 21
Total Dispensed 21 Total Costs $0.00 Total Charges $2355.80
Rx Number 01332145

Discontinued Comments Reached Stop Date

History
04/25/15 2151 - POM ORDER by MUMAR
04/26/15 1124 - REVIEW PROVIDER ACTIVITY by EBALILO
by ACABELLO Eff: 04/25/15 2209
by DRYAN Eff: 04/26/15 0531
04/26/15 1124 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 04/25/15 - 2200
For: 04/26/15 - 0600
For: 04/26/15 - 1400
04/26/15 1134 - FILL by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 04/26/15 - 2200
For: 04/27/15 - 0600
For: 04/27/15 - 1400
04/27/15 1021 - FILL by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 04/27/15 - 2200
For: 04/28/15 - 0600
For: 04/28/15 - 1400
04/28/15 0951 - FILL by GZEIARATI
Items Dispensed: 3 Doses Dispensed: 3
For: 04/28/15 - 2200
For: 04/29/15 - 0600
For: 04/29/15 - 1400
04/29/15 1058 - FILL by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 04/29/15 - 2200
For: 04/30/15 - 0600
For: 04/30/15 - 1400
04/30/15 1004 - FILL by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 04/30/15 - 2200
For: 05/01/15 - 0600
For: 05/01/15 - 1400
05/01/15 1004 - FILL by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 05/01/15 - 2200
For: 05/02/15 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

For: 05/02/15 - 1400

05/02/15 2159 - DISCONTINUE by PHABKGJOB Eff: 05/02/15 2159
DC COMMENTS:
Reached Stop Date

D5500 - DEXTROSE 5% 500 ML BAG - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 03/24/15-1615 Stop Date 03/25/15 0214 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Last Bag 1
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01322712

Discontinued Comments DC'd by Discharge

History
03/24/15 1612 - POM ORDER by CDOHLE
03/24/15 1612 - VERIFIED by GZEIARATI
Items Dispensed: 1 Doses Dispensed: 1
For: 03/24/15 - 1615
03/24/15 2223 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 03/16/15-1530 Stop Date 04/15/15 1529 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01320378

Discontinued Comments DC'd by Discharge

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1555 - VERIFIED by MHAIMOWITZ
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 04/17/15-1500 Stop Date 05/17/15 1459 DC: 05/08/15-1100
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01329840

History
04/17/15 1500 - POM ORDER by MREDING
04/17/15 1507 - VERIFIED by GZEIARATI
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 1108 - DISCONTINUE by CDOHLE Eff: 05/08/15 1100
EDIT DOCTOR: DOHLE,CAROLIN MD
06/08/15 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by CDOHLE Eff: 05/08/15 1108)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 08/30/17 0859 DC: 08/28/17-0926
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $258.80
Rx Number 01539626

History
08/24/17 1404 - POM ORDER by RMINASSIAN
08/24/17 1422 - VERIFIED by EBALILO
Items Dispensed: 14 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0927 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0926
Items Auto Credited: 6 Doses Auto Credited: 3
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0927 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426716
08/28/17 1346 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 08/28/17 0927
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
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COLLINS,JAMES R W00001219465 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859 DC: 08/30/17-0900
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539627

History
08/24/17 1405 - POM ORDER by RMINASSIAN
08/24/17 1422 - VERIFIED by EBALILO
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/28/17 1346 - DISCONTINUE by AADEGBAMIG Eff: 08/30/17 0900
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 08/28/17 2101 DC: 08/28/17-2101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 2 Total Costs $0.00 Total Charges $32.35
Rx Number 01540701

Discontinued Comments Reached Stop Date

History
08/28/17 0927 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01539626
08/28/17 1341 - EDIT by AADEGBAMIG
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/02/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/02/17-2059 SOFT STOP:
08/28/17 1346 - EDIT by AADEGBAMIG
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/02/17 2059 SOFT STOP:
DISPENSE: 14
TO:
START: 08/28/17-2100 STOP: 08/28/17-2101 SOFT STOP: 0
DISPENSE: 2
08/28/17 1347 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 1
For: 08/28/17 - 2100
08/28/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 03/17/15-0900 Stop Date 04/16/15 0859 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 8 Total Costs $0.00 Total Charges $0.80
Rx Number 01320379

Discontinued Comments DC'd by Discharge

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1556 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 03/17/15 - 0900
For: 03/18/15 - 0900
For: 03/19/15 - 0900
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 03/20/15 - 0900
For: 03/21/15 - 0900
For: 03/22/15 - 0900
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 03/23/15 - 0900
For: 03/24/15 - 0900
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
Items Auto Credited: 2 Doses Auto Credited: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency EVERY OTHER DAY (SCH)
Start Date 05/03/15-0900 Stop Date 06/02/15 0859 DC: 05/08/15-1212
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.24
Rx Number 01333659

Discontinued Comments DC'd by Discharge

History
05/01/15 1308 - POM ORDER by CDOHLE
05/01/15 1318 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 05/03/15 - 0900
For: 05/05/15 - 0900
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 05/07/15 - 0900
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 1 Doses Dispensed: 1
For: 05/09/15 - 0900
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 05/11/15 - 0900
05/08/15 1213 - DISCONTINUE by DISCHARGE Eff: 05/08/15 1212
Items Auto Credited: 2 Doses Auto Credited: 2
For: 05/09/15 - 0900
For: 05/11/15 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 03/16/15-2200 Stop Date 04/15/15 2159 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 24 Total Costs $0.00 Total Charges $49.40
Rx Number 01320380

Discontinued Comments DC'd by Discharge

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1556 - VERIFIED by MHAIMOWITZ
Items Dispensed: 11 Doses Dispensed: 11
For: 03/16/15 - 2200
For: 03/17/15 - 0600
For: 03/17/15 - 1400
For: 03/17/15 - 2200
For: 03/18/15 - 0600
For: 03/18/15 - 1400
For: 03/18/15 - 2200
For: 03/19/15 - 0600
For: 03/19/15 - 1400
For: 03/19/15 - 2200
For: 03/20/15 - 0600
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 03/20/15 - 1400
For: 03/20/15 - 2200
For: 03/21/15 - 0600
For: 03/21/15 - 1400
For: 03/21/15 - 2200
For: 03/22/15 - 0600
For: 03/22/15 - 1400
For: 03/22/15 - 2200
For: 03/23/15 - 0600
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 03/23/15 - 1400
For: 03/23/15 - 2200
For: 03/24/15 - 0600
For: 03/24/15 - 1400
For: 03/24/15 - 2200
For: 03/25/15 - 0600
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 03/25/15 - 1400
For: 03/25/15 - 2200
For: 03/26/15 - 0600
For: 03/26/15 - 1400
For: 03/26/15 - 2200
For: 03/27/15 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700

Items Auto Credited: 8 Doses Auto Credited: 8
For: 03/24/15 - 2200
For: 03/25/15 - 0600
For: 03/25/15 - 1400
For: 03/25/15 - 2200
For: 03/26/15 - 0600
For: 03/26/15 - 1400
For: 03/26/15 - 2200
For: 03/27/15 - 0600
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 04/17/15-1700 Stop Date 05/17/15 1659 DC: 05/08/15-1212
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 62 Total Costs $0.00 Total Charges $161.20
Rx Number 01329852

Discontinued Comments DC'd by Discharge

History
04/17/15 1510 - POM ORDER by MREDING
04/17/15 1513 - VERIFIED by GZEIARATI
Items Dispensed: 13 Doses Dispensed: 13
For: 04/17/15 - 1700
For: 04/18/15 - 0900
For: 04/18/15 - 1300
For: 04/18/15 - 1700
For: 04/19/15 - 0900
For: 04/19/15 - 1300
For: 04/19/15 - 1700
For: 04/20/15 - 0900
For: 04/20/15 - 1300
For: 04/20/15 - 1700
For: 04/21/15 - 0900
For: 04/21/15 - 1300
For: 04/21/15 - 1700
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 04/22/15 - 0900
For: 04/22/15 - 1300
For: 04/22/15 - 1700
For: 04/23/15 - 0900
For: 04/23/15 - 1300
For: 04/23/15 - 1700
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 04/24/15 - 0900
For: 04/24/15 - 1300
For: 04/24/15 - 1700
For: 04/25/15 - 0900
For: 04/25/15 - 1300
For: 04/25/15 - 1700
For: 04/26/15 - 0900
For: 04/26/15 - 1300
For: 04/26/15 - 1700
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 04/27/15 - 0900
For: 04/27/15 - 1300
For: 04/27/15 - 1700
For: 04/28/15 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

For: 04/28/15 - 1300

For: 04/28/15 - 1700
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 04/29/15 - 0900
For: 04/29/15 - 1300
For: 04/29/15 - 1700
For: 04/30/15 - 0900
For: 04/30/15 - 1300
For: 04/30/15 - 1700
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 05/01/15 - 0900
For: 05/01/15 - 1300
For: 05/01/15 - 1700
For: 05/02/15 - 0900
For: 05/02/15 - 1300
For: 05/02/15 - 1700
For: 05/03/15 - 0900
For: 05/03/15 - 1300
For: 05/03/15 - 1700
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/04/15 - 0900
For: 05/04/15 - 1300
For: 05/04/15 - 1700
For: 05/05/15 - 0900
For: 05/05/15 - 1300
For: 05/05/15 - 1700
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 05/06/15 - 0900
For: 05/06/15 - 1300
For: 05/06/15 - 1700
For: 05/07/15 - 0900
For: 05/07/15 - 1300
For: 05/07/15 - 1700
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 9 Doses Dispensed: 9
For: 05/08/15 - 0900
For: 05/08/15 - 1300
For: 05/08/15 - 1700
For: 05/09/15 - 0900
For: 05/09/15 - 1300
For: 05/09/15 - 1700
For: 05/10/15 - 0900
For: 05/10/15 - 1300
For: 05/10/15 - 1700
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/11/15 - 0900
For: 05/11/15 - 1300
For: 05/11/15 - 1700
For: 05/12/15 - 0900
For: 05/12/15 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

For: 05/12/15 - 1700

05/08/15 1213 - DISCONTINUE by DISCHARGE Eff: 05/08/15 1212
Items Auto Credited: 14 Doses Auto Credited: 14
For: 05/08/15 - 1300
For: 05/08/15 - 1700
For: 05/09/15 - 0900
For: 05/09/15 - 1300
For: 05/09/15 - 1700
For: 05/10/15 - 0900
For: 05/10/15 - 1300
For: 05/10/15 - 1700
For: 05/11/15 - 0900
For: 05/11/15 - 1300
For: 05/11/15 - 1700
For: 05/12/15 - 0900
For: 05/12/15 - 1300
For: 05/12/15 - 1700
DC COMMENTS:
DC'd by Discharge

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 03/16/15-1530 Stop Date 04/15/15 1529 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01320381

Discontinued Comments DC'd by Discharge

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1556 - VERIFIED by MHAIMOWITZ
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 04/17/15-1500 Stop Date 05/17/15 1459 DC: 05/08/15-1100
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01329841

History
04/17/15 1500 - POM ORDER by MREDING
04/17/15 1507 - VERIFIED by GZEIARATI
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 1108 - DISCONTINUE by CDOHLE Eff: 05/08/15 1100
EDIT DOCTOR: DOHLE,CAROLIN MD
06/08/15 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by CDOHLE Eff: 05/08/15 1108)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

DGX.125T - DIGOXIN 0.125 MG TAB

Dose 0.125 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 03/17/15-0900 Stop Date 04/16/15 0859 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 8 Total Costs $0.00 Total Charges $42.00
Rx Number 01320382

Discontinued Comments DC'd by Discharge

History
03/16/15 1553 - POM ORDER by CDOHLE
03/16/15 1557 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 03/17/15 - 0900
For: 03/18/15 - 0900
For: 03/19/15 - 0900
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 03/20/15 - 0900
For: 03/21/15 - 0900
For: 03/22/15 - 0900
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 03/23/15 - 0900
For: 03/24/15 - 0900
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
Items Auto Credited: 2 Doses Auto Credited: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

DGX.125T - DIGOXIN 0.125 MG TAB

Dose 0.125 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/18/15-0900 Stop Date 05/18/15 0859 DC: 05/08/15-1212
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 21 Total Costs $0.00 Total Charges $120.00
Rx Number 01329846

Discontinued Comments DC'd by Discharge

History
04/17/15 1509 - POM ORDER by MREDING
04/17/15 1511 - VERIFIED by GZEIARATI
Items Dispensed: 4 Doses Dispensed: 4
For: 04/18/15 - 0900
For: 04/19/15 - 0900
For: 04/20/15 - 0900
For: 04/21/15 - 0900
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 04/22/15 - 0900
For: 04/23/15 - 0900
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 04/24/15 - 0900
For: 04/25/15 - 0900
For: 04/26/15 - 0900
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 04/27/15 - 0900
For: 04/28/15 - 0900
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 04/29/15 - 0900
For: 04/30/15 - 0900
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/01/15 - 0900
For: 05/02/15 - 0900
For: 05/03/15 - 0900
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/04/15 - 0900
For: 05/05/15 - 0900
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/06/15 - 0900
For: 05/07/15 - 0900
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 05/08/15 - 0900
For: 05/09/15 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

For: 05/10/15 - 0900

05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/11/15 - 0900
For: 05/12/15 - 0900
05/08/15 1213 - DISCONTINUE by DISCHARGE Eff: 05/08/15 1212
Items Auto Credited: 4 Doses Auto Credited: 4
For: 05/09/15 - 0900
For: 05/10/15 - 0900
For: 05/11/15 - 0900
For: 05/12/15 - 0900
DC COMMENTS:
DC'd by Discharge

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 03/17/15-0900 Stop Date 04/16/15 0859 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01320384

Discontinued Comments DC'd by Discharge

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1557 - VERIFIED by MHAIMOWITZ
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 03/20/15 - 0900
For: 03/21/15 - 0900
For: 03/22/15 - 0900
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 03/23/15 - 0900
For: 03/24/15 - 0900
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 03/16/15-1700 Stop Date 04/15/15 1659 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01320383

Discontinued Comments DC'd by Discharge

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1557 - VERIFIED by MHAIMOWITZ
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 03/20/15 - 1700
For: 03/21/15 - 1700
For: 03/22/15 - 1700
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 03/23/15 - 1700
For: 03/24/15 - 1700
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 03/25/15 - 1700
For: 03/26/15 - 1700
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/18/15-0900 Stop Date 05/18/15 0859 DC: 05/08/15-1100
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $5.00
Rx Number 01329835

History
04/17/15 1500 - POM ORDER by MREDING
04/17/15 1506 - VERIFIED by GZEIARATI
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 04/22/15 - 0900
For: 04/23/15 - 0900
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 04/24/15 - 0900
For: 04/25/15 - 0900
For: 04/26/15 - 0900
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 04/27/15 - 0900
For: 04/28/15 - 0900
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 04/29/15 - 0900
For: 04/30/15 - 0900
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/01/15 - 0900
For: 05/02/15 - 0900
For: 05/03/15 - 0900
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/04/15 - 0900
For: 05/05/15 - 0900
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/06/15 - 0900
For: 05/07/15 - 0900
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 05/08/15 - 0900
For: 05/09/15 - 0900
For: 05/10/15 - 0900
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/11/15 - 0900
For: 05/12/15 - 0900
05/08/15 1108 - DISCONTINUE by CDOHLE Eff: 05/08/15 1100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

EDIT DOCTOR: DOHLE,CAROLIN MD

06/08/15 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by CDOHLE Eff: 05/08/15 1108)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 04/17/15-1700 Stop Date 05/17/15 1659 DC: 05/08/15-1100
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $5.25
Rx Number 01329838

History
04/17/15 1500 - POM ORDER by MREDING
04/17/15 1507 - VERIFIED by GZEIARATI
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 04/22/15 - 1700
For: 04/23/15 - 1700
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 04/24/15 - 1700
For: 04/25/15 - 1700
For: 04/26/15 - 1700
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 04/27/15 - 1700
For: 04/28/15 - 1700
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 04/29/15 - 1700
For: 04/30/15 - 1700
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 05/01/15 - 1700
For: 05/02/15 - 1700
For: 05/03/15 - 1700
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/04/15 - 1700
For: 05/05/15 - 1700
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 05/06/15 - 1700
For: 05/07/15 - 1700
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 6 Doses Dispensed: 3
For: 05/08/15 - 1700
For: 05/09/15 - 1700
For: 05/10/15 - 1700
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/11/15 - 1700
For: 05/12/15 - 1700
05/08/15 1108 - DISCONTINUE by CDOHLE Eff: 05/08/15 1100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

EDIT DOCTOR: DOHLE,CAROLIN MD

06/08/15 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by CDOHLE Eff: 05/08/15 1108)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

ESCI10TA - ESCITALOPRAM OXALATE 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 04/23/15-2100 Stop Date 05/23/15 2059 DC: 05/01/15-1219
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 8 Total Costs $0.00 Total Charges $137.04
Rx Number 01331463

History
04/23/15 1648 - POM ORDER by CDOHLE
04/23/15 1654 - VERIFIED by GZEIARATI
Items Dispensed: 4 Doses Dispensed: 4
For: 04/23/15 - 2100
For: 04/24/15 - 2100
For: 04/25/15 - 2100
For: 04/26/15 - 2100
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 04/27/15 - 2100
For: 04/28/15 - 2100
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 04/29/15 - 2100
For: 04/30/15 - 2100
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/01/15 - 2100
For: 05/02/15 - 2100
For: 05/03/15 - 2100
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/04/15 - 2100
For: 05/05/15 - 2100
05/01/15 1220 - DISCONTINUE by CDOHLE Eff: 05/01/15 1219
Items Auto Credited: 5 Doses Auto Credited: 5
For: 05/01/15 - 2100
For: 05/02/15 - 2100
For: 05/03/15 - 2100
For: 05/04/15 - 2100
For: 05/05/15 - 2100
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: Written
05/01/15 1220 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01224669
05/01/15 1233 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
by CDOHLE Eff: 05/01/15 1220
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

ESCI10TA - ESCITALOPRAM OXALATE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 05/01/15-2100 Stop Date 05/31/15 2059 DC: 05/08/15-1212
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 7 Total Costs $0.00 Total Charges $119.91
Rx Number 01333597

Discontinued Comments DC'd by Discharge

History
05/01/15 1220 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01331463
05/01/15 1233 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 05/01/15 - 2100
For: 05/02/15 - 2100
For: 05/03/15 - 2100
For: 05/04/15 - 2100
For: 05/05/15 - 2100
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/06/15 - 2100
For: 05/07/15 - 2100
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 05/08/15 - 2100
For: 05/09/15 - 2100
For: 05/10/15 - 2100
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/11/15 - 2100
For: 05/12/15 - 2100
05/08/15 1213 - DISCONTINUE by DISCHARGE Eff: 05/08/15 1212
Items Auto Credited: 5 Doses Auto Credited: 5
For: 05/08/15 - 2100
For: 05/09/15 - 2100
For: 05/10/15 - 2100
For: 05/11/15 - 2100
For: 05/12/15 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

FLU45SYR11 - FLU VACC TS 2014-15 (18+)CELL/PF 45 MCG/0.5 ML SYRINGE

Dose 45 MCG (0.5 ML)

Admin Route INTRAMUSC.
Frequency ONETIME (ONE)
Start Date 03/16/15-1530 Stop Date 03/16/15 1531 DC: 03/16/15-1531
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01320385

Discontinued Comments Reached Stop Date

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1558 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 03/16/15 - 1530
03/16/15 1558 - DISCONTINUE by PHABKGJOB Eff: 03/16/15 1531
DC COMMENTS:
Reached Stop Date

FLX10C - FLUOXETINE HCL 10 MG CAP

Dose 10 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 03/20/15-0900 Stop Date 03/20/15 0900 DC: 03/20/15-0900
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01321360

History
03/19/15 1721 - POM ORDER by CDOHLE
03/19/15 1725 - EDIT by CDOHLE
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: Written
FROM:
START: 03/20/15-0900 STOP: 04/19/15 0859 SOFT STOP: 0
TO:
START: 03/20/15-0900 STOP: 03/20/15-0900 SOFT STOP:
03/19/15 1725 - DISCONTINUE by CDOHLE Eff: 03/20/15 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: Written
03/19/15 1725 - VERIFIED by SYSTEM
Verified in order to DC
03/19/15 1741 - REVIEW PROVIDER ACTIVITY by EBALILO
by CDOHLE Eff: 03/19/15 1725
by SYSTEM Eff: 03/19/15 1725
by CDOHLE Eff: 03/19/15 1725
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 03/17/15-0900 Stop Date 04/16/15 0859 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 8 Total Costs $0.00 Total Charges $4.40
Rx Number 01320386

Discontinued Comments DC'd by Discharge

History
03/16/15 1553 - POM ORDER by CDOHLE
03/16/15 1558 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 03/17/15 - 0900
For: 03/18/15 - 0900
For: 03/19/15 - 0900
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 03/20/15 - 0900
For: 03/21/15 - 0900
For: 03/22/15 - 0900
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 03/23/15 - 0900
For: 03/24/15 - 0900
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
Items Auto Credited: 2 Doses Auto Credited: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Dose Instructions ask for review on 4-20-15
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/18/15-0900 Stop Date 05/18/15 0859 DC: 04/20/15-1015
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 3 Total Costs $0.00 Total Charges $1.10
Rx Number 01329847

History
04/17/15 1510 - POM ORDER by MREDING
04/17/15 1511 - VERIFIED by GZEIARATI
Items Dispensed: 4 Doses Dispensed: 4
For: 04/18/15 - 0900
For: 04/19/15 - 0900
For: 04/20/15 - 0900
For: 04/21/15 - 0900
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 04/22/15 - 0900
For: 04/23/15 - 0900
04/20/15 1017 - DISCONTINUE by MREDING Eff: 04/20/15 1015
Items Auto Credited: 3 Doses Auto Credited: 3
For: 04/21/15 - 0900
For: 04/22/15 - 0900
For: 04/23/15 - 0900
EDIT DOCTOR: REDING,MICHAEL MD.
EDIT SOURCE: Written
04/20/15 1018 - POM COPY AND EDIT by MREDING
TO: Rx #U01221344
04/20/15 1033 - REVIEW PROVIDER ACTIVITY by JORPHAL
by MREDING Eff: 04/20/15 1017
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 20 MG (0.5 TABLETS)

Dose Instructions ask for review on 4-20-15
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/21/15-0900 Stop Date 05/21/15 0859 DC: 04/21/15-0900
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01330297

History
04/20/15 1018 - POM COPY AND EDIT by MREDING
FROM: Rx #01329847
04/20/15 1033 - VERIFIED by SYSTEM
Verified in order to DC
04/20/15 1033 - DISCONTINUE by JORPHAL Eff: 04/21/15 0900
EDIT DOCTOR: REDING,MICHAEL MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/21/15-0900 Stop Date 04/21/15 0900 DC: 04/21/15-0900
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01330296

Discontinued Comments Dysphagic and trying to convert from PEG to PO

hydration. Stop the Lasix. No evidence of CHF at
present.

History
04/20/15 1033 - ENTER by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 04/21/15 - 0900
For: 04/22/15 - 0900
For: 04/23/15 - 0900
04/20/15 1432 - EDIT by MREDING
EDIT DOCTOR: REDING,MICHAEL MD.
EDIT SOURCE: Written
FROM:
START: 04/21/15-0900 STOP: 05/21/15 0859 SOFT STOP: 0
DC COMMENTS:
TO:
START: 04/21/15-0900 STOP: 04/21/15-0900 SOFT STOP:
DC COMMENTS:
Dysphagic and trying to convert from PEG to PO
hydration. Stop the Lasix. No evidence of CHF at
present.
04/20/15 1432 - DISCONTINUE by MREDING Eff: 04/21/15 0900
EDIT DOCTOR: REDING,MICHAEL MD.
EDIT SOURCE: Written
DC COMMENTS:
Dysphagic and trying to convert from PEG to PO
hydration. Stop the Lasix. No evidence of CHF at
present.
04/22/15 0736 - REVIEW PROVIDER ACTIVITY by JORPHAL
by MREDING Eff: 04/20/15 1432
by MREDING Eff: 04/20/15 1432
Dysphagic and trying to convert from PEG to PO
hydration. Stop the Lasix. No evidence of CHF at
present.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency EVERY 6 HOURS (PRN) PRN REASON: WHEEZE - for Wheezing
Start Date 03/16/15-1530 Stop Date 04/15/15 1529 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01320387

Discontinued Comments DC'd by Discharge

History
03/16/15 1553 - POM ORDER by CDOHLE
03/16/15 1558 - VERIFIED by MHAIMOWITZ
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
03/24/15 2223 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (PRN) PRN REASON: WHEEZE - for Wheezing
Start Date 04/17/15-1500 Stop Date 05/17/15 1459 DC: 05/08/15-1100
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01329849

History
04/17/15 1510 - POM ORDER by MREDING
04/17/15 1511 - VERIFIED by GZEIARATI
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 1108 - DISCONTINUE by CDOHLE Eff: 05/08/15 1100
EDIT DOCTOR: DOHLE,CAROLIN MD
06/08/15 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by CDOHLE Eff: 05/08/15 1108)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

LVF250T - LEVOFLOXACIN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 03/17/15-0900 Stop Date 03/23/15 0901 DC: 03/23/15-0901
Ordering Doctor DOHLE,CAROLIN MD
Clinical Indication DOCUMENTED INFECTION
Total Dispensed 7 Total Costs $0.00 Total Charges $417.41
Rx Number 01320388

Discontinued Comments Reached Stop Date

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1559 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 03/17/15 - 0900
For: 03/18/15 - 0900
For: 03/19/15 - 0900
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 03/20/15 - 0900
For: 03/21/15 - 0900
For: 03/22/15 - 0900
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 03/23/15 - 0900
03/23/15 0901 - DISCONTINUE by PHABKGJOB Eff: 03/23/15 0901
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 03/16/15-1530 Stop Date 04/15/15 1529 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01320390

Discontinued Comments DC'd by Discharge

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1559 - VERIFIED by MHAIMOWITZ
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 04/17/15-1500 Stop Date 05/17/15 1459 DC: 05/08/15-1100
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01329843

History
04/17/15 1501 - POM ORDER by MREDING
04/17/15 1507 - VERIFIED by GZEIARATI
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 1108 - DISCONTINUE by CDOHLE Eff: 05/08/15 1100
EDIT DOCTOR: DOHLE,CAROLIN MD
06/08/15 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by CDOHLE Eff: 05/08/15 1108)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 03/16/15-1530 Stop Date 04/15/15 1529 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01320391

Discontinued Comments DC'd by Discharge

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1559 - VERIFIED by MHAIMOWITZ
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 04/17/15-1500 Stop Date 05/17/15 1459 DC: 05/08/15-1100
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01329842

History
04/17/15 1500 - POM ORDER by MREDING
04/17/15 1507 - VERIFIED by GZEIARATI
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/08/15 1108 - DISCONTINUE by CDOHLE Eff: 05/08/15 1100
EDIT DOCTOR: DOHLE,CAROLIN MD
06/08/15 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by CDOHLE Eff: 05/08/15 1108)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MGS40T - MEGESTROL ACETATE 40 MG TAB

Dose 400 MG (10 TABLETS)

Dose Instructions as an appetite stimulant
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 04/18/15-0900 Stop Date 05/18/15 0859 DC: 04/20/15-1051
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 30 Total Costs $0.00 Total Charges $32.25
Rx Number 01329855

Discontinued Comments not needed.

History
04/17/15 1509 - POM ORDER by MREDING
04/17/15 1515 - VERIFIED by GZEIARATI
Items Dispensed: 40 Doses Dispensed: 4
For: 04/18/15 - 0900
For: 04/19/15 - 0900
For: 04/20/15 - 0900
For: 04/21/15 - 0900
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 20 Doses Dispensed: 2
For: 04/22/15 - 0900
For: 04/23/15 - 0900
04/20/15 1052 - DISCONTINUE by MREDING Eff: 04/20/15 1051
Items Auto Credited: 30 Doses Auto Credited: 3
For: 04/21/15 - 0900
For: 04/22/15 - 0900
For: 04/23/15 - 0900
EDIT DOCTOR: REDING,MICHAEL MD.
EDIT SOURCE: Written
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
not needed.
04/22/15 0736 - REVIEW PROVIDER ACTIVITY by JORPHAL
by MREDING Eff: 04/20/15 1052
not needed.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 03/16/15-2100 Stop Date 04/15/15 2059 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 16 Total Costs $0.00 Total Charges $40.77
Rx Number 01320392

Discontinued Comments DC'd by Discharge

History
03/16/15 1553 - POM ORDER by CDOHLE
03/16/15 1559 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 03/16/15 - 2100
For: 03/17/15 - 0900
For: 03/17/15 - 2100
For: 03/18/15 - 0900
For: 03/18/15 - 2100
For: 03/19/15 - 0900
For: 03/19/15 - 2100
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 03/20/15 - 0900
For: 03/20/15 - 2100
For: 03/21/15 - 0900
For: 03/21/15 - 2100
For: 03/22/15 - 0900
For: 03/22/15 - 2100
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 03/23/15 - 0900
For: 03/23/15 - 2100
For: 03/24/15 - 0900
For: 03/24/15 - 2100
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 03/25/15 - 0900
For: 03/25/15 - 2100
For: 03/26/15 - 0900
For: 03/26/15 - 2100
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
Items Auto Credited: 5 Doses Auto Credited: 5
For: 03/24/15 - 2100
For: 03/25/15 - 0900
For: 03/25/15 - 2100
For: 03/26/15 - 0900
For: 03/26/15 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 04/17/15-1700 Stop Date 05/17/15 1659 DC: 05/08/15-1212
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 42 Total Costs $0.00 Total Charges $149.49
Rx Number 01329848

Discontinued Comments DC'd by Discharge

History
04/17/15 1510 - POM ORDER by MREDING
04/17/15 1511 - VERIFIED by GZEIARATI
Items Dispensed: 9 Doses Dispensed: 9
For: 04/17/15 - 1700
For: 04/18/15 - 0900
For: 04/18/15 - 1700
For: 04/19/15 - 0900
For: 04/19/15 - 1700
For: 04/20/15 - 0900
For: 04/20/15 - 1700
For: 04/21/15 - 0900
For: 04/21/15 - 1700
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 04/22/15 - 0900
For: 04/22/15 - 1700
For: 04/23/15 - 0900
For: 04/23/15 - 1700
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 04/24/15 - 0900
For: 04/24/15 - 1700
For: 04/25/15 - 0900
For: 04/25/15 - 1700
For: 04/26/15 - 0900
For: 04/26/15 - 1700
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 04/27/15 - 0900
For: 04/27/15 - 1700
For: 04/28/15 - 0900
For: 04/28/15 - 1700
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 04/29/15 - 0900
For: 04/29/15 - 1700
For: 04/30/15 - 0900
For: 04/30/15 - 1700
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

For: 05/01/15 - 0900

For: 05/01/15 - 1700
For: 05/02/15 - 0900
For: 05/02/15 - 1700
For: 05/03/15 - 0900
For: 05/03/15 - 1700
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 05/04/15 - 0900
For: 05/04/15 - 1700
For: 05/05/15 - 0900
For: 05/05/15 - 1700
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 05/06/15 - 0900
For: 05/06/15 - 1700
For: 05/07/15 - 0900
For: 05/07/15 - 1700
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 6 Doses Dispensed: 6
For: 05/08/15 - 0900
For: 05/08/15 - 1700
For: 05/09/15 - 0900
For: 05/09/15 - 1700
For: 05/10/15 - 0900
For: 05/10/15 - 1700
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 05/11/15 - 0900
For: 05/11/15 - 1700
For: 05/12/15 - 0900
For: 05/12/15 - 1700
05/08/15 1213 - DISCONTINUE by DISCHARGE Eff: 05/08/15 1212
Items Auto Credited: 9 Doses Auto Credited: 9
For: 05/08/15 - 1700
For: 05/09/15 - 0900
For: 05/09/15 - 1700
For: 05/10/15 - 0900
For: 05/10/15 - 1700
For: 05/11/15 - 0900
For: 05/11/15 - 1700
For: 05/12/15 - 0900
For: 05/12/15 - 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MTR250T - METRONIDAZOLE 250 MG TAB

Dose 500 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 03/16/15-2200 Stop Date 03/23/15 2159 DC: 03/23/15-2159
Ordering Doctor DOHLE,CAROLIN MD
Clinical Indication DOCUMENTED INFECTION
Total Dispensed 42 Total Costs $0.00 Total Charges $8.80
Rx Number 01320393

Discontinued Comments Reached Stop Date

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1600 - VERIFIED by MHAIMOWITZ
Items Dispensed: 22 Doses Dispensed: 11
For: 03/16/15 - 2200
For: 03/17/15 - 0600
For: 03/17/15 - 1400
For: 03/17/15 - 2200
For: 03/18/15 - 0600
For: 03/18/15 - 1400
For: 03/18/15 - 2200
For: 03/19/15 - 0600
For: 03/19/15 - 1400
For: 03/19/15 - 2200
For: 03/20/15 - 0600
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 03/20/15 - 1400
For: 03/20/15 - 2200
For: 03/21/15 - 0600
For: 03/21/15 - 1400
For: 03/21/15 - 2200
For: 03/22/15 - 0600
For: 03/22/15 - 1400
For: 03/22/15 - 2200
For: 03/23/15 - 0600
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 03/23/15 - 1400
03/23/15 2159 - DISCONTINUE by PHABKGJOB Eff: 03/23/15 2159
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

MRTZ15T - MIRTAZAPINE 15 MG TAB

Dose 7.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 03/19/15-2100 Stop Date 04/18/15 2059 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $1.16
Rx Number 01321363

Discontinued Comments DC'd by Discharge

History
03/19/15 1725 - POM ORDER by CDOHLE
03/19/15 1739 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 03/19/15 - 2100
For: 03/20/15 - 2100
For: 03/21/15 - 2100
For: 03/22/15 - 2100
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 03/23/15 - 2100
For: 03/24/15 - 2100
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 03/25/15 - 2100
For: 03/26/15 - 2100
03/24/15 2223 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
Items Auto Credited: 3 Doses Auto Credited: 3
For: 03/24/15 - 2100
For: 03/25/15 - 2100
For: 03/26/15 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

OXB5T - OXYBUTYNIN CHLORIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 03/17/15-0900 Stop Date 04/16/15 0859 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 8 Total Costs $0.00 Total Charges $12.00
Rx Number 01320425

Discontinued Comments DC'd by Discharge

History
03/16/15 1553 - POM ORDER by CDOHLE
03/16/15 1613 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 03/17/15 - 0900
For: 03/18/15 - 0900
For: 03/19/15 - 0900
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 03/20/15 - 0900
For: 03/21/15 - 0900
For: 03/22/15 - 0900
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 03/23/15 - 0900
For: 03/24/15 - 0900
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
Items Auto Credited: 2 Doses Auto Credited: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

RIVA15TA2 - RIVAROXABAN 15 MG TABLET

Dose 15 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 03/16/15-1700 Stop Date 04/15/15 1659 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 17 Total Costs $0.00 Total Charges $417.33
Rx Number 01320394

Discontinued Comments DC'd by Discharge

History
03/16/15 1552 - POM ORDER by CDOHLE
03/16/15 1600 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 03/16/15 - 1700
For: 03/17/15 - 0900
For: 03/17/15 - 1700
For: 03/18/15 - 0900
For: 03/18/15 - 1700
For: 03/19/15 - 0900
For: 03/19/15 - 1700
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 03/20/15 - 0900
For: 03/20/15 - 1700
For: 03/21/15 - 0900
For: 03/21/15 - 1700
For: 03/22/15 - 0900
For: 03/22/15 - 1700
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 03/23/15 - 0900
For: 03/23/15 - 1700
For: 03/24/15 - 0900
For: 03/24/15 - 1700
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 03/25/15 - 0900
For: 03/25/15 - 1700
For: 03/26/15 - 0900
For: 03/26/15 - 1700
03/24/15 2222 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
Items Auto Credited: 4 Doses Auto Credited: 4
For: 03/25/15 - 0900
For: 03/25/15 - 1700
For: 03/26/15 - 0900
For: 03/26/15 - 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

ROSU10TA - ROSUVASTATIN CALCIUM 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 04/17/15-2100 Stop Date 05/17/15 2059 DC: 05/08/15-1212
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 21 Total Costs $0.00 Total Charges $343.00
Rx Number 01329845

Discontinued Comments DC'd by Discharge

History
04/17/15 1509 - POM ORDER by MREDING
04/17/15 1511 - VERIFIED by GZEIARATI
Items Dispensed: 5 Doses Dispensed: 5
For: 04/17/15 - 2100
For: 04/18/15 - 2100
For: 04/19/15 - 2100
For: 04/20/15 - 2100
For: 04/21/15 - 2100
04/20/15 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 04/22/15 - 2100
For: 04/23/15 - 2100
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 04/24/15 - 2100
For: 04/25/15 - 2100
For: 04/26/15 - 2100
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 04/27/15 - 2100
For: 04/28/15 - 2100
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 04/29/15 - 2100
For: 04/30/15 - 2100
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/01/15 - 2100
For: 05/02/15 - 2100
For: 05/03/15 - 2100
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/04/15 - 2100
For: 05/05/15 - 2100
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/06/15 - 2100
For: 05/07/15 - 2100
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 05/08/15 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

For: 05/09/15 - 2100

For: 05/10/15 - 2100
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/11/15 - 2100
For: 05/12/15 - 2100
05/08/15 1213 - DISCONTINUE by DISCHARGE Eff: 05/08/15 1212
Items Auto Credited: 5 Doses Auto Credited: 5
For: 05/08/15 - 2100
For: 05/09/15 - 2100
For: 05/10/15 - 2100
For: 05/11/15 - 2100
For: 05/12/15 - 2100
DC COMMENTS:
DC'd by Discharge

SMV20T - SIMVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059 DC: 08/24/17-2100
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539628

History
08/24/17 1404 - POM ORDER by RMINASSIAN
08/24/17 1429 - VERIFIED by SYSTEM
Verified in order to DC
08/24/17 1429 - DISCONTINUE by RMINASSIAN Eff: 08/24/17 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/24/17 1429 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01425799
08/24/17 1430 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by SYSTEM Eff: 08/24/17 1429
Discontinue by RMINASSIAN Eff: 08/24/17 1429
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 03/17/15-0900 Stop Date 04/16/15 0859 DC: 03/24/15-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 8 Total Costs $0.00 Total Charges $125.60
Rx Number 01320426

Discontinued Comments DC'd by Discharge

History
03/16/15 1553 - POM ORDER by CDOHLE
03/16/15 1613 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 03/17/15 - 0900
For: 03/18/15 - 0900
For: 03/19/15 - 0900
03/18/15 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 03/20/15 - 0900
For: 03/21/15 - 0900
For: 03/22/15 - 0900
03/20/15 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 03/23/15 - 0900
For: 03/24/15 - 0900
03/23/15 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
03/24/15 2223 - DISCONTINUE by DISCHARGE Eff: 03/24/15 1700
Items Auto Credited: 2 Doses Auto Credited: 2
For: 03/25/15 - 0900
For: 03/26/15 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions use as sleep aid and for post stroke depression.
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 04/20/15-2100 Stop Date 05/20/15 2059 DC: 05/08/15-1212
Ordering Doctor REDING,MICHAEL MD.
Total Dispensed 18 Total Costs $0.00 Total Charges $3.91
Rx Number 01330295

Discontinued Comments DC'd by Discharge

History
04/20/15 1021 - POM ORDER by MREDING
04/20/15 1030 - VERIFIED by JORPHAL
Items Dispensed: 4 Doses Dispensed: 4
For: 04/20/15 - 2100
For: 04/21/15 - 2100
For: 04/22/15 - 2100
For: 04/23/15 - 2100
04/22/15 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 04/24/15 - 2100
For: 04/25/15 - 2100
For: 04/26/15 - 2100
04/24/15 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 04/27/15 - 2100
For: 04/28/15 - 2100
04/27/15 0847 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 04/29/15 - 2100
For: 04/30/15 - 2100
04/29/15 0844 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 05/01/15 - 2100
For: 05/02/15 - 2100
For: 05/03/15 - 2100
05/01/15 0832 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/04/15 - 2100
For: 05/05/15 - 2100
05/04/15 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 05/06/15 - 2100
For: 05/07/15 - 2100
05/06/15 0826 - FILL by JORPHAL
Items Dispensed: 3 Doses Dispensed: 3
For: 05/08/15 - 2100
For: 05/09/15 - 2100
For: 05/10/15 - 2100
05/08/15 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

COLLINS,JAMES R W00001219465 (Continued)

For: 05/11/15 - 2100

For: 05/12/15 - 2100
05/08/15 1213 - DISCONTINUE by DISCHARGE Eff: 05/08/15 1212
Items Auto Credited: 5 Doses Auto Credited: 5
For: 05/08/15 - 2100
For: 05/09/15 - 2100
For: 05/10/15 - 2100
For: 05/11/15 - 2100
For: 05/12/15 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient COMSTOCK,GRAYDON E Responsible Doctor VALLES,JENNIE MD

Account Number W00001219544 Location B1NN Unit Number M000209421
Age/Sex 75/M Room 132 Registered Date 08/31/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 5.98 in 167.6 cm Body Surface Area 1.86 m2

Weight 167 lb 9.6 oz 76.022 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/31/17-1545 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

INSU100V13 - INSULIN ASPART (NOVOLOG) 100 UNIT/ML VIAL

Dose 6 UNIT (0.06 ML)

Admin Route SUBCUTAN.
Frequency AFTER MEALS (SCH)
Start Date 08/31/17-1800 Stop Date 09/30/17 1759
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $134.43
Rx Number 01541655

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1519 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 35 UNIT (0.35 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/30/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $322.41
Rx Number 01541656

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1519 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 2100

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541778

History
08/31/17 1638 - POM ORDER by SMOHAMED
08/31/17 1643 - VERIFIED by AADEGBAMIG
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $0.09
Rx Number 01541657

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1519 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

ATEN25TA4 - ATENOLOL 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $37.50
Rx Number 01541669

History
08/31/17 1523 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/30/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $2.25
Rx Number 01541665

History
08/31/17 1521 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541779

History
08/31/17 1638 - POM ORDER by SMOHAMED
08/31/17 1643 - VERIFIED by AADEGBAMIG
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $255.69
Rx Number 01541784

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.53
MG/KG/DAY is below the Low Daily Dose.

History
08/31/17 1638 - POM ORDER by SMOHAMED
08/31/17 1643 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $0.60
Rx Number 01541664

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1520 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

GLIP10TA - GLIPIZIDE XL 10 MG TABCR

Dose 10 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $8.58
Rx Number 01541671

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1524 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541781

History
08/31/17 1638 - POM ORDER by SMOHAMED
08/31/17 1643 - VERIFIED by AADEGBAMIG
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541780

History
08/31/17 1638 - POM ORDER by SMOHAMED
08/31/17 1643 - VERIFIED by AADEGBAMIG
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $5.28
Rx Number 01541658

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1519 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/30/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 12 Total Costs $0.00 Total Charges $58.35
Rx Number 01541659

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1519 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

SAXA5TAB6 - SAXAGLIPTIN HCL 5 MG TABLET

Dose 5 MG (1 TABLET)
Dose Instructions ON ORDER FOR 9/1/17-MD AWARE
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $64.20
Rx Number 01541682

History
08/31/17 1528 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1528 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
LABEL COMMENTS:
DO NOT SPLIT OR CUT TABLET
****TIME-CRITICAL SCHEDULED MEDICATION****
TO:
DOSE INSTRUCTIONS:
ON ORDER FOR 9/1/17-MD AWARE
LABEL COMMENTS:
DO NOT SPLIT OR CUT TABLET
****TIME-CRITICAL SCHEDULED MEDICATION****
ON ORDER FOR 9/1/17-MD AWARE
08/31/17 1528 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01541660
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: constipation
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01541782

History
08/31/17 1638 - POM ORDER by SMOHAMED
08/31/17 1643 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 1
For: 08/31/17 - 1645
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/30/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $51.75
Rx Number 01541661

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1519 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

TROS20TA - TROSPIUM CHLORIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $52.98
Rx Number 01541662

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1519 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 2.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/07/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.84
Rx Number 01541663

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1519 - VERIFIED by AADEGBAMIG
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

VENL150C2 - VENLAFAXINE HCL 150 MG CAPCR - 150 MG

VNL375CCR - VENLAFAXINE HCL 37.5 MG CAPCR - 37.5 MG

Dose 187.5 MG (2 CAPSULE CONTROLLED-RELEASES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $191.19
Rx Number 01541667

History
08/31/17 1522 - ENTER by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/30/17 2059 DC: 08/31/17-2100
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541666

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1521 - DISCONTINUE by AADEGBAMIG Eff: 08/31/17 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/31/17 1521 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions atenolol 25mg

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859 DC: 09/01/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541670

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1523 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1523 - DISCONTINUE by AADEGBAMIG Eff: 09/01/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

SAXA5TAB6 - SAXAGLIPTIN HCL 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859 DC: 09/01/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541660

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1519 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1528 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01541682
08/31/17 1528 - DISCONTINUE by AADEGBAMIG Eff: 09/01/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

COMSTOCK,GRAYDON E W00001219544 (Continued)

SAXA5TAB6 - SAXAGLIPTIN HCL 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 09/01/17-1245 Stop Date 09/01/17 1246 DC: 09/01/17-1246
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01541906

Discontinued Comments Reached Stop Date

History
09/01/17 1241 - ENTER by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1245
09/01/17 1246 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 1246
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

VENL150C2 - VENLAFAXINE HCL 150 MG CAPCR

Dose 187.5 MG (1.25 CAPSULE CONTROLLED-RELEASES)

Dose Instructions ONCE A DAY DOSING
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859 DC: 09/01/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541668

History
08/31/17 1514 - POM ORDER by SMOHAMED
08/31/17 1522 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1522 - DISCONTINUE by AADEGBAMIG Eff: 09/01/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CROUSSET,RAPHAEL Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219483 Location B2WEII Unit Number M000208533
Age/Sex 30/M Room 255 Registered Date 08/24/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 10 in 177.8 cm Body Surface Area 2.25 m2

Weight 239 lb oz 108.409 kg
Hem-Onc No

Drug Allergies caffeine (From Fioricet), butalbital (From Fioricet),

acetaminophen (From Fioricet)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: ARNOLD CHIARI MALFORMATION ANOXIC BRAIN INJURY
Secondary Diagnosis:

CHL12B473 - CHLORHEXIDINE GLUCONATE 0.12% ORAL SOLN 473 ML BTL

Dose 15 ML (0.0317125 BOTTLES)

Admin Route MTH/THROAT
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $39.57
Rx Number 01539737

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1635 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 0900

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/24/17-1700 Stop Date 09/23/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $28.41
Rx Number 01539741

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1635 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1500 Stop Date 09/23/17 1459
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539649

History
08/24/17 1449 - POM ORDER by SDAS
08/24/17 1509 - VERIFIED by AMACCA
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/24/17-1700 Stop Date 09/23/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $7.25
Rx Number 01539645

History
08/24/17 1449 - POM ORDER by SDAS
08/24/17 1509 - VERIFIED by AMACCA
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $852.30
Rx Number 01539744

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.37
MG/KG/DAY is below the Low Daily Dose.

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1636 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

LEVE500T - LEVETIRACETAM 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 50 Total Costs $0.00 Total Charges $764.00
Rx Number 01539738

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1635 - VERIFIED by AMACCA
Items Dispensed: 14 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/24/17-1500 Stop Date 09/23/17 1459
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539648

History
08/24/17 1449 - POM ORDER by SDAS
08/24/17 1509 - VERIFIED by AMACCA
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1500 Stop Date 09/23/17 1459
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539647

History
08/24/17 1449 - POM ORDER by SDAS
08/24/17 1509 - VERIFIED by AMACCA
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MTP100TCR - METOPROLOL SUCCINATE XL 100 MG TABCR

Dose 100 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $22.64
Rx Number 01539739

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1635 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01539740

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1635 - VERIFIED by AMACCA
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 25 Total Costs $0.00 Total Charges $194.60
Rx Number 01539742

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1635 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

RNT150T - RANITIDINE HCL 150 MG TAB

Dose 150 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $2.10
Rx Number 01541566

History
08/31/17 1203 - ENTER by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $0.50
Rx Number 01539743

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1636 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

BACI3.5O - BACITRACIN OPHTH. OINT. 3.5 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions Apply daily to the drain site
Admin Route XX
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 08/19/17 0859 DC: 08/12/17-0900
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536056

Discontinued Comments SPOKE TO MD- NOT OPTH OINT

History
08/11/17 1315 - POM ORDER by YOLEE
08/11/17 1319 - DISCONTINUE by AMOLINARI Eff: 08/12/17 0900
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
SPOKE TO MD- NOT OPTH OINT
08/11/17 1319 - VERIFIED by SYSTEM
Verified in order to DC

CHL12B473 - CHLORHEXIDINE GLUCONATE 0.12% ORAL SOLN 473 ML BTL

Dose 15 ML (0.0317125 BOTTLES)

Admin Route MTH/THROAT
Frequency DAILY@1800 (SCH)
Start Date 07/20/17-1800 Stop Date 08/19/17 1759 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $39.57
Rx Number 01530200

Discontinued Comments DC'd by Discharge

History
07/20/17 1519 - POM ORDER by EALEXEEV
07/20/17 1525 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/20/17 - 1800
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

CHL12B473 - CHLORHEXIDINE GLUCONATE 0.12% ORAL SOLN 473 ML BTL

Dose 15 ML (0.0317125 BOTTLES)

Admin Route MTH/THROAT
Frequency DAILY (SCH)
Start Date 08/06/17-0900 Stop Date 09/05/17 0859 DC: 08/18/17-1500
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $39.57
Rx Number 01534618

Discontinued Comments DC'd by Discharge

History
08/05/17 1444 - POM ORDER by HAZIZI
08/05/17 1456 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/06/17 - 0900
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

LEVE100S4 - LEVETIRACETAM 100MG/ML 473 ML ML

Dose 10 ML (10 MLS)

Admin Route PEG TUBE
Frequency 2 TIMES A DAY (SCH)
Start Date 07/20/17-1700 Stop Date 08/19/17 1659 DC: 07/20/17-1700
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01530202

History
07/20/17 1519 - POM ORDER by EALEXEEV
07/20/17 1526 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
BULK: Y
DISPENSE: 1
CHARGE: $2085.93
TO:
ROUTE: PEG TUBE
BULK: N
DISPENSE: 60
CHARGE: $44.10
07/20/17 1526 - VERIFIED by AMOLINARI
Items Dispensed: 60 Doses Dispensed: 6
For: 07/20/17 - 1700
07/20/17 1527 - DISCONTINUE by EALEXEEV Eff: 07/20/17 1700
EDIT DOCTOR: Alexeev,Edward MD PGY-4
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01416730
07/20/17 1528 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 07/20/17 1527
07/20/17 1627 - CREDIT by MHAIMOWITZ
ITEMS: 60 DOSES: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

LEVE100S4 - LEVETIRACETAM 100MG/ML 473 ML ML

Dose 10 ML (10 MLS)

Admin Route PEG TUBE
Frequency 2 TIMES A DAY (SCH)
Start Date 07/20/17-1700 Stop Date 08/19/17 1659 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 120 Total Costs $0.00 Total Charges $529.20
Rx Number 01530208

Discontinued Comments DC'd by Discharge

History
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01530202
07/20/17 1528 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
BULK: Y
DISPENSE: 1
CHARGE: $2085.93
TO:
BULK: N
DISPENSE: 0
CHARGE: $44.10
07/20/17 1528 - VERIFIED by AMOLINARI
07/20/17 1543 - DEBIT by MHAIMOWITZ
ITEMS: 60 DOSES: 6
07/21/17 1710 - DEBIT by MHAIMOWITZ
ITEMS: 60 DOSES: 6
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 07/20/17-2100 Stop Date 08/19/17 2059 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $28.41
Rx Number 01530205

Discontinued Comments DC'd by Discharge

History
07/20/17 1519 - POM ORDER by EALEXEEV
07/20/17 1527 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/20/17 - 2100
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

NYST15CR2 - NYSTATIN CR 15 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/05/17-1700 Stop Date 09/04/17 1659 DC: 08/18/17-1500
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $52.65
Rx Number 01534619

Discontinued Comments DC'd by Discharge

History
08/05/17 1444 - POM ORDER by HAZIZI
08/05/17 1458 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/05/17 - 1700
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

SNN218240 - SENNA SYRUP 176MG/5 ML 237 ML ML

Dose 5 ML (5 MLS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/20/17-2100 Stop Date 08/19/17 2059 DC: 07/20/17-2100
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530206

History
07/20/17 1519 - POM ORDER by EALEXEEV
07/20/17 1527 - DISCONTINUE by EALEXEEV Eff: 07/20/17 2100
EDIT DOCTOR: Alexeev,Edward MD PGY-4
07/20/17 1527 - VERIFIED by SYSTEM
Verified in order to DC
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01416733
07/20/17 1528 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 07/20/17 1527
Discontinue by EALEXEEV Eff: 07/20/17 1527

SNN218240 - SENNA SYRUP 176MG/5 ML 237 ML ML

Dose 5 ML (5 MLS)
Admin Route PEG TUBE
Frequency NIGHTLY (SCH)
Start Date 07/20/17-2100 Stop Date 08/19/17 2059 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 237 Total Costs $0.00 Total Charges $56.88
Rx Number 01530211

Discontinued Comments DC'd by Discharge

History
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01530206
07/20/17 1528 - VERIFIED by AMOLINARI
Items Dispensed: 237 Doses Dispensed: 1
For: 07/20/17 - 2100
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/05/17-1315 Stop Date 09/04/17 1314 DC: 08/18/17-1500
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $2.75
Rx Number 01534574

Discontinued Comments DC'd by Discharge

History
08/05/17 1310 - POM ORDER by HAZIZI
08/05/17 1332 - VERIFIED by MHAIMOWITZ
08/05/17 1630 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Conflict with New Allergy by PHABKGJOB Eff: 08/05/17 1608
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/24/17-1500 Stop Date 09/23/17 1459 DC: 08/25/17-1149
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539646

History
08/24/17 1449 - POM ORDER by SDAS
08/24/17 1509 - VERIFIED by AMACCA
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 1149 - DISCONTINUE by SDAS Eff: 08/25/17 1149
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/27/17 1529 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 08/25/17 1149

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Admin Route PEG TUBE
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 07/20/17-1515 Stop Date 08/19/17 1514 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01530176

Discontinued Comments DC'd by Discharge

History
07/20/17 1501 - ENTER by AMOLINARI
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

AGM500T - AMOXICILLIN 500MG/CLAVULANATE K 125MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/05/17-2200 Stop Date 08/08/17 2159 DC: 08/08/17-2159
Ordering Doctor AZIZI,HANA MD
Clinical Indication OTHER
Total Dispensed 9 Total Costs $0.00 Total Charges $30.42
Rx Number 01534623

Discontinued Comments Reached Stop Date

History
08/05/17 1508 - POM ORDER by HAZIZI
08/05/17 1521 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
08/08/17 2200 - DISCONTINUE by PHABKGJOB Eff: 08/08/17 2159
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

ART15OP - ARTIFICIAL TEARS OP SOLN 15 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Admin Route OPHTHALMIC
Frequency 3 TIMES A DAY (SCH)
Start Date 07/20/17-1700 Stop Date 08/19/17 1659 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $5.94
Rx Number 01530223

Discontinued Comments DC'd by Discharge

History
07/20/17 1540 - ENTER by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/20/17 - 1700
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/20/17-1445 Stop Date 08/19/17 1444 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530171

Discontinued Comments DC'd by Discharge

History
07/20/17 1448 - POM ORDER by EALEXEEV
07/20/17 1459 - VERIFIED by AMOLINARI
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/05/17-1315 Stop Date 09/04/17 1314 DC: 08/14/17-1712
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534575

History
08/05/17 1310 - POM ORDER by HAZIZI
08/05/17 1334 - VERIFIED by MHAIMOWITZ
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 1713 - DISCONTINUE by JRUSSO Eff: 08/14/17 1712
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/16/17 0950 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by JRUSSO Eff: 08/14/17 1713
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route PEG TUBE
Frequency 3 TIMES A DAY (SCH)
Start Date 07/20/17-1700 Stop Date 08/19/17 1659 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01530174

Discontinued Comments DC'd by Discharge

History
07/20/17 1448 - POM ORDER by EALEXEEV
07/20/17 1500 - VERIFIED by AMOLINARI
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 0900
For: 07/24/17 - 1300
For: 07/24/17 - 1700
For: 07/25/17 - 0900
For: 07/25/17 - 1300
For: 07/25/17 - 1700
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 0900
For: 07/26/17 - 1300
For: 07/26/17 - 1700
For: 07/27/17 - 0900
For: 07/27/17 - 1300
For: 07/27/17 - 1700
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/05/17-1700 Stop Date 09/04/17 1659 DC: 08/18/17-1500
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $8.75
Rx Number 01534576

Discontinued Comments DC'd by Discharge

History
08/05/17 1310 - POM ORDER by HAZIZI
08/05/17 1334 - VERIFIED by MHAIMOWITZ
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 0900
For: 08/11/17 - 1300
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 0900
For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 0900
For: 08/18/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

For: 08/18/17 - 1700

For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/08/17-0900 Stop Date 09/07/17 0859 DC: 08/17/17-0942
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $767.07
Rx Number 01534875

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.38
MG/KG/DAY is below the Low Daily Dose.

History
08/07/17 1315 - POM ORDER by JRUSSO
08/07/17 1323 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/08/17 - 0900
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/17/17 0943 - DISCONTINUE by JRUSSO Eff: 08/17/17 0942
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/17/17 1148 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/17/17 0943
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

ESOM40SU - ESOMEPRAZOLE MAG TRIHYDRATE 40 MG PKT

Dose 40 MG (1 PACKET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 07/21/17-0900 Stop Date 08/20/17 0859 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $90.32
Rx Number 01530238

Discontinued Comments DC'd by Discharge

History
07/20/17 1637 - ENTER by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
Items Auto Credited: 3 Doses Auto Credited: 3
For: 07/25/17 - 0900
For: 07/26/17 - 0900
For: 07/27/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/05/17-1700 Stop Date 09/04/17 1659 DC: 08/17/17-0942
Ordering Doctor AZIZI,HANA MD
Total Dispensed 24 Total Costs $0.00 Total Charges $8.05
Rx Number 01534610

History
08/05/17 1429 - POM ORDER by HAZIZI
08/05/17 1435 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

For: 08/20/17 - 0900

For: 08/20/17 - 1700
08/17/17 0943 - DISCONTINUE by JRUSSO Eff: 08/17/17 0942
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/17/17 - 1700
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/17/17 1148 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/17/17 0943

GUAI100S17 - GUAIFENESIN 100 MG/5 ML UDC

Dose 100 MG (5 ML)

Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: COUGH - FOR COUGH
Start Date 07/20/17-1500 Stop Date 08/19/17 1459 DC: 07/20/17-1523
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530201

History
07/20/17 1519 - POM ORDER by EALEXEEV
07/20/17 1525 - VERIFIED by AMOLINARI
07/20/17 1527 - DISCONTINUE by EALEXEEV Eff: 07/20/17 1523
EDIT DOCTOR: Alexeev,Edward MD PGY-4
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01416729
07/20/17 1528 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 07/20/17 1527
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

GUAI100S17 - GUAIFENESIN 100 MG/5 ML UDC

Dose 100 MG (5 ML)

Dose Instructions Via PEG
Admin Route XX
Frequency 4 TIMES A DAY (PRN) PRN REASON: COUGH - FOR COUGH
Start Date 07/20/17-1530 Stop Date 08/19/17 1529 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530207

Discontinued Comments DC'd by Discharge

History
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01530201
07/20/17 1527 - VERIFIED by AMOLINARI
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 07/20/17-2200 Stop Date 08/19/17 2159 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 12 Total Costs $0.00 Total Charges $111.36
Rx Number 01530235

Discontinued Comments DC'd by Discharge

History
07/20/17 1622 - POM ORDER by EALEXEEV
07/20/17 1625 - VERIFIED by MHAIMOWITZ
Items Dispensed: 11 Doses Dispensed: 11
For: 07/20/17 - 2200
For: 07/21/17 - 0600
For: 07/21/17 - 1400
For: 07/21/17 - 2200
For: 07/22/17 - 0600
For: 07/22/17 - 1400
For: 07/22/17 - 2200
For: 07/23/17 - 0600
For: 07/23/17 - 1400
For: 07/23/17 - 2200
For: 07/24/17 - 0600
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 1400
For: 07/24/17 - 2200
For: 07/25/17 - 0600
For: 07/25/17 - 1400
For: 07/25/17 - 2200
For: 07/26/17 - 0600
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 1400
For: 07/26/17 - 2200
For: 07/27/17 - 0600
For: 07/27/17 - 1400
For: 07/27/17 - 2200
For: 07/28/17 - 0600
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
Items Auto Credited: 11 Doses Auto Credited: 11
For: 07/24/17 - 2200
For: 07/25/17 - 0600
For: 07/25/17 - 1400
For: 07/25/17 - 2200
For: 07/26/17 - 0600
For: 07/26/17 - 1400
For: 07/26/17 - 2200
For: 07/27/17 - 0600
For: 07/27/17 - 1400
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

For: 07/27/17 - 2200

For: 07/28/17 - 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

LEVE500T - LEVETIRACETAM 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/05/17-1700 Stop Date 09/04/17 1659 DC: 08/18/17-1500
Ordering Doctor AZIZI,HANA MD
Total Dispensed 52 Total Costs $0.00 Total Charges $955.00
Rx Number 01534620

Discontinued Comments DC'd by Discharge

History
08/05/17 1449 - POM ORDER by HAZIZI
08/05/17 1458 - VERIFIED by MHAIMOWITZ
Items Dispensed: 14 Doses Dispensed: 7
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

For: 08/19/17 - 1700

For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
Items Auto Credited: 18 Doses Auto Credited: 9
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

LD2V50 - LIDOCAINE HCL 2% LOCAL INJ 20 MG/ML ML

Dose 20 MG (1 ML)
Admin Route INTRAARTIC
Frequency NOW (STA)
Start Date 08/14/17-1043 Stop Date 08/14/17 1044 DC: 08/14/17-1044
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.30
Rx Number 01536469

Discontinued Comments Reached Stop Date

History
08/14/17 1044 - POM ORDER by JRUSSO
08/14/17 1044 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/14/17 - 1043
08/14/17 1045 - DISCONTINUE by PHABKGJOB Eff: 08/14/17 1044
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

LD2V50 - LIDOCAINE HCL 2% LOCAL INJ 20 MG/ML ML

Dose 20 MG (1 ML)
Admin Route INTRAARTIC
Frequency NOW (ONE)
Start Date 08/29/17-1045 Stop Date 08/29/17 1046 DC: 08/29/17-1046
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.30
Rx Number 01540926

Discontinued Comments Reached Stop Date

History
08/29/17 1047 - POM ORDER by JRUSSO
08/29/17 1049 - EDIT by AADEGBAMIG
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
SCHEDULE: SCH
START: 08/29/17-1045 STOP: 09/28/17 1044 SOFT STOP: 0
DISPENSE: 0
TO:
SCHEDULE: ONE
START: 08/29/17-1045 STOP: 08/29/17-1046 SOFT STOP:
DISPENSE: 1
08/29/17 1054 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1045
08/29/17 1054 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 1046
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

LRZ1T - LORAZEPAM 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: agitation
Start Date 08/24/17-1600 Stop Date 08/31/17 1559 DC: 08/28/17-0932
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539745

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1636 - VERIFIED by AMACCA
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0932 - DISCONTINUE by JRUSSO Eff: 08/28/17 0932
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/28/17 0932 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01426724
08/28/17 1056 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by JRUSSO Eff: 08/28/17 0932

LRZ1T - LORAZEPAM 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: agitation
Start Date 08/28/17-0945 Stop Date 09/04/17 DC: 08/31/17-1215
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540575

Activity Needing Review

RS - Discontinue by JRUSSO Eff: 08/31/17 1217

History
08/28/17 0932 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01539745
08/28/17 1057 - VERIFIED by JDIMARCO
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/31/17 1217 - DISCONTINUE by JRUSSO Eff: 08/31/17 1215
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route PEG TUBE
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 07/20/17-1445 Stop Date 08/19/17 1444 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530173

Discontinued Comments DC'd by Discharge

History
07/20/17 1448 - POM ORDER by EALEXEEV
07/20/17 1500 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
07/20/17 1500 - VERIFIED by AMOLINARI
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/05/17-1315 Stop Date 09/04/17 1314 DC: 08/18/17-1500
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534577

Discontinued Comments DC'd by Discharge

History
08/05/17 1310 - POM ORDER by HAZIZI
08/05/17 1334 - VERIFIED by MHAIMOWITZ
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route PEG TUBE
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/20/17-1445 Stop Date 08/19/17 1444 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530172

Discontinued Comments DC'd by Discharge

History
07/20/17 1447 - POM ORDER by EALEXEEV
07/20/17 1500 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
07/20/17 1500 - VERIFIED by AMOLINARI
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/05/17-1315 Stop Date 09/04/17 1314 DC: 08/18/17-1500
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534578

Discontinued Comments DC'd by Discharge

History
08/05/17 1310 - POM ORDER by HAZIZI
08/05/17 1335 - VERIFIED by MHAIMOWITZ
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route PEG TUBE
Frequency NIGHTLY (SCH)
Start Date 07/20/17-2100 Stop Date 08/19/17 2059 DC: 07/20/17-2100
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530203

History
07/20/17 1519 - POM ORDER by EALEXEEV
07/20/17 1526 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
07/20/17 1526 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/20/17 - 2100
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
07/20/17 1527 - DISCONTINUE by EALEXEEV Eff: 07/20/17 2100
Items Auto Credited: 4 Doses Auto Credited: 4
For: 07/20/17 - 2100
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
EDIT DOCTOR: Alexeev,Edward MD PGY-4
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01416731
07/20/17 1528 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 07/20/17 1527
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route PEG TUBE
Frequency NIGHTLY (SCH)
Start Date 07/20/17-2100 Stop Date 08/19/17 2059 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $0.80
Rx Number 01530209

Discontinued Comments DC'd by Discharge

History
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01530203
07/20/17 1528 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/20/17 - 2100
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 2100
For: 07/27/17 - 2100
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
Items Auto Credited: 4 Doses Auto Credited: 4
For: 07/24/17 - 2100
For: 07/25/17 - 2100
For: 07/26/17 - 2100
For: 07/27/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MTP100TCR - METOPROLOL SUCCINATE XL 100 MG TABCR

Dose 100 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859 DC: 08/18/17-1500
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $2.83
Rx Number 01537561

Discontinued Comments DC'd by Discharge

History
08/17/17 1135 - POM ORDER by JRUSSO
08/17/17 1148 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route PEG TUBE
Frequency 3 TIMES A DAY (SCH)
Start Date 07/20/17-1700 Stop Date 08/19/17 1659 DC: 07/20/17-1700
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530204

History
07/20/17 1519 - POM ORDER by EALEXEEV
07/20/17 1526 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
07/20/17 1526 - VERIFIED by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 10
For: 07/20/17 - 1700
For: 07/21/17 - 0900
For: 07/21/17 - 1300
For: 07/21/17 - 1700
For: 07/22/17 - 0900
For: 07/22/17 - 1300
For: 07/22/17 - 1700
For: 07/23/17 - 0900
For: 07/23/17 - 1300
For: 07/23/17 - 1700
07/20/17 1527 - DISCONTINUE by EALEXEEV Eff: 07/20/17 1700
Items Auto Credited: 10 Doses Auto Credited: 10
For: 07/20/17 - 1700
For: 07/21/17 - 0900
For: 07/21/17 - 1300
For: 07/21/17 - 1700
For: 07/22/17 - 0900
For: 07/22/17 - 1300
For: 07/22/17 - 1700
For: 07/23/17 - 0900
For: 07/23/17 - 1300
For: 07/23/17 - 1700
EDIT DOCTOR: Alexeev,Edward MD PGY-4
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01416732
07/20/17 1528 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 07/20/17 1527
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route PEG TUBE
Frequency 3 TIMES A DAY (SCH)
Start Date 07/20/17-1700 Stop Date 08/19/17 1659 DC: 07/24/17-1433
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 12 Total Costs $0.00 Total Charges $2.50
Rx Number 01530210

Discontinued Comments DC'd by Discharge

History
07/20/17 1527 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01530204
07/20/17 1528 - VERIFIED by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 10
For: 07/20/17 - 1700
For: 07/21/17 - 0900
For: 07/21/17 - 1300
For: 07/21/17 - 1700
For: 07/22/17 - 0900
For: 07/22/17 - 1300
For: 07/22/17 - 1700
For: 07/23/17 - 0900
For: 07/23/17 - 1300
For: 07/23/17 - 1700
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 0900
For: 07/24/17 - 1300
For: 07/24/17 - 1700
For: 07/25/17 - 0900
For: 07/25/17 - 1300
For: 07/25/17 - 1700
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 0900
For: 07/26/17 - 1300
For: 07/26/17 - 1700
For: 07/27/17 - 0900
For: 07/27/17 - 1300
For: 07/27/17 - 1700
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
Items Auto Credited: 10 Doses Auto Credited: 10
For: 07/24/17 - 1700
For: 07/25/17 - 0900
For: 07/25/17 - 1300
For: 07/25/17 - 1700
For: 07/26/17 - 0900
For: 07/26/17 - 1300
For: 07/26/17 - 1700
For: 07/27/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

For: 07/27/17 - 1300

For: 07/27/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/05/17-1700 Stop Date 08/17/17 2359 DC: 08/17/17-2359
Ordering Doctor AZIZI,HANA MD
Total Dispensed 31 Total Costs $0.00 Total Charges $5.50
Rx Number 01534611

Discontinued Comments Reached Stop Date

History
08/05/17 1429 - POM ORDER by HAZIZI
08/05/17 1436 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

For: 08/19/17 - 0900

For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/17/17 1135 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 08/05/17-1700 STOP: 09/04/17 1659 SOFT STOP: 0
DISPENSE: 6
TO:
START: 08/05/17-1700 STOP: 08/17/17-2359 SOFT STOP:
DISPENSE: 25
08/17/17 1148 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by JRUSSO Eff: 08/17/17 1135
08/18/17 0000 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 2359
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

MULT-481 - MULTIVITAMINS W-MINERALS (ICAPS PLUS) TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/08/17-0900 Stop Date 09/07/17 0859 DC: 08/18/17-1500
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $4.80
Rx Number 01534772

Discontinued Comments DC'd by Discharge

History
08/07/17 1038 - POM ORDER by JRUSSO
08/07/17 1046 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/08/17 - 0900
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (0 EACHS)
Dose Instructions Ocular Lubricant opthalmic solution 1 drop each eye tid
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/20/17-1700 Stop Date 08/19/17 1659 DC: 07/20/17-1700
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530222

History
07/20/17 1529 - POM ORDER by EALEXEEV
07/20/17 1540 - DISCONTINUE by AMACCA Eff: 07/20/17 1700
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/20/17 1540 - VERIFIED by SYSTEM
Verified in order to DC

NF-MED - NON FORMULARY MEDICATION

Dose 150 EA (0 EACHS)

Dose Instructions Zantac
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659 DC: 08/31/17-1700
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541565

History
08/31/17 1201 - POM ORDER by JRUSSO
08/31/17 1202 - DISCONTINUE by AMACCA Eff: 08/31/17 1700
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/31/17 1202 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Dose Instructions PRN NAUSEA
Admin Route PEG TUBE
Frequency 3 TIMES A DAY (PRN) PRN REASON: For Nausea/vomiting
Start Date 07/22/17-1115 Stop Date 08/21/17 1114 DC: 07/24/17-1433
Ordering Doctor AZIZI,HANA MD
Total Dispensed 5 Total Costs $0.00 Total Charges $1.10
Rx Number 01530619

Discontinued Comments DC'd by Discharge

History
07/22/17 1110 - POM ORDER by HAZIZI
07/22/17 1111 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 07/22/17 - 1115
07/24/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 2351 - DISCONTINUE by DISCHARGE Eff: 07/24/17 1433
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Dose Instructions PRN NAUSEA
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/17/17-1530 Stop Date 09/16/17 1529 DC: 08/17/17-1646
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $1.10
Rx Number 01537663

History
08/17/17 1522 - POM ORDER by JRUSSO
08/17/17 1523 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/17/17 - 1530
08/17/17 1646 - DISCONTINUE by JRUSSO Eff: 08/17/17 1646
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/17/17 1652 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by JRUSSO Eff: 08/17/17 1646
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: FOR MODERATE to severe PAIN
Start Date 08/05/17-1515 Stop Date 08/12/17 1514 DC: 08/07/17-1312
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534622

History
08/05/17 1515 - POM ORDER by HAZIZI
08/05/17 1521 - VERIFIED by MHAIMOWITZ
08/05/17 1630 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Conflict with New Allergy by PHABKGJOB Eff: 08/05/17 1608
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 1312 - DISCONTINUE by JRUSSO Eff: 08/07/17 1312
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/07/17 1322 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 08/07/17 1312
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/05/17-1700 Stop Date 08/17/17 1634 DC: 08/17/17-1634
Ordering Doctor AZIZI,HANA MD
Total Dispensed 31 Total Costs $0.00 Total Charges $233.52
Rx Number 01534612

History
08/05/17 1429 - POM ORDER by HAZIZI
08/05/17 1436 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

For: 08/20/17 - 0900

For: 08/20/17 - 1700
08/17/17 1636 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 08/05/17-1700 STOP: 09/04/17 1659 SOFT STOP: 0
DISPENSE: 6
TO:
START: 08/05/17-1700 STOP: 08/17/17-1634 SOFT STOP:
DISPENSE: 24
08/17/17 1636 - DISCONTINUE by JRUSSO Eff: 08/17/17 1634
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/17/17 1636 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01423957
08/17/17 1652 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by JRUSSO Eff: 08/17/17 1636
Discontinue by JRUSSO Eff: 08/17/17 1636
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/17/17-1700 Stop Date 09/16/17 1659 DC: 08/18/17-1500
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $9.73
Rx Number 01537703

Discontinued Comments DC'd by Discharge

History
08/17/17 1646 - POM ORDER by JRUSSO
08/17/17 1651 - REVIEW PROVIDER ACTIVITY by EBALILO
Administration of Unverified Order by JJOSE Eff: 08/17/17 1649
08/17/17 1651 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 08/17/17 - 1700
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: Agitation
Start Date 08/24/17-1600 Stop Date 09/23/17 1559 DC: 08/28/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01539746

History
08/24/17 1558 - POM ORDER by SDAS
08/24/17 1636 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/24/17 - 1600
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 1313 - DISCONTINUE by JRUSSO Eff: 08/28/17 1305
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/30/17 1106 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by JRUSSO Eff: 08/28/17 1313
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/06/17-0900 Stop Date 09/05/17 0859 DC: 08/18/17-1500
Ordering Doctor AZIZI,HANA MD
Total Dispensed 13 Total Costs $0.00 Total Charges $0.60
Rx Number 01534613

Discontinued Comments DC'd by Discharge

History
08/05/17 1429 - POM ORDER by HAZIZI
08/05/17 1436 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0824 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/18/17 1829 - DISCONTINUE by DISCHARGE Eff: 08/18/17 1500
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
FROM:
DC COMMENTS:
TO:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

DC COMMENTS:
DC'd by Discharge

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions Give via PEG tube
Admin Route XX
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 07/20/17-1445 Stop Date 08/19/17 1444 CAN: 07/20/17-1501
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01416689

History
07/20/17 1447 - POM ORDER by EALEXEEV
07/20/17 1501 - CANCEL by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO LIQUID

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/20/17-1700 Stop Date 08/19/17 1659 CAN: 07/20/17-1500
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01416688

History
07/20/17 1447 - POM ORDER by EALEXEEV
07/20/17 1500 - CANCEL by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
HAS LIQUID CUPS ALREADY
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
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CROUSSET,RAPHAEL W00001219483 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Dose Instructions Via PEG
Admin Route XX
Frequency DAILY (SCH)
Start Date 07/21/17-0900 Stop Date 08/20/17 0859 CAN: 07/20/17-1632
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01416748

History
07/20/17 1609 - POM ORDER by EALEXEEV
07/20/17 1632 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO NEXIUM 40MG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

CROUSSET,RAPHAEL W00001219483 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/17/17-2100 Stop Date 09/04/17 1659 CAN: 08/17/17-1644
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01423957

History
08/17/17 1636 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01534612
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/17/17 - 0900
Last Actual Administration Time: 08/17/17 - 1613
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/17/17 - 1634
New Order Start: 08/17/17 - 2100
New Order Stop: 09/04/17 - 1659
08/17/17 1644 - CANCEL by EBALILO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CANCEL ORDER PER DR. RUSSO
08/17/17 1652 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by JRUSSO Eff: 08/17/17 1636
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/17/17 - 0900
Last Actual Administration Time: 08/17/17 - 1613
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/17/17 - 1634
New Order Start: 08/17/17 - 2100
New Order Stop: 09/04/17 - 1659
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CUEVAS,YBERTO Responsible Doctor VAIDYA, SUDHIR M.D.

Account Number W00001217528 Location B1NN Unit Number M000208470
Age/Sex 54/M Room 122 Registered Date 07/17/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 1.90 m2

Weight 173 lb oz 78.471 kg
Hem-Onc No

Drug Allergies Tetanus Vaccines and Toxoid, tetanus toxoid, adsorbed

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/04/17-1101 RENAL DOSING COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 18 UNIT (0.18 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/15/17-0900 Stop Date 09/13/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $281.94
Rx Number 01536557

History
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529494
08/14/17 1316 - EDIT by AMACCA
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/15/17-0900 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/15/17-0900 STOP: 09/13/17-0859 SOFT STOP:
08/14/17 1316 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/15/17 - 0900
08/16/17 1831 - DEBIT by AADEGBAMIG
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/14/17-0645 Stop Date 09/13/17 0644
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536415

History
08/14/17 0644 - POM ORDER by NCHANDEL
08/14/17 0736 - VERIFIED by AMOLINARI

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 325 MG (1 TABLET)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: FEVER - Fever
Start Date 08/20/17-0815 Stop Date 09/19/17 0814
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538355

History
08/20/17 0816 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01531178
08/20/17 0957 - EDIT by AADEGBAMIG
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/20/17-0815 STOP: 09/19/17 SOFT STOP:
TO:
START: 08/20/17-0815 STOP: 09/19/17-0814 SOFT STOP:
08/20/17 0957 - VERIFIED by AADEGBAMIG
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/15/17-0900 Stop Date 09/13/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 22 Total Costs $0.00 Total Charges $12.92
Rx Number 01536552

History
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529487
08/14/17 1315 - EDIT by AMACCA
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/15/17-0900 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/15/17-0900 STOP: 09/13/17-0859 SOFT STOP:
08/14/17 1315 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 09/01/17 - 0900

For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/15/17-0900 Stop Date 09/13/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 22 Total Costs $0.00 Total Charges $2.00
Rx Number 01536553

History
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529491
08/14/17 1315 - EDIT by AMACCA
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/15/17-0900 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/15/17-0900 STOP: 09/13/17-0859 SOFT STOP:
08/14/17 1315 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 09/01/17 - 0900

For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/14/17-2100 Stop Date 09/13/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 23 Total Costs $0.00 Total Charges $14.25
Rx Number 01536533

History
08/14/17 1244 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529513
08/14/17 1247 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/14/17-2100 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/14/17-2100 STOP: 09/13/17-2059 SOFT STOP:
08/14/17 1248 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 2100
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/14/17-0700 Stop Date 09/13/17 0659
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536413

History
08/14/17 0651 - POM ORDER by NCHANDEL
08/14/17 0736 - VERIFIED by AMOLINARI
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

CRV25T - CARVEDILOL 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/14/17-2100 Stop Date 09/13/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 45 Total Costs $0.00 Total Charges $8.25
Rx Number 01536534

History
08/14/17 1245 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529490
08/14/17 1247 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/14/17-2100 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/14/17-2100 STOP: 09/13/17-2059 SOFT STOP:
08/14/17 1248 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 08/25/17 - 2100

For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/21/17-1700 Stop Date 09/20/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $9.75
Rx Number 01538663

History
08/21/17 1524 - POM ORDER by SMOHAMED
08/21/17 1540 - VERIFIED by EBALILO
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 09/04/17 - 0900

For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/14/17-1400 Stop Date 09/13/17 1359
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 69 Total Costs $0.00 Total Charges $556.80
Rx Number 01536535

History
08/14/17 1245 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529489
08/14/17 1247 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/14/17-1400 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/14/17-1400 STOP: 09/13/17-1359 SOFT STOP:
08/14/17 1248 - VERIFIED by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 12
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 1400
For: 08/18/17 - 2200
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
For: 08/21/17 - 0600
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 1400
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

08/21/17 0826 - FILL by AMOLINARI

Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/14/17-1700 Stop Date 09/13/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 90 Total Costs $0.00 Total Charges $140.00
Rx Number 01536558

History
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529501
08/14/17 1316 - EDIT by AMACCA
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/14/17-1700 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/14/17-1700 STOP: 09/13/17-1659 SOFT STOP:
08/14/17 1316 - VERIFIED by AMACCA
Items Dispensed: 14 Doses Dispensed: 7
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 08/26/17 - 0900

For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/16/17-0900 Stop Date 09/14/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $4.75
Rx Number 01536900

History
08/15/17 1147 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529531
08/15/17 1148 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/16/17-0900 STOP: 09/14/17 SOFT STOP:
TO:
START: 08/16/17-0900 STOP: 09/14/17-0859 SOFT STOP: 0
08/15/17 1148 - VERIFIED by AMOLINARI
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 09/04/17 - 0900
For: 09/05/17 - 0900

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Dose Instructions PRN NAUSEA
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/14/17-0700 Stop Date 09/13/17 0659
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $8.80
Rx Number 01536417

History
08/14/17 0651 - POM ORDER by NCHANDEL
08/14/17 0736 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by SHTHOMAS Eff: 08/14/17 0706
08/14/17 0736 - VERIFIED by AMOLINARI
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/14/17-0900 Stop Date 09/15/17 0859
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $5.25
Rx Number 01536418

History
08/14/17 0644 - POM ORDER by NCHANDEL
08/14/17 0737 - VERIFIED by AMOLINARI
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

PRM25T - PROMETHAZINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: nausea
Start Date 08/29/17-0945 Stop Date 09/28/17 0944
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01540908

History
08/29/17 0942 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01533685
08/29/17 0943 - EDIT by AMACCA
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0945 STOP: 09/28/17 SOFT STOP:
TO:
START: 08/29/17-0945 STOP: 09/28/17-0944 SOFT STOP:
08/29/17 0943 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/29/17 - 0945
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/14/17-2100 Stop Date 09/13/17 2059
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 46 Total Costs $0.00 Total Charges $3.80
Rx Number 01536416

History
08/14/17 0644 - POM ORDER by NCHANDEL
08/14/17 0736 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0816 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Items Dispensed: 4 Doses Dispensed: 2

For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/15/17-0900 Stop Date 09/13/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 22 Total Costs $0.00 Total Charges $2.00
Rx Number 01536559

History
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529493
08/14/17 1317 - EDIT by AMACCA
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/15/17-0900 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/15/17-0900 STOP: 09/13/17-0859 SOFT STOP:
08/14/17 1317 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 09/01/17 - 0900

For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

SDCH1T - SODIUM CHLORIDE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/15/17-1700 Stop Date 09/10/17 1259
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 43 Total Costs $0.00 Total Charges $10.80
Rx Number 01536880

History
08/15/17 1001 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01535965
Result of Frequency/Schedule Edit
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 08/15/17 - 0900
Last Actual Administration Time: 08/15/17 - 0821
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/15/17 - 0959
New Order Start: 08/15/17 - 1700
New Order Stop: 09/10/17 - 1259
08/15/17 1002 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by EALEXEEV Eff: 08/15/17 1001
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 08/15/17 - 0900
Last Actual Administration Time: 08/15/17 - 0821
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/15/17 - 0959
New Order Start: 08/15/17 - 1700
New Order Stop: 09/10/17 - 1259
08/15/17 1002 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/15/17 - 1700
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

08/21/17 0826 - FILL by AMOLINARI

Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/15/17-0900 Stop Date 09/13/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 22 Total Costs $0.00 Total Charges $345.00
Rx Number 01536560

History
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529488
08/14/17 1317 - EDIT by AMACCA
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/15/17-0900 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/15/17-0900 STOP: 09/13/17-0859 SOFT STOP:
08/14/17 1317 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 09/01/17 - 0900

For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

TICA90TA2 - TICAGRELOR 90 MG TABLET

Dose 90 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/14/17-2100 Stop Date 09/13/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 45 Total Costs $0.00 Total Charges $0.00
Rx Number 01536536

History
08/14/17 1245 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529499
08/14/17 1247 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/14/17-2100 STOP: 09/13/17 SOFT STOP:
TO:
START: 08/14/17-2100 STOP: 09/13/17-2059 SOFT STOP: 0
08/14/17 1248 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
TO:
CHARGE TYPE: PSM - PATIENT'S SELF MEDS
CHARGE: $0.00
08/14/17 1249 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 08/23/17 - 2100

For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 18 UNIT (0.18 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 07/18/17-0900 Stop Date 08/17/17 0859 DC: 08/14/17-1312
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01529494

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1756 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/18/17 - 0900
08/14/17 1313 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1312
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422854
08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/14/17 1313

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 07/17/17-2200 Stop Date 08/16/17 2159 DC: 08/08/17-1733
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $458.64
Rx Number 01529495

History
07/17/17 1748 - POM ORDER by SMOHAMED
07/17/17 1756 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/17/17 - 2200
07/19/17 1802 - DEBIT by AADEGBAMIG
ITEMS: 1
08/08/17 1736 - DISCONTINUE by RSHARMA Eff: 08/08/17 1733
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/09/17 1444 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RSHARMA Eff: 08/08/17 1736
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 30 GM (120 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/22/17-1445 Stop Date 08/22/17 1446 DC: 08/22/17-1446
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01538999

Discontinued Comments Reached Stop Date

History
08/22/17 1441 - POM ORDER by RSHARMA
08/22/17 1442 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 1445
08/22/17 1446 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 1446
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 75 MLS/HR Duration 6 HR 40 MIN
Frequency .Q6H40M (ONE)
Start Date 08/08/17-1230 Stop Date 08/08/17 1909 DC: 08/08/17-1627
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Last Bag 1
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01535137

History
08/08/17 1219 - ENTER by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/08/17 - 1230
08/08/17 1627 - DISCONTINUE by SMOHAMED Eff: 08/08/17 1627
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/09/17 1444 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/08/17 1627
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 1,000 ML (6.6666667 BAGS)

Dose Instructions 75cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/02/17-1130 Stop Date 08/02/17 1142 DC: 08/02/17-1142
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533623

History
08/02/17 1131 - POM ORDER by SMOHAMED
08/02/17 1142 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/02/17-1130 STOP: 08/02/17 1131 SOFT STOP:
TO:
START: 08/02/17-1130 STOP: 08/02/17-1142 SOFT STOP:
08/02/17 1142 - VERIFIED by SYSTEM
Verified in order to DC
08/02/17 1142 - DISCONTINUE by SMOHAMED Eff: 08/02/17 1142
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/02/17 1336 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by SMOHAMED Eff: 08/02/17 1142
Edit by SYSTEM Eff: 08/02/17 1142
Discontinue by SMOHAMED Eff: 08/02/17 1142
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 325 MG (1 TABLET)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: FEVER - Fever
Start Date 07/25/17-0900 Stop Date 08/24/17 0859 DC: 08/20/17-0816
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01531178

History
07/25/17 0850 - POM ORDER by SMOHAMED
07/25/17 0856 - VERIFIED by AMACCA
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/20/17 0816 - DISCONTINUE by RSHARMA Eff: 08/20/17 0816
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/20/17 0816 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01424578
08/22/17 1311 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RSHARMA Eff: 08/20/17 0816
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/18/17-0900 Stop Date 08/17/17 0859 DC: 08/14/17-1312
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 28 Total Costs $0.00 Total Charges $18.36
Rx Number 01529487

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1756 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 07/18/17 - 0900
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0814 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0807 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 0900
08/14/17 1313 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1312
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/15/17 - 0900
For: 08/16/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422851
08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/14/17 1313
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/18/17-0900 Stop Date 08/17/17 0859 DC: 08/14/17-1312
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 28 Total Costs $0.00 Total Charges $2.80
Rx Number 01529491

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1756 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 07/18/17 - 0900
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0814 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0807 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 0900
08/14/17 1313 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1312
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/15/17 - 0900
For: 08/16/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422852
08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/14/17 1313
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/17/17-2100 Stop Date 08/16/17 2059 DC: 08/14/17-1244
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 28 Total Costs $0.00 Total Charges $21.00
Rx Number 01529513

History
07/17/17 1909 - POM ORDER by RSHARMA
07/17/17 1915 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 07/17/17 - 2100
For: 07/18/17 - 2100
For: 07/19/17 - 2100
For: 07/20/17 - 2100
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 2100
For: 07/27/17 - 2100
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 2100
For: 07/29/17 - 2100
For: 07/30/17 - 2100
07/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 2100
For: 08/01/17 - 2100
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 2100
For: 08/03/17 - 2100
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

08/07/17 0814 - FILL by BGIRLING

Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 1244 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1244
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1244 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422836
08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/14/17 1244
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

CPT12.5T - CAPTOPRIL 12.5 MG TAB

Dose 12.5 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 07/17/17-2200 Stop Date 08/16/17 2159 DC: 07/23/17-1119
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 17 Total Costs $0.00 Total Charges $42.00
Rx Number 01529497

History
07/17/17 1802 - ENTER by AADEGBAMIG
Items Dispensed: 11 Doses Dispensed: 11
For: 07/17/17 - 2200
For: 07/18/17 - 0600
For: 07/18/17 - 1400
For: 07/18/17 - 2200
For: 07/19/17 - 0600
For: 07/19/17 - 1400
For: 07/19/17 - 2200
For: 07/20/17 - 0600
For: 07/20/17 - 1400
For: 07/20/17 - 2200
For: 07/21/17 - 0600
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 07/21/17 - 1400
For: 07/21/17 - 2200
For: 07/22/17 - 0600
For: 07/22/17 - 1400
For: 07/22/17 - 2200
For: 07/23/17 - 0600
For: 07/23/17 - 1400
For: 07/23/17 - 2200
For: 07/24/17 - 0600
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 1400
For: 07/24/17 - 2200
For: 07/25/17 - 0600
For: 07/25/17 - 1400
For: 07/25/17 - 2200
For: 07/26/17 - 0600
07/23/17 1121 - DISCONTINUE by SMOHAMED Eff: 07/23/17 1119
Items Auto Credited: 9 Doses Auto Credited: 9
For: 07/23/17 - 1400
For: 07/23/17 - 2200
For: 07/24/17 - 0600
For: 07/24/17 - 1400
For: 07/24/17 - 2200
For: 07/25/17 - 0600
For: 07/25/17 - 1400
For: 07/25/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 07/26/17 - 0600

EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
07/23/17 1121 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01417285
07/25/17 0855 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 07/23/17 1121
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

CPT12.5T - CAPTOPRIL 12.5 MG TAB

Dose 12.5 MG (1 TABLET)

Dose Instructions Don't give if SBP <110 and HR <60
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 07/23/17-1400 Stop Date 08/12/17 2100 DC: 08/12/17-2100
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 33 Total Costs $0.00 Total Charges $78.40
Rx Number 01530755

Discontinued Comments Reached Stop Date

History
07/23/17 1121 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01529497
07/23/17 1217 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 07/23/17 - 1400
For: 07/23/17 - 2200
For: 07/24/17 - 0600
For: 07/24/17 - 1400
For: 07/24/17 - 2200
For: 07/25/17 - 0600
For: 07/25/17 - 1400
For: 07/25/17 - 2200
For: 07/26/17 - 0600
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 1400
For: 07/26/17 - 2200
For: 07/27/17 - 0600
For: 07/27/17 - 1400
For: 07/27/17 - 2200
For: 07/28/17 - 0600
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 07/28/17 - 1400
For: 07/28/17 - 2200
For: 07/29/17 - 0600
For: 07/29/17 - 1400
For: 07/29/17 - 2200
For: 07/30/17 - 0600
For: 07/30/17 - 1400
For: 07/30/17 - 2200
For: 07/31/17 - 0600
07/28/17 0808 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/31/17 - 1400
For: 07/31/17 - 2200
For: 08/01/17 - 0600
For: 08/01/17 - 1400
For: 08/01/17 - 2200
For: 08/02/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

07/31/17 0823 - FILL by BGIRLING

Items Dispensed: 6 Doses Dispensed: 6
For: 08/02/17 - 1400
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/04/17 - 1400
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
08/03/17 0908 - HOLD by RSHARMA Eff: 08/03/17 0908
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
Items Auto Credited: 12 Doses Auto Credited: 12
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
For: 08/04/17 - 1400
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 1057 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by RSHARMA Eff: 08/03/17 0908
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/12/17 1635 - EDIT by EGITLER
EDIT DOCTOR: GITLER, ELLEN M.D.
FROM:
START: 07/23/17-1400 STOP: 08/22/17 1359 SOFT STOP: 0
DISPENSE: 0
TO:
START: 07/23/17-1400 STOP: 08/12/17-2100 SOFT STOP:
DISPENSE: 33
08/12/17 1635 - POM COPY AND EDIT by EGITLER
TO: Rx #U01422663
08/12/17 1636 - REVIEW PROVIDER ACTIVITY by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Edit by EGITLER Eff: 08/12/17 1635

08/12/17 2100 - DISCONTINUE by PHABKGJOB Eff: 08/12/17 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

CPT12.5T - CAPTOPRIL 12.5 MG TAB

Dose 12.5 MG (1 TABLET)

Dose Instructions Don't give if SBP <110 and HR <60
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/12/17-2200 Stop Date 08/22/17 1359 DC: 08/16/17-1728
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $25.20
Rx Number 01536354

History
08/12/17 1635 - POM COPY AND EDIT by EGITLER
FROM: Rx #01530755
Result of Frequency/Schedule Edit
Ordering Doctor: GITLER, ELLEN M.D.
Last Scheduled Administration Time:
Last Actual Administration Time: 08/03/17 - 0600 (Not Given)
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 08/12/17 - 2100
New Order Start: 08/12/17 - 2200
New Order Stop: 08/22/17 - 1359
08/12/17 1637 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by EGITLER Eff: 08/12/17 1635
Ordering Doctor: GITLER, ELLEN M.D.
Last Scheduled Administration Time:
Last Actual Administration Time: 08/03/17 - 0600 (Not Given)
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 08/12/17 - 2100
New Order Start: 08/12/17 - 2200
New Order Stop: 08/22/17 - 1359
08/12/17 1637 - VERIFIED by AMACCA
Items Dispensed: 11 Doses Dispensed: 11
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 08/18/17 - 0600

08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 1400
For: 08/18/17 - 2200
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
For: 08/21/17 - 0600
08/16/17 1729 - DISCONTINUE by EALEXEEV Eff: 08/16/17 1728
Items Auto Credited: 14 Doses Auto Credited: 14
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
For: 08/18/17 - 1400
For: 08/18/17 - 2200
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
For: 08/21/17 - 0600
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/17/17 1304 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/16/17 1729
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

CRV25T - CARVEDILOL 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/17/17-2100 Stop Date 08/16/17 2059 DC: 08/14/17-1244
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 56 Total Costs $0.00 Total Charges $14.85
Rx Number 01529490

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1756 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 07/17/17 - 2100
For: 07/18/17 - 0900
For: 07/18/17 - 2100
For: 07/19/17 - 0900
For: 07/19/17 - 2100
For: 07/20/17 - 0900
For: 07/20/17 - 2100
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 2100
For: 07/22/17 - 0900
For: 07/22/17 - 2100
For: 07/23/17 - 0900
For: 07/23/17 - 2100
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 2100
For: 07/25/17 - 0900
For: 07/25/17 - 2100
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 2100
For: 07/27/17 - 0900
For: 07/27/17 - 2100
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
For: 07/30/17 - 2100
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 07/31/17 - 2100

For: 08/01/17 - 0900
For: 08/01/17 - 2100
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0807 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 0900
08/14/17 1244 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1244
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
For: 08/16/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1245 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422837
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA

Discontinue by SMOHAMED Eff: 08/14/17 1244
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/18/17-0900 Stop Date 08/14/17 0642 DC: 08/14/17-0642
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $13.25
Rx Number 01529492

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1756 - VERIFIED by AADEGBAMIG
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 1700
For: 07/22/17 - 0900
For: 07/22/17 - 1700
For: 07/23/17 - 0900
For: 07/23/17 - 1700
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 1700
For: 07/25/17 - 0900
For: 07/25/17 - 1700
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 1700
For: 07/27/17 - 0900
For: 07/27/17 - 1700
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 1700
For: 07/29/17 - 0900
For: 07/29/17 - 1700
For: 07/30/17 - 0900
For: 07/30/17 - 1700
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/17 - 0900
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1700
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

08/02/17 0814 - FILL by AMOLINARI

Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0644 - EDIT by NCHANDEL
EDIT DOCTOR: CHANDEL,NEEL MD
FROM:
START: 07/18/17-0900 STOP: 08/17/17 0859 SOFT STOP: 0
TO:
START: 07/18/17-0900 STOP: 08/14/17-0642 SOFT STOP:
08/14/17 0644 - DISCONTINUE by NCHANDEL Eff: 08/14/17 0642
EDIT DOCTOR: CHANDEL,NEEL MD
08/14/17 0644 - POM COPY AND EDIT by NCHANDEL
TO: Rx #U01422726
08/14/17 0737 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by NCHANDEL Eff: 08/14/17 0644
Discontinue by NCHANDEL Eff: 08/14/17 0644
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/14/17-0900 Stop Date 08/17/17 0859 DC: 08/14/17-1312
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01536414

History
08/14/17 0644 - POM COPY AND EDIT by NCHANDEL
FROM: Rx #01529492
Result of Frequency/Schedule Edit
Ordering Doctor: CHANDEL,NEEL MD
Last Scheduled Administration Time: 08/13/17 - 1700
Last Actual Administration Time: 08/13/17 - 1740
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/14/17 - 0642
New Order Start: 08/14/17 - 0900
New Order Stop: 08/17/17 - 0859
08/14/17 0736 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by NCHANDEL Eff: 08/14/17 0644
Ordering Doctor: CHANDEL,NEEL MD
Last Scheduled Administration Time: 08/13/17 - 1700
Last Actual Administration Time: 08/13/17 - 1740
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/14/17 - 0642
New Order Start: 08/14/17 - 0900
New Order Stop: 08/17/17 - 0859
08/14/17 0736 - VERIFIED by AMOLINARI
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
08/14/17 1313 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1312
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
For: 08/16/17 - 0900
For: 08/16/17 - 1700
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422853
08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/14/17 1313
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/14/17-1700 Stop Date 08/17/17 1659 DC: 08/15/17-1147
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01536555

History
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01536414
08/14/17 1316 - EDIT by AMACCA
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/14/17-1700 STOP: 08/17/17 SOFT STOP:
TO:
START: 08/14/17-1700 STOP: 08/17/17-1659 SOFT STOP:
08/14/17 1316 - VERIFIED by AMACCA
08/15/17 1147 - DISCONTINUE by SMOHAMED Eff: 08/15/17 1147
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/15/17 1147 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01423192
08/15/17 1148 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/15/17 1147
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/15/17-1300 Stop Date 08/18/17 1259 DC: 08/17/17-1300
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01536899

History
08/15/17 1147 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01536555
08/15/17 1148 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/15/17-1300 STOP: 08/18/17 SOFT STOP:
TO:
START: 08/15/17-1300 STOP: 08/18/17-1259 SOFT STOP: 0
08/15/17 1148 - VERIFIED by AMOLINARI
08/16/17 0822 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 0900
08/17/17 1301 - DISCONTINUE by EALEXEEV Eff: 08/17/17 1300
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/17/17 1301 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01423868
08/17/17 1304 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/17/17 1301
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/17/17-1300 Stop Date 08/20/17 1259 DC: 08/18/17-1923
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01537613

History
08/17/17 1301 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01536899
08/17/17 1304 - EDIT by AMACCA
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/17/17-1300 STOP: 08/20/17 SOFT STOP:
TO:
START: 08/17/17-1300 STOP: 08/20/17-1259 SOFT STOP:
08/17/17 1305 - VERIFIED by AMACCA
08/18/17 1923 - DISCONTINUE by SMOHAMED Eff: 08/18/17 1923
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/18/17 1923 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424463
08/21/17 1541 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SMOHAMED Eff: 08/18/17 1923
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 08/21/17 0859 DC: 08/21/17-0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01538241

Discontinued Comments Reached Stop Date

History
08/18/17 1923 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01537613
08/18/17 1925 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/19/17-0900 STOP: 08/21/17 SOFT STOP:
TO:
START: 08/19/17-0900 STOP: 08/21/17-0859 SOFT STOP:
08/18/17 1925 - VERIFIED by AADEGBAMIG
08/21/17 0859 - DISCONTINUE by PHABKGJOB Eff: 08/21/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

FLX10C - FLUOXETINE HCL 10 MG CAP

Dose 10 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/28/17-0900 Stop Date 07/28/17 0900 DC: 07/28/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01532186

History
07/27/17 1350 - POM ORDER by SMOHAMED
07/27/17 1353 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/27/17 1646 - DISCONTINUE by SMOHAMED Eff: 07/28/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
07/27/17 1646 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 07/28/17-0900 STOP: 08/27/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 07/28/17-0900 STOP: 07/28/17-0900 SOFT STOP:
DISPENSE: 0
08/01/17 1014 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SMOHAMED Eff: 07/27/17 1646
Discontinue by SMOHAMED Eff: 07/27/17 1646
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 07/17/17-2200 Stop Date 08/16/17 2159 DC: 08/14/17-1244
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 83 Total Costs $0.00 Total Charges $770.24
Rx Number 01529489

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1756 - VERIFIED by AADEGBAMIG
Items Dispensed: 11 Doses Dispensed: 11
For: 07/17/17 - 2200
For: 07/18/17 - 0600
For: 07/18/17 - 1400
For: 07/18/17 - 2200
For: 07/19/17 - 0600
For: 07/19/17 - 1400
For: 07/19/17 - 2200
For: 07/20/17 - 0600
For: 07/20/17 - 1400
For: 07/20/17 - 2200
For: 07/21/17 - 0600
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 07/21/17 - 1400
For: 07/21/17 - 2200
For: 07/22/17 - 0600
For: 07/22/17 - 1400
For: 07/22/17 - 2200
For: 07/23/17 - 0600
For: 07/23/17 - 1400
For: 07/23/17 - 2200
For: 07/24/17 - 0600
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 1400
For: 07/24/17 - 2200
For: 07/25/17 - 0600
For: 07/25/17 - 1400
For: 07/25/17 - 2200
For: 07/26/17 - 0600
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 1400
For: 07/26/17 - 2200
For: 07/27/17 - 0600
For: 07/27/17 - 1400
For: 07/27/17 - 2200
For: 07/28/17 - 0600
07/26/17 0813 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Items Dispensed: 9 Doses Dispensed: 9

For: 07/28/17 - 1400
For: 07/28/17 - 2200
For: 07/29/17 - 0600
For: 07/29/17 - 1400
For: 07/29/17 - 2200
For: 07/30/17 - 0600
For: 07/30/17 - 1400
For: 07/30/17 - 2200
For: 07/31/17 - 0600
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/31/17 - 1400
For: 07/31/17 - 2200
For: 08/01/17 - 0600
For: 08/01/17 - 1400
For: 08/01/17 - 2200
For: 08/02/17 - 0600
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/02/17 - 1400
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/04/17 - 1400
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
For: 08/09/17 - 0600
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 1400
For: 08/09/17 - 2200
For: 08/10/17 - 0600
For: 08/10/17 - 1400
For: 08/10/17 - 2200
For: 08/11/17 - 0600
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 08/11/17 - 1400

For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/14/17 0807 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 1400
08/14/17 1244 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1244
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
For: 08/16/17 - 1400
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1245 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422838
08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/14/17 1244

MTF850T - METFORMIN HCL 850 MG TAB

Dose 1,000 MG (1.1764706 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/18/17-0900 Stop Date 08/17/17 0859 DC: 07/18/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01529502

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1804 - DISCONTINUE by AADEGBAMIG Eff: 07/18/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/17/17 1804 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/18/17-0900 Stop Date 08/17/17 0859 DC: 08/14/17-1312
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 110 Total Costs $0.00 Total Charges $192.50
Rx Number 01529501

History
07/17/17 1804 - ENTER by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 6
For: 07/18/17 - 0900
For: 07/18/17 - 1700
For: 07/19/17 - 0900
For: 07/19/17 - 1700
For: 07/20/17 - 0900
For: 07/20/17 - 1700
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 1700
For: 07/22/17 - 0900
For: 07/22/17 - 1700
For: 07/23/17 - 0900
For: 07/23/17 - 1700
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 1700
For: 07/25/17 - 0900
For: 07/25/17 - 1700
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 1700
For: 07/27/17 - 0900
For: 07/27/17 - 1700
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 1700
For: 07/29/17 - 0900
For: 07/29/17 - 1700
For: 07/30/17 - 0900
For: 07/30/17 - 1700
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 07/31/17 - 0900
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

07/31/17 0823 - FILL by BGIRLING

Items Dispensed: 8 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1700
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/16/17 - 1700
08/14/17 1313 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1312
Items Auto Credited: 10 Doses Auto Credited: 5
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
For: 08/16/17 - 0900
For: 08/16/17 - 1700
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422855
08/14/17 1317 - REVIEW PROVIDER ACTIVITY by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Discontinue by SMOHAMED Eff: 08/14/17 1313

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/19/17-0900 Stop Date 08/18/17 0859 DC: 08/15/17-1147
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $7.00
Rx Number 01529531

History
07/18/17 0945 - POM ORDER by SMOHAMED
07/18/17 0946 - VERIFIED by AMOLINARI
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0816 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/15/17 1147 - DISCONTINUE by SMOHAMED Eff: 08/15/17 1147
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/15/17 1147 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01423193
08/15/17 1148 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/15/17 1147
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/04/17-1101 Stop Date 08/11/17 1100 DC: 08/07/17-0922
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Total Dispensed 7 Total Costs $0.00 Total Charges $48.18
Rx Number 01534125

History
08/04/17 1055 - POM ORDER by SMOHAMED
08/04/17 1101 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
SIG: 2 TIMES A DAY
START: 08/04/17-1700 STOP: 08/11/17 1659 SOFT STOP: 0
DISPENSE: 9
TO:
SIG: EVERY 12 HOURS
START: 08/04/17-1101 STOP: 08/11/17-1100 SOFT STOP: 0
DISPENSE: 10
08/04/17 1101 - VERIFIED by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 10
For: 08/04/17 - 1101
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/04/17 1101 - NOW DOSE by AMOLINARI
Now Dose: 08/04/17 1101
08/04/17 1101 - KEEP NEXT DOSE by System
Keep Next Dose: 08/04/17 2100
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/07/17 0925 - DISCONTINUE by SMOHAMED Eff: 08/07/17 0922
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
For: 08/09/17 - 0900
For: 08/09/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 08/10/17 - 0900

For: 08/10/17 - 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/09/17 1444 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/07/17 0925

NF-MED - NON FORMULARY MEDICATION

Dose Instructions captopril 12.5mg PO q8hr

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 07/17/17-2200 Stop Date 08/16/17 2159 DC: 07/17/17-2200
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01529498

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1802 - VERIFIED by SYSTEM
Verified in order to DC
07/17/17 1802 - DISCONTINUE by AADEGBAMIG Eff: 07/17/17 2200
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Ticagrelor tab 90mg PO q12hr

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/17/17-2100 Stop Date 08/16/17 2059 DC: 07/17/17-2100
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01529500

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1803 - DISCONTINUE by AADEGBAMIG Eff: 07/17/17 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
07/17/17 1803 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

PRM25T - PROMETHAZINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: nausea
Start Date 08/02/17-1245 Stop Date 09/01/17 1244 DC: 08/29/17-0941
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $1.08
Rx Number 01533685

History
08/02/17 1238 - POM ORDER by SMOHAMED
08/02/17 1337 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/02/17 - 1245
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/29/17 0942 - DISCONTINUE by EALEXEEV Eff: 08/29/17 0941
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/29/17 0942 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427012
08/29/17 0942 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/29/17 0942
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/18/17-0900 Stop Date 08/17/17 0859 DC: 08/14/17-1312
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 28 Total Costs $0.00 Total Charges $2.80
Rx Number 01529493

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1756 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 07/18/17 - 0900
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0814 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 0900
08/14/17 1313 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1312
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/15/17 - 0900
For: 08/16/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422856
08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/14/17 1313
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

SDCH1T - SODIUM CHLORIDE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/01/17-1700 Stop Date 08/02/17 1131 DC: 08/02/17-1131
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $0.60
Rx Number 01533326

History
08/01/17 1017 - POM ORDER by SMOHAMED
08/01/17 1019 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/01/17 - 1700
For: 08/02/17 - 0900
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1700
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
08/02/17 1132 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/01/17-1700 STOP: 08/31/17 1659 SOFT STOP: 0
DISPENSE: 6
TO:
START: 08/01/17-1700 STOP: 08/02/17-1131 SOFT STOP:
DISPENSE: 2
08/02/17 1132 - DISCONTINUE by SMOHAMED Eff: 08/02/17 1131
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/02/17 1133 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01420025
08/02/17 1336 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by SMOHAMED Eff: 08/02/17 1132
Discontinue by SMOHAMED Eff: 08/02/17 1132
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

SDCH1T - SODIUM CHLORIDE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/02/17-1300 Stop Date 08/31/17 1659 DC: 08/08/17-1211
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $5.40
Rx Number 01533633

History
08/02/17 1133 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01533326
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/02/17 - 0900
Last Actual Administration Time: 08/02/17 - 0843
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/02/17 - 1131
New Order Start: 08/02/17 - 1300
New Order Stop: 08/31/17 - 1659
08/02/17 1159 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by SMOHAMED Eff: 08/02/17 1133
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/02/17 - 0900
Last Actual Administration Time: 08/02/17 - 0843
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/02/17 - 1131
New Order Start: 08/02/17 - 1300
New Order Stop: 08/31/17 - 1659
08/02/17 1159 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 08/02/17 - 1300
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1300
For: 08/03/17 - 1700
For: 08/04/17 - 0900
For: 08/04/17 - 1300
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

For: 08/08/17 - 0900

For: 08/08/17 - 1300
For: 08/08/17 - 1700
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
08/08/17 1213 - DISCONTINUE by SMOHAMED Eff: 08/08/17 1211
Items Auto Credited: 8 Doses Auto Credited: 8
For: 08/08/17 - 1300
For: 08/08/17 - 1700
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/09/17 1444 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/08/17 1213
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

SDCH1T - SODIUM CHLORIDE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/11/17-1300 Stop Date 08/15/17 0959 DC: 08/15/17-0959
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 20 Total Costs $0.00 Total Charges $3.60
Rx Number 01535965

History
08/11/17 0959 - POM ORDER by SMOHAMED
08/11/17 1135 - VERIFIED by AMOLINARI
Items Dispensed: 14 Doses Dispensed: 14
For: 08/11/17 - 1300
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
For: 08/14/17 - 0900
For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/15/17 1001 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/11/17-1300 STOP: 09/10/17 1259 SOFT STOP: 0
DISPENSE: 6
TO:
START: 08/11/17-1300 STOP: 08/15/17-0959 SOFT STOP:
DISPENSE: 12
08/15/17 1001 - DISCONTINUE by EALEXEEV Eff: 08/15/17 0959
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Allergies/Duplicates/Interactions differ from order entry

Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/15/17 1001 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01423173
08/15/17 1002 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by EALEXEEV Eff: 08/15/17 1001
Discontinue by EALEXEEV Eff: 08/15/17 1001
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/18/17-0900 Stop Date 08/17/17 0859 DC: 08/14/17-1312
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 28 Total Costs $0.00 Total Charges $483.00
Rx Number 01529488

History
07/17/17 1739 - POM ORDER by SMOHAMED
07/17/17 1756 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 07/18/17 - 0900
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0814 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0807 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 0900
08/14/17 1313 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1312
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/15/17 - 0900
For: 08/16/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1313 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422857
08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/14/17 1313
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

CUEVAS,YBERTO W00001217528 (Continued)

TICA90TA2 - TICAGRELOR 90 MG TABLET

Dose 90 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/17/17-2100 Stop Date 08/16/17 2059 DC: 08/14/17-1244
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 56 Total Costs $0.00 Total Charges $0.00
Rx Number 01529499

History
07/17/17 1803 - ENTER by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 07/17/17 - 2100
For: 07/18/17 - 0900
For: 07/18/17 - 2100
For: 07/19/17 - 0900
For: 07/19/17 - 2100
For: 07/20/17 - 0900
For: 07/20/17 - 2100
07/19/17 0806 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 2100
For: 07/22/17 - 0900
For: 07/22/17 - 2100
For: 07/23/17 - 0900
For: 07/23/17 - 2100
07/21/17 0808 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 2100
For: 07/25/17 - 0900
For: 07/25/17 - 2100
07/24/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 2100
For: 07/27/17 - 0900
For: 07/27/17 - 2100
07/26/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
For: 07/30/17 - 2100
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/17 - 0900
For: 07/31/17 - 2100
For: 08/01/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
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CUEVAS,YBERTO W00001217528 (Continued)

For: 08/01/17 - 2100

07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
08/02/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/07/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0808 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 0900
08/14/17 1244 - DISCONTINUE by SMOHAMED Eff: 08/14/17 1244
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
For: 08/16/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/14/17 1245 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01422839
08/14/17 1314 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/14/17 1244
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
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CUEVAS,YBERTO W00001217528 (Continued)

TS160800 - TRIMETHOPRIM/SULFAMETHOXAZOLE 160-800 MG TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/07/17-2100 Stop Date 08/14/17 2059 DC: 08/14/17-2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Total Dispensed 14 Total Costs $0.00 Total Charges $6.72
Rx Number 01534804

Discontinued Comments Reached Stop Date

History
08/07/17 0925 - POM ORDER by SMOHAMED
08/07/17 1159 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0807 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/14/17 - 0900
08/14/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/14/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
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CUEVAS,YBERTO W00001217528 (Continued)

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 500 ML (3.3333333 BAGS)

Dose Instructions 75cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/08/17-1215 Stop Date 08/08/17 1216 CAN: 08/08/17-1219
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01421490

History
08/08/17 1212 - POM ORDER by SMOHAMED
08/08/17 1219 - CANCEL by EBALILO
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
ENTERED AS LVP
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient CUMMINGS,JOHN Responsible Doctor GITLER, ELLEN M.D.

Account Number W00001219294 Location B1EA Unit Number M000209140
Age/Sex 57/M Room 114 Registered Date 08/19/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 10 in 177.8 cm Body Surface Area 2.15 m2

Weight 215 lb oz 97.522 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/19/17-1812 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/19/17-1630 Stop Date 09/18/17 1629
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538325

History
08/19/17 1623 - POM ORDER by HAZIZI
08/19/17 1624 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
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CUMMINGS,JOHN W00001219294 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions Mild pain/Fever
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/19/17-1630 Stop Date 09/18/17 1629
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01538324

History
08/19/17 1623 - POM ORDER by HAZIZI
08/19/17 1624 - VERIFIED by AADEGBAMIG
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 09/09/17-0900 Stop Date 09/30/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538347

History
08/19/17 1802 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01538343
08/19/17 1804 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions Constipation
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/19/17-1630 Stop Date 09/18/17 1629
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538327

History
08/19/17 1623 - POM ORDER by HAZIZI
08/19/17 1624 - VERIFIED by AADEGBAMIG
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/19/17-1630 Stop Date 09/18/17 1629
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01538323

History
08/19/17 1623 - POM ORDER by HAZIZI
08/19/17 1624 - VERIFIED by AADEGBAMIG
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/20/17-0900 Stop Date 09/08/17 2300
Ordering Doctor AZIZI,HANA MD
Total Dispensed 17 Total Costs $0.00 Total Charges $1278.45
Rx Number 01538337

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.41
MG/KG/DAY is below the Low Daily Dose.

History
08/19/17 1628 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01538332
08/19/17 1632 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/20/17-0900 Stop Date 09/19/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 17 Total Costs $0.00 Total Charges $5.25
Rx Number 01538333

History
08/19/17 1625 - POM ORDER by HAZIZI
08/19/17 1625 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
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CUMMINGS,JOHN W00001219294 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/20/17-0900 Stop Date 09/19/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 17 Total Costs $0.00 Total Charges $4.50
Rx Number 01538334

History
08/19/17 1625 - POM ORDER by HAZIZI
08/19/17 1625 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
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CUMMINGS,JOHN W00001219294 (Continued)

IRON45TA - IRON,CARBONYL (FERRO SEQUELS) TAB

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/20/17-0900 Stop Date 09/19/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 17 Total Costs $0.00 Total Charges $7.50
Rx Number 01538330

History
08/19/17 1623 - POM ORDER by HAZIZI
08/19/17 1624 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Dose Instructions Dyspepsia/Abdominal Discomfort
Admin Route ORAL
Frequency AFTER MEALS & BEDTIM (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/19/17-1630 Stop Date 09/18/17 1629
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538328

History
08/19/17 1623 - POM ORDER by HAZIZI
08/19/17 1624 - VERIFIED by AADEGBAMIG
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/19/17-1630 Stop Date 09/18/17 1629
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538326

History
08/19/17 1623 - POM ORDER by HAZIZI
08/19/17 1624 - VERIFIED by AADEGBAMIG
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/20/17-0900 Stop Date 09/19/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $3.75
Rx Number 01538335

History
08/19/17 1627 - POM ORDER by HAZIZI
08/19/17 1631 - VERIFIED by AADEGBAMIG
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/01/17-1300 Stop Date 09/08/17 1259
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541907

History
09/01/17 1250 - POM ORDER by MBRIONES
09/01/17 1255 - VERIFIED by AADEGBAMIG

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/01/17-1300 Stop Date 09/08/17 1259
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01541908

History
09/01/17 1250 - POM ORDER by MBRIONES
09/01/17 1255 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions 374 MG = 2 tablets
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/19/17-1630 Stop Date 09/18/17 1629
Ordering Doctor AZIZI,HANA MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.20
Rx Number 01538331

History
08/19/17 1623 - POM ORDER by HAZIZI
08/19/17 1624 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 1
For: 08/19/17 - 1630
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN SLEEP
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 09/01/17-2230 Stop Date 09/08/17 2229
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.56
Rx Number 01542170

History
09/01/17 2218 - POM ORDER by RMINASSIAN
09/02/17 1054 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by CPENOL Eff: 09/01/17 2220
09/02/17 1054 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
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CUMMINGS,JOHN W00001219294 (Continued)

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/24/17-0900 Stop Date 08/31/17 0859 DC: 08/25/17-0953
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $7.98
Rx Number 01539433

History
08/23/17 1717 - POM ORDER by EGITLER
08/23/17 1722 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 0900
08/25/17 0954 - DISCONTINUE by EGITLER Eff: 08/25/17 0953
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0954 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426086
08/25/17 1228 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by EGITLER Eff: 08/25/17 0954
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
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CUMMINGS,JOHN W00001219294 (Continued)

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/25/17-1700 Stop Date 09/01/17 1659 DC: 09/01/17-1659
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $7.98
Rx Number 01539948

Discontinued Comments Reached Stop Date

History
08/25/17 0954 - POM COPY AND EDIT by EGITLER
FROM: Rx #01539433
08/25/17 1228 - EDIT by EBALILO
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1700 STOP: 09/01/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/25/17-1700 STOP: 09/01/17-1659 SOFT STOP: 0
DISPENSE: 0
08/25/17 1228 - VERIFIED by EBALILO
08/31/17 0929 - DEBIT by BGIRLING
ITEMS: 1
DEBIT COMMENTS:
sent up 8/31/17
09/01/17 1700 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 1659
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
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CUMMINGS,JOHN W00001219294 (Continued)

HC1O30 - HYDROCORTISONE 1% OINT 28.35 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions Apply to rash on upper back
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/23/17-1700 Stop Date 08/30/17 1659 DC: 08/23/17-1716
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $4.50
Rx Number 01539360

History
08/23/17 1621 - POM ORDER by DSPUNBERG
08/23/17 1622 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 1700
08/23/17 1717 - DISCONTINUE by EGITLER Eff: 08/23/17 1716
EDIT DOCTOR: GITLER, ELLEN M.D.
08/24/17 1338 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EGITLER Eff: 08/23/17 1717

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/09/17-0900 Stop Date 09/30/17 0859 DC: 09/09/17-0900
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538338

History
08/19/17 1628 - POM ORDER by HAZIZI
08/19/17 1632 - VERIFIED by AADEGBAMIG
08/19/17 1633 - DISCONTINUE by HAZIZI Eff: 09/09/17 0900
EDIT DOCTOR: AZIZI,HANA MD
08/19/17 1633 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01424562
08/19/17 1638 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HAZIZI Eff: 08/19/17 1633
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/19/17-1700 Stop Date 09/09/17 1659 DC: 08/19/17-1724
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538339

History
08/19/17 1633 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01538338
Result of Frequency/Schedule Edit
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/09/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 09/09/17 - 0900
New Order Start: 08/19/17 - 1700
New Order Stop: 09/09/17 - 1659
08/19/17 1637 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by HAZIZI Eff: 08/19/17 1633
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/09/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 09/09/17 - 0900
New Order Start: 08/19/17 - 1700
New Order Stop: 09/09/17 - 1659
08/19/17 1637 - VERIFIED by AADEGBAMIG
08/19/17 1725 - DISCONTINUE by HAZIZI Eff: 08/19/17 1724
EDIT DOCTOR: AZIZI,HANA MD
08/19/17 1725 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01424565
08/19/17 1805 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HAZIZI Eff: 08/19/17 1725
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
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CUMMINGS,JOHN W00001219294 (Continued)

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 09/09/17-0900 Stop Date 10/09/17 0859 DC: 09/09/17-0900
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538343

History
08/19/17 1725 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01538339
08/19/17 1727 - VERIFIED by AADEGBAMIG
08/19/17 1802 - DISCONTINUE by HAZIZI Eff: 09/09/17 0900
EDIT DOCTOR: AZIZI,HANA MD
08/19/17 1802 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01424568
08/19/17 1805 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HAZIZI Eff: 08/19/17 1802
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
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CUMMINGS,JOHN W00001219294 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/20/17-0900 Stop Date 09/10/17 0859 DC: 08/20/17-0900
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538332

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.39
MG/KG/DAY is below the Low Daily Dose.

History
08/19/17 1625 - POM ORDER by HAZIZI
08/19/17 1625 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/19/17 1628 - DISCONTINUE by HAZIZI Eff: 08/20/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: AZIZI,HANA MD
08/19/17 1628 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01424559
08/19/17 1632 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HAZIZI Eff: 08/19/17 1628
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
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CUMMINGS,JOHN W00001219294 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/01/17 0859 DC: 09/01/17-0859
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 3 Total Costs $0.00 Total Charges $0.84
Rx Number 01540733

Discontinued Comments Reached Stop Date

History
08/28/17 1456 - POM ORDER by MBRIONES
08/28/17 1500 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
09/01/17 0859 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: FOR mod to SIGNIFICANT PAIN
Start Date 08/19/17-1630 Stop Date 08/21/17 0917 DC: 08/21/17-0917
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01538336

History
08/19/17 1627 - POM ORDER by HAZIZI
08/19/17 1631 - VERIFIED by AADEGBAMIG
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0921 - EDIT by EGITLER
EDIT DOCTOR: GITLER, ELLEN M.D.
FROM:
START: 08/19/17-1630 STOP: 08/26/17 1629 SOFT STOP: 0
TO:
START: 08/19/17-1630 STOP: 08/21/17-0917 SOFT STOP:
08/21/17 0921 - DISCONTINUE by EGITLER Eff: 08/21/17 0917
EDIT DOCTOR: GITLER, ELLEN M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/21/17 0921 - POM COPY AND EDIT by EGITLER
TO: Rx #U01424704
08/21/17 1240 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by EGITLER Eff: 08/21/17 0921
Discontinue by EGITLER Eff: 08/21/17 0921
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: FOR mod to SIGNIFICANT PAIN
Start Date 08/21/17-1200 Stop Date 08/26/17 1629 DC: 08/21/17-1200
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538490

History
08/21/17 0921 - POM COPY AND EDIT by EGITLER
FROM: Rx #01538336
Result of Frequency/Schedule Edit
Ordering Doctor: GITLER, ELLEN M.D.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/21/17 - 0911
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 3 HOURS (PRN)
Old Order Stop: 08/21/17 - 0917
New Order Start: 08/21/17 - 1200
New Order Stop: 08/26/17 - 1629
08/21/17 0949 - DISCONTINUE by EGITLER Eff: 08/21/17 1200
EDIT DOCTOR: GITLER, ELLEN M.D.
08/21/17 0949 - VERIFIED by SYSTEM
Verified in order to DC
08/21/17 0949 - POM COPY AND EDIT by EGITLER
TO: Rx #U01424710
08/21/17 1241 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by EGITLER Eff: 08/21/17 0921
Ordering Doctor: GITLER, ELLEN M.D.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/21/17 - 0911
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 3 HOURS (PRN)
Old Order Stop: 08/21/17 - 0917
New Order Start: 08/21/17 - 1200
New Order Stop: 08/26/17 - 1629
Edit by SYSTEM Eff: 08/21/17 0949
Freq/Sch Edit by SYSTEM Eff: 08/21/17 0949
Ordering Doctor: GITLER, ELLEN M.D.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/21/17 - 0911
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 3 HOURS (PRN)
Old Order Stop: 08/21/17 - 0917
New Order Start: 08/21/17 - 1200
New Order Stop: 08/26/17 - 1629
Discontinue by EGITLER Eff: 08/21/17 0949
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
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CUMMINGS,JOHN W00001219294 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/21/17-0930 Stop Date 08/28/17 0929 DC: 08/25/17-0953
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538537

History
08/21/17 0921 - POM ORDER by EGITLER
08/21/17 1240 - VERIFIED by MHAIMOWITZ
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0954 - DISCONTINUE by EGITLER Eff: 08/25/17 0953
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0954 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426087
08/25/17 1228 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by EGITLER Eff: 08/25/17 0954

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/21/17-1200 Stop Date 08/28/17 1159 DC: 08/25/17-0953
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01538538

History
08/21/17 0949 - POM COPY AND EDIT by EGITLER
FROM: Rx #01538490
08/21/17 1240 - VERIFIED by MHAIMOWITZ
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0954 - DISCONTINUE by EGITLER Eff: 08/25/17 0953
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0954 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426088
08/25/17 1228 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by EGITLER Eff: 08/25/17 0954
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
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CUMMINGS,JOHN W00001219294 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/25/17-1000 Stop Date 09/01/17 0959 DC: 09/01/17-0959
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539940

Discontinued Comments Reached Stop Date

History
08/25/17 0954 - POM COPY AND EDIT by EGITLER
FROM: Rx #01538537
08/25/17 1227 - EDIT by EBALILO
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1000 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1000 STOP: 09/01/17-0959 SOFT STOP: 0
08/25/17 1227 - VERIFIED by EBALILO
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0959 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 0959
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
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CUMMINGS,JOHN W00001219294 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/25/17-1000 Stop Date 09/01/17 0959 DC: 09/01/17-0959
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $5.50
Rx Number 01539942

Discontinued Comments Reached Stop Date

History
08/25/17 0954 - POM COPY AND EDIT by EGITLER
FROM: Rx #01538538
08/25/17 1227 - EDIT by EBALILO
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1000 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1000 STOP: 09/01/17-0959 SOFT STOP: 0
08/25/17 1227 - VERIFIED by EBALILO
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0959 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 0959
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/19/17-1630 Stop Date 08/26/17 1629 DC: 08/23/17-0921
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.28
Rx Number 01538329

History
08/19/17 1623 - POM ORDER by HAZIZI
08/19/17 1624 - VERIFIED by AADEGBAMIG
08/21/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0922 - DISCONTINUE by EGITLER Eff: 08/23/17 0921
EDIT DOCTOR: GITLER, ELLEN M.D.
08/23/17 0922 - POM COPY AND EDIT by EGITLER
TO: Rx #U01425409
08/23/17 1217 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EGITLER Eff: 08/23/17 0922
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/23/17-0930 Stop Date 08/30/17 0929 DC: 08/25/17-0953
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539246

History
08/23/17 0922 - POM COPY AND EDIT by EGITLER
FROM: Rx #01538329
08/23/17 1217 - EDIT by AMOLINARI
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/23/17-0930 STOP: 08/30/17 SOFT STOP:
TO:
START: 08/23/17-0930 STOP: 08/30/17-0929 SOFT STOP: 0
08/23/17 1217 - VERIFIED by AMOLINARI
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0954 - DISCONTINUE by EGITLER Eff: 08/25/17 0953
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0954 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426089
08/25/17 1228 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by EGITLER Eff: 08/25/17 0954
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

CUMMINGS,JOHN W00001219294 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/25/17-1000 Stop Date 09/01/17 0959 DC: 09/01/17-0959
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539945

Discontinued Comments Reached Stop Date

History
08/25/17 0954 - POM COPY AND EDIT by EGITLER
FROM: Rx #01539246
08/25/17 1228 - EDIT by EBALILO
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1000 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1000 STOP: 09/01/17-0959 SOFT STOP: 0
08/25/17 1228 - VERIFIED by EBALILO
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0959 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 0959
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient DANGELICA,DOMENICK Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219491 Location B1WE Unit Number M000158286
Age/Sex 81/M Room 157 Registered Date 08/25/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 5.98 in 167.6 cm Body Surface Area 1.93 m2

Weight 183 lb 3.2 oz 83.098 kg
Hem-Onc No

Drug Allergies No Known Drug Allergies (No Known Drug Allergies)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 4 GM (4 GEL APPLICATIONS)

Dose Instructions R ankle
Admin Route TOPICALLY
Frequency EVERY 8 HOURS (SCH)
Start Date 08/28/17-2200 Stop Date 09/04/17 2159
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $217.20
Rx Number 01540734

History
08/28/17 1504 - POM ORDER by NBALCETIS
08/28/17 1507 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2200
09/03/17 1445 - DEBIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

NTR.4SL - NITROGLYCERIN 0.4 MG SUBL

Dose 0.4 MG (1 TABLET, SUBLINGUAL)

Dose Instructions Notify MD if patient requires this medicine
Admin Route SUBLINGUAL
Frequency EVERY 5 MINUTES X 3 (PRN) PRN REASON: CP - Chest Pain
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 25 Total Costs $0.00 Total Charges $22.50
Rx Number 01540253

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2102 - VERIFIED by AADEGBAMIG
Items Dispensed: 25 Doses Dispensed: 1
For: 08/25/17 - 2100

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Dose Instructions Groin rash
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $28.41
Rx Number 01540295

History
08/25/17 2315 - POM ORDER by YIVANOV
08/25/17 2336 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/26/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/28/17-2200 Stop Date 09/04/17 2159
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $4.50
Rx Number 01540735

History
08/28/17 1504 - POM ORDER by NBALCETIS
08/28/17 1507 - VERIFIED by AADEGBAMIG
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 09/04/17 - 1400

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Dose Instructions FOR MILD PAIN
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/04/17-0900 Stop Date 10/04/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541874

History
09/01/17 0957 - POM ORDER by NBALCETIS
09/01/17 1023 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 15 Total Costs $0.00 Total Charges $7.48
Rx Number 01540918

History
08/29/17 1035 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540250
08/29/17 1040 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $127.80
Rx Number 01540246

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2102 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $0.90
Rx Number 01540247

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2102 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540256

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2103 - VERIFIED by AADEGBAMIG
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $1.80
Rx Number 01540251

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2102 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/29/17-2100 Stop Date 09/25/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 15 Total Costs $0.00 Total Charges $2.75
Rx Number 01540919

History
08/29/17 1035 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540252
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/29/17 - 0900
Last Actual Administration Time: 08/29/17 - 0900 (Not Given)
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/29/17 - 1033
New Order Start: 08/29/17 - 2100
New Order Stop: 09/25/17 - 0859
08/29/17 1040 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by NBALCETIS Eff: 08/29/17 1035
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/29/17 - 0900
Last Actual Administration Time: 08/29/17 - 0900 (Not Given)
Old Freq/Sch: 2 TIMES A DAY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/29/17 - 1033
New Order Start: 08/29/17 - 2100
New Order Stop: 09/25/17 - 0859
08/29/17 1040 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 22 Total Costs $0.00 Total Charges $375.84
Rx Number 01540248

Warnings
Type: BURKE
Range: PROTONIX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/DAY - 40 MG/DAY. Ordered dose of 80 MG/DAY is
above the Daily Dose range but not greater than the Maximum Daily Dose
of 240 MG/DAY.

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2102 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 8
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01540255

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2103 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 08/25/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

SMV10T - SIMVASTATIN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $2.70
Rx Number 01540254

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2103 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059 DC: 08/29/17-1033
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01540249

Discontinued Comments dc

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2102 - VERIFIED by AADEGBAMIG
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/29/17 1035 - DISCONTINUE by NBALCETIS Eff: 08/29/17 1033
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/29/17 1041 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 08/29/17 1035
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859 DC: 08/29/17-1033
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $4.08
Rx Number 01540250

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2102 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 8
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/29/17 1035 - DISCONTINUE by NBALCETIS Eff: 08/29/17 1033
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/29/17 1035 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427021
08/29/17 1041 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 08/29/17 1035
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/26/17-0900 Stop Date 08/29/17 1033 DC: 08/29/17-1033
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $1.50
Rx Number 01540252

History
08/25/17 2058 - POM ORDER by YIVANOV
08/25/17 2102 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 8
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/29/17 1035 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/26/17-0900 STOP: 09/25/17 0859 SOFT STOP: 0
DISPENSE: 4
TO:
START: 08/26/17-0900 STOP: 08/29/17-1033 SOFT STOP:
DISPENSE: 7
08/29/17 1035 - DISCONTINUE by NBALCETIS Eff: 08/29/17 1033
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/29/17 1035 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427022
08/29/17 1041 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by NBALCETIS Eff: 08/29/17 1035
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

DANGELICA,DOMENICK W00001219491 (Continued)

Discontinue by NBALCETIS Eff: 08/29/17 1035

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient DELLACAVA,JANE Responsible Doctor ELASHVILI, MERY

Account Number W00001217873 Location B2EA Unit Number M000208735
Age/Sex 65/F Room 207 Registered Date 07/31/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 5.98 in 167.6 cm Body Surface Area 1.94 m2

Weight 186 lb oz 84.368 kg
Hem-Onc No

Drug Allergies Penicillins

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 4 GM (4 GEL APPLICATIONS)

Dose Instructions TO LOWER BACK AND GLUTEUS, LEFT LATERAL FOOT, LEFT SHOULDER
AND FINGERS, AREA OF SPINE AND BILATERALLY AROUND IT.
MAX DOSE/DAY =32GM
Admin Route TOPICALLY
Frequency 4 TIMES A DAY (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/14/17-1500 Stop Date 09/13/17 1459
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $108.60
Rx Number 01536584

History
08/14/17 1455 - ENTER by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/14/17 - 1500
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions right arm: redness on anticubital
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541900

History
09/01/17 1159 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540599
09/01/17 1209 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
DISPENSE: 1
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP: 0
DISPENSE: 0
09/01/17 1210 - VERIFIED by AMOLINARI

LTN005OP2 - LATANOPROST 0.005% OP SOLN 2.5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions each eye
Admin Route OPHTHALMIC
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540602

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01533073
08/28/17 1149 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/27/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/28/17-2100 STOP: 09/27/17-2059 SOFT STOP: 0
DISPENSE: 0
08/28/17 1149 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

LEVA0.63 - LEVALBUTEROL HCL 0.63 MG/3 ML VIAL

Dose 0.63 MG (3 ML)

Admin Route NEBULIZER
Frequency EVERY 6 HOURS (SCH)
Start Date 08/28/17-1200 Stop Date 09/21/17 1159
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 24 Total Costs $0.00 Total Charges $444.96
Rx Number 01540606

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01535115
08/28/17 1155 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1200 STOP: 09/21/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/28/17-1200 STOP: 09/21/17-1159 SOFT STOP: 0
DISPENSE: 0
08/28/17 1155 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by KMCCOY Eff: 08/28/17 1153
08/28/17 1155 - VERIFIED by MHAIMOWITZ
08/30/17 1023 - DEBIT by AMOLINARI
ITEMS: 1
09/02/17 1019 - DEBIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

SLFL50500 - SALMETEROL XINAF/FLUTICASONE 50-500 MCG/DOSE DISK

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 08/28/17-1700 Stop Date 09/27/17 1659
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540612

History
08/28/17 0920 - POM COPY AND EDIT by YCHO
FROM: Rx #01533074
08/28/17 1159 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1700 STOP: 09/27/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/28/17-1700 STOP: 09/27/17-1659 SOFT STOP: 0
DISPENSE: 0
08/28/17 1159 - VERIFIED by MHAIMOWITZ

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD, MODERATE AND SEVERE PAIN
Start Date 08/28/17-0930 Stop Date 09/27/17 0929
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01540591

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01534531
08/28/17 1140 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0930 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-0930 STOP: 09/27/17-0929 SOFT STOP: 0
08/28/17 1140 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/27/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $0.60
Rx Number 01540592

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01533336
08/28/17 1140 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0900 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/29/17-0900 STOP: 09/27/17-0859 SOFT STOP: 0
08/28/17 1140 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $409.80
Rx Number 01540593

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01533069
08/28/17 1141 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/27/17-2059 SOFT STOP: 0
08/28/17 1141 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/17/17-1045 Stop Date 09/16/17 1044
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537524

History
08/17/17 1033 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01533173
08/17/17 1037 - VERIFIED by AMOLINARI
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 1,000 UNIT (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/01/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $0.26
Rx Number 01541899

History
09/01/17 1159 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01534342
09/01/17 1209 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
09/01/17 1209 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/02/17-0900 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/02/17-0900 STOP: 10/01/17-0859 SOFT STOP: 0

CLON0.126 - CLONAZEPAM 0.125 MG ORALLY DISINTEGRATING TAB

Dose 0.125 MG (1 TAB.RAPDIS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/04/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01541527

History
08/31/17 1008 - POM COPY AND EDIT by YCHO
FROM: Rx #01540594
08/31/17 1019 - EDIT by AMOLINARI
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-0900 STOP: 09/04/17 SOFT STOP:
TO:
START: 09/01/17-0900 STOP: 09/04/17-0859 SOFT STOP: 0
08/31/17 1019 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 1,000 MCG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 9 Total Costs $0.00 Total Charges $0.48
Rx Number 01540595

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01533371
08/28/17 1144 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/27/17-2059 SOFT STOP: 0
08/28/17 1144 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

DLT90T - DILTIAZEM HCL 90 MG TAB

Dose 90 MG (1 TABLET)
Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/28/17-1300 Stop Date 09/27/17 1259
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 35 Total Costs $0.00 Total Charges $23.25
Rx Number 01540596

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01533070
08/28/17 1145 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1300 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-1300 STOP: 09/27/17-1259 SOFT STOP: 0
08/28/17 1145 - VERIFIED by MHAIMOWITZ
Items Dispensed: 15 Doses Dispensed: 15
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 09/04/17 - 0900

For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
For: 09/05/17 - 2100

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/27/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $511.38
Rx Number 01540597

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.47
MG/KG/DAY is below the Low Daily Dose.

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01533076
08/28/17 1145 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0900 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/29/17-0900 STOP: 09/27/17-0859 SOFT STOP: 0
08/28/17 1145 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

FLX20C - FLUOXETINE HCL 20 MG CAP

Dose 20 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/21/17-1800 Stop Date 09/20/17 1759
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 16 Total Costs $0.00 Total Charges $6.50
Rx Number 01538606

History
08/21/17 1210 - POM ORDER by YCHO
08/21/17 1419 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 1800
For: 08/22/17 - 1800
For: 08/23/17 - 1800
For: 08/24/17 - 1800
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1800
For: 08/26/17 - 1800
For: 08/27/17 - 1800
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1800
For: 08/29/17 - 1800
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1800
For: 08/31/17 - 1800
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1800
For: 09/02/17 - 1800
For: 09/03/17 - 1800
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1800
For: 09/05/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 9 Total Costs $0.00 Total Charges $1.80
Rx Number 01540598

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01533372
08/28/17 1146 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/27/17-2059 SOFT STOP: 0
08/28/17 1146 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/14/17-2100 Stop Date 09/13/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 23 Total Costs $0.00 Total Charges $3.00
Rx Number 01536528

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 100 MG/DAY
is below the Low Daily Dose.

History
08/14/17 1233 - POM ORDER by YCHO
08/14/17 1234 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 2100
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency EVERY 4 HOURS (PRN) PRN REASON: SOB - For Shortness of Breath
Start Date 08/28/17-0930 Stop Date 09/27/17 0929
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540600

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01533072
08/28/17 1147 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0930 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-0930 STOP: 09/27/17-0929 SOFT STOP: 0
08/28/17 1147 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-0930 Stop Date 09/27/17 0929
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540607

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01533063
08/28/17 1156 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0930 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-0930 STOP: 09/27/17-0929 SOFT STOP: 0
08/28/17 1156 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MGX400T - MAGNESIUM OXIDE 400 MG TAB

Dose 400 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY@1800,2200 (SCH)
Start Date 08/28/17-1800 Stop Date 09/24/17 1759
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $1.56
Rx Number 01540608

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01534784
08/28/17 1157 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1800 STOP: 09/24/17 SOFT STOP:
TO:
START: 08/28/17-1800 STOP: 09/24/17-1759 SOFT STOP: 0
08/28/17 1157 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 1800
For: 08/28/17 - 2200
For: 08/29/17 - 1800
For: 08/29/17 - 2200
For: 08/30/17 - 1800
For: 08/30/17 - 2200
For: 08/31/17 - 1800
For: 08/31/17 - 2200
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 1800
For: 09/01/17 - 2200
For: 09/02/17 - 1800
For: 09/02/17 - 2200
For: 09/03/17 - 1800
For: 09/03/17 - 2200
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 1800
For: 09/04/17 - 2200
For: 09/05/17 - 1800
For: 09/05/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 6 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 52 Total Costs $0.00 Total Charges $9.20
Rx Number 01535991

History
08/11/17 0944 - POM COPY AND EDIT by YCHO
FROM: Rx #01535375
08/11/17 1146 - VERIFIED by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 5
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 09/02/17 - 2100

For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 750 MG (1.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 40 Total Costs $0.00 Total Charges $63.00
Rx Number 01537287

History
08/16/17 1558 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01533337
08/16/17 1559 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MTC5T - METOCLOPRAMIDE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency WITH MEALS & BEDTIME (SCH)
Start Date 08/16/17-1200 Stop Date 09/15/17 1159
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 83 Total Costs $0.00 Total Charges $35.04
Rx Number 01537186

History
08/16/17 1159 - POM ORDER by YCHO
08/16/17 1206 - VERIFIED by AMACCA
Items Dispensed: 19 Doses Dispensed: 19
For: 08/16/17 - 1200
For: 08/16/17 - 1700
For: 08/16/17 - 2200
For: 08/17/17 - 0800
For: 08/17/17 - 1200
For: 08/17/17 - 1700
For: 08/17/17 - 2200
For: 08/18/17 - 0800
For: 08/18/17 - 1200
For: 08/18/17 - 1700
For: 08/18/17 - 2200
For: 08/19/17 - 0800
For: 08/19/17 - 1200
For: 08/19/17 - 1700
For: 08/19/17 - 2200
For: 08/20/17 - 0800
For: 08/20/17 - 1200
For: 08/20/17 - 1700
For: 08/20/17 - 2200
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/21/17 - 0800
For: 08/21/17 - 1200
For: 08/21/17 - 1700
For: 08/21/17 - 2200
For: 08/22/17 - 0800
For: 08/22/17 - 1200
For: 08/22/17 - 1700
For: 08/22/17 - 2200
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/23/17 - 0800
For: 08/23/17 - 1200
For: 08/23/17 - 1700
For: 08/23/17 - 2200
For: 08/24/17 - 0800
For: 08/24/17 - 1200
For: 08/24/17 - 1700
For: 08/24/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

08/23/17 0824 - FILL by AMOLINARI

Items Dispensed: 12 Doses Dispensed: 12
For: 08/25/17 - 0800
For: 08/25/17 - 1200
For: 08/25/17 - 1700
For: 08/25/17 - 2200
For: 08/26/17 - 0800
For: 08/26/17 - 1200
For: 08/26/17 - 1700
For: 08/26/17 - 2200
For: 08/27/17 - 0800
For: 08/27/17 - 1200
For: 08/27/17 - 1700
For: 08/27/17 - 2200
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 0800
For: 08/28/17 - 1200
For: 08/28/17 - 1700
For: 08/28/17 - 2200
For: 08/29/17 - 0800
For: 08/29/17 - 1200
For: 08/29/17 - 1700
For: 08/29/17 - 2200
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/30/17 - 0800
For: 08/30/17 - 1200
For: 08/30/17 - 1700
For: 08/30/17 - 2200
For: 08/31/17 - 0800
For: 08/31/17 - 1200
For: 08/31/17 - 1700
For: 08/31/17 - 2200
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 09/01/17 - 0800
For: 09/01/17 - 1200
For: 09/01/17 - 1700
For: 09/01/17 - 2200
For: 09/02/17 - 0800
For: 09/02/17 - 1200
For: 09/02/17 - 1700
For: 09/02/17 - 2200
For: 09/03/17 - 0800
For: 09/03/17 - 1200
For: 09/03/17 - 1700
For: 09/03/17 - 2200
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 09/04/17 - 0800
For: 09/04/17 - 1200
For: 09/04/17 - 1700
For: 09/04/17 - 2200
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 09/05/17 - 1200

For: 09/05/17 - 1700
For: 09/05/17 - 2200

NCT14TD - NICOTINE 14 MG/24 HR TDSY

Dose 1 EA (1 TRANSDERMAL SYSTEM)

Admin Route TRANSDERM.
Frequency DAILY@1800 (SCH)
Start Date 08/28/17-1800 Stop Date 09/27/17 1759
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 9 Total Costs $0.00 Total Charges $26.70
Rx Number 01540839

History
08/28/17 1735 - POM ORDER by YCHO
08/28/17 1739 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 1800
For: 08/29/17 - 1800
For: 08/30/17 - 1800
For: 08/31/17 - 1800
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1800
For: 09/02/17 - 1800
For: 09/03/17 - 1800
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1800
For: 09/05/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 3 EA (0 EACHS)
Admin Route ORAL
Frequency 7 TIMES A DAY (SCH)
Start Date 08/28/17-1200 Stop Date 09/27/17 1159
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 35 Total Costs $0.00 Total Charges $0.00
Rx Number 01540610

History
08/28/17 0920 - POM COPY AND EDIT by YCHO
FROM: Rx #01533382
08/28/17 1157 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1200 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-1200 STOP: 09/27/17-1159 SOFT STOP: 0
08/28/17 1157 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 21 Doses Dispensed: 21
For: 09/01/17 - 0900
For: 09/01/17 - 1200
For: 09/01/17 - 1500
For: 09/01/17 - 1800
For: 09/01/17 - 2100
For: 09/02/17 - 0000
For: 09/02/17 - 0600
For: 09/02/17 - 0900
For: 09/02/17 - 1200
For: 09/02/17 - 1500
For: 09/02/17 - 1800
For: 09/02/17 - 2100
For: 09/03/17 - 0000
For: 09/03/17 - 0600
For: 09/03/17 - 0900
For: 09/03/17 - 1200
For: 09/03/17 - 1500
For: 09/03/17 - 1800
For: 09/03/17 - 2100
For: 09/04/17 - 0000
For: 09/04/17 - 0600
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 14 Doses Dispensed: 14
For: 09/04/17 - 0900
For: 09/04/17 - 1200
For: 09/04/17 - 1500
For: 09/04/17 - 1800
For: 09/04/17 - 2100
For: 09/05/17 - 0000
For: 09/05/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 09/05/17 - 0900

For: 09/05/17 - 1200
For: 09/05/17 - 1500
For: 09/05/17 - 1800
For: 09/05/17 - 2100
For: 09/06/17 - 0000
For: 09/06/17 - 0600

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 09/01/17-0800 Stop Date 10/01/17 0759
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $2.64
Rx Number 01541634

History
08/31/17 1448 - POM ORDER by YCHO
08/31/17 1448 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY@1300 (SCH)
Start Date 08/28/17-1300 Stop Date 09/29/17 1259
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540611

History
08/28/17 0920 - POM COPY AND EDIT by YCHO
FROM: Rx #01533370
08/28/17 1158 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1300 STOP: 09/29/17 SOFT STOP:
TO:
START: 08/28/17-1300 STOP: 09/29/17-1259 SOFT STOP: 0
08/28/17 1158 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1300
For: 09/02/17 - 1300
For: 09/03/17 - 1300
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1300
For: 09/05/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@1600 (SCH)
Start Date 08/28/17-1600 Stop Date 09/17/17 1559
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $0.60
Rx Number 01540613

History
08/28/17 0920 - POM COPY AND EDIT by YCHO
FROM: Rx #01535376
08/28/17 1159 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1600 STOP: 09/17/17 SOFT STOP:
TO:
START: 08/28/17-1600 STOP: 09/17/17-1559 SOFT STOP: 0
08/28/17 1159 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 1600
For: 08/29/17 - 1600
For: 08/30/17 - 1600
For: 08/31/17 - 1600
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1600
For: 09/02/17 - 1600
For: 09/03/17 - 1600
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1600
For: 09/05/17 - 1600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 2 GM (2 GEL APPLICATIONS)

Dose Instructions to left ankle and left lateral foot
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-0900 Stop Date 08/11/17 0942 DC: 08/11/17-0942
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $108.60
Rx Number 01535912

History
08/10/17 2206 - POM ORDER by MELASHVI
08/11/17 0723 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 0900
08/11/17 0943 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/11/17-0900 STOP: 09/10/17 0859 SOFT STOP: 0
TO:
START: 08/11/17-0900 STOP: 08/11/17-0942 SOFT STOP:
08/11/17 0943 - DISCONTINUE by YCHO Eff: 08/11/17 0942
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/11/17 0943 - POM COPY AND EDIT by YCHO
TO: Rx #U01422297
08/11/17 1147 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YCHO Eff: 08/11/17 0943
Discontinue by YCHO Eff: 08/11/17 0943
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 2 GM (2 GEL APPLICATIONS)

Dose Instructions to left ankle and left lateral foot
Admin Route TOPICALLY
Frequency DAILY@0700,1900 (SCH)
Start Date 08/11/17-1900 Stop Date 09/10/17 0859 DC: 08/11/17-1900
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01535992

History
08/11/17 0943 - POM COPY AND EDIT by YCHO
FROM: Rx #01535912
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/11/17 - 0900
Last Actual Administration Time: 08/11/17 - 0914
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: DAILY@0700,1900 (SCH)
Old Order Stop: 08/11/17 - 0942
New Order Start: 08/11/17 - 1900
New Order Stop: 09/10/17 - 0859
08/11/17 1147 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by YCHO Eff: 08/11/17 0943
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/11/17 - 0900
Last Actual Administration Time: 08/11/17 - 0914
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: DAILY@0700,1900 (SCH)
Old Order Stop: 08/11/17 - 0942
New Order Start: 08/11/17 - 1900
New Order Stop: 09/10/17 - 0859
08/11/17 1147 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 1900
08/11/17 1147 - CREDIT by AMOLINARI
ITEMS: 1
08/11/17 1727 - DISCONTINUE by YCHO Eff: 08/11/17 1900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/11/17 1727 - POM COPY AND EDIT by YCHO
TO: Rx #U01422574
08/11/17 1802 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by YCHO Eff: 08/11/17 1727
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 4 GM (4 GEL APPLICATIONS)

Dose Instructions to lower back and gluteus (area spine and bilaterally
around it also )
Admin Route TOPICALLY
Frequency 4 TIMES A DAY (SCH)
Start Date 08/11/17-1700 Stop Date 09/10/17 1659 DC: 08/14/17-1440
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $108.60
Rx Number 01536207

History
08/11/17 1655 - POM ORDER by YCHO
08/11/17 1710 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 1700
08/14/17 1444 - DISCONTINUE by MELASHVI Eff: 08/14/17 1440
EDIT DOCTOR: ELASHVILI, MERY
08/14/17 1445 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01422877
08/14/17 1445 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 08/14/17 1444
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 2 GM (2 GEL APPLICATIONS)

Dose Instructions to left ankle and left lateral foot
Admin Route TOPICALLY
Frequency DAILY@0700,2100 (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 0859 DC: 08/14/17-1440
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $108.60
Rx Number 01536257

History
08/11/17 1727 - POM COPY AND EDIT by YCHO
FROM: Rx #01535992
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/11/17 - 1900
Last Actual Administration Time:
Old Freq/Sch: DAILY@0700,1900 (SCH)
New Freq/Sch: DAILY@0700,2100 (SCH)
Old Order Stop: 08/11/17 - 1900
New Order Start: 08/11/17 - 2100
New Order Stop: 09/10/17 - 0859
08/11/17 1802 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by YCHO Eff: 08/11/17 1727
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/11/17 - 1900
Last Actual Administration Time:
Old Freq/Sch: DAILY@0700,1900 (SCH)
New Freq/Sch: DAILY@0700,2100 (SCH)
Old Order Stop: 08/11/17 - 1900
New Order Start: 08/11/17 - 2100
New Order Stop: 09/10/17 - 0859
08/11/17 1802 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 2100
08/14/17 1444 - DISCONTINUE by MELASHVI Eff: 08/14/17 1440
EDIT DOCTOR: ELASHVILI, MERY
08/14/17 1445 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 08/14/17 1444
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 4 GM (4 GEL APPLICATIONS)

Dose Instructions to lower back and gluteus ,left lateral foot , left
shoulder and fingers.(area spine and bilaterally around it
also )
Admin Route TOPICALLY
Frequency 4 TIMES A DAY (SCH)
Start Date 08/14/17-1700 Stop Date 09/13/17 1659 DC: 08/14/17-1700
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536582

History
08/14/17 1445 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01536207
08/14/17 1453 - DISCONTINUE by AMACCA Eff: 08/14/17 1700
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/14/17 1453 - VERIFIED by SYSTEM
Verified in order to DC

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/27/17-2100 Stop Date 09/03/17 2059 DC: 08/27/17-2100
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540444

History
08/27/17 1044 - POM ORDER by YCHO
08/27/17 1048 - VERIFIED by SYSTEM
Verified in order to DC
08/27/17 1048 - DISCONTINUE by YCHO Eff: 08/27/17 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/27/17 1048 - POM COPY AND EDIT by YCHO
TO: Rx #U01426585
08/28/17 0739 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 08/27/17 1048
Discontinue by YCHO Eff: 08/27/17 1048
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions right arm: redness on anticubital
Admin Route TOPICALLY
Frequency ONETIME (ONE)
Start Date 08/27/17-1045 Stop Date 08/27/17 1046 DC: 08/27/17-1046
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $7.98
Rx Number 01540448

Discontinued Comments Reached Stop Date

History
08/27/17 1047 - POM ORDER by YCHO
08/27/17 1052 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/27/17 - 1045
08/27/17 1052 - DISCONTINUE by PHABKGJOB Eff: 08/27/17 1046
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions right arm: redness on anticubital
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/27/17-2100 Stop Date 09/03/17 2059 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $7.98
Rx Number 01540449

History
08/27/17 1048 - POM COPY AND EDIT by YCHO
FROM: Rx #01540444
08/27/17 1052 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/27/17 - 2100
08/28/17 0919 - DISCONTINUE by YCHO Eff: 08/28/17 0917
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426684
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0919
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions right arm: redness on anticubital
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-1158
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $7.98
Rx Number 01540599

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01540449
08/28/17 1147 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/04/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/28/17-2100 STOP: 09/04/17-2059 SOFT STOP: 0
DISPENSE: 0
08/28/17 1147 - VERIFIED by MHAIMOWITZ
08/29/17 2019 - DEBIT by MHAIMOWITZ
ITEMS: 1
09/01/17 1159 - DISCONTINUE by EALEXEEV Eff: 09/01/17 1158
EDIT DOCTOR: Alexeev,Edward MD PGY-4
09/01/17 1159 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427939
09/01/17 1210 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 09/01/17 1159
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

LTN005OP2 - LATANOPROST 0.005% OP SOLN 2.5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions each eye
Admin Route OPHTHALMIC
Frequency NIGHTLY (SCH)
Start Date 07/31/17-2100 Stop Date 08/30/17 2059 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $570.00
Rx Number 01533073

History
07/31/17 1329 - POM ORDER by YCHO
07/31/17 1441 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 2100
08/03/17 0827 - DEBIT by AMOLINARI
ITEMS: 1
08/03/17 0827 - CREDIT by AMOLINARI
ITEMS: 1
08/11/17 2023 - DEBIT by AMACCA
ITEMS: 1
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426686
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

LEVA0.63 - LEVALBUTEROL HCL 0.63 MG/3 ML VIAL

Dose 0.63 MG (3 ML)

Admin Route NEBULIZER
Frequency EVERY 8 HOURS (SCH)
Start Date 08/02/17-1400 Stop Date 08/08/17 1106 DC: 08/08/17-1106
Ordering Doctor ELASHVILI, MERY
Total Dispensed 24 Total Costs $0.00 Total Charges $444.96
Rx Number 01533616

History
08/02/17 1104 - POM ORDER by MELASHVI
08/02/17 1134 - VERIFIED by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 1
For: 08/02/17 - 1400
08/03/17 2026 - DEBIT by EBALILO
ITEMS: 1
08/08/17 1110 - EDIT by MELASHVI
EDIT DOCTOR: ELASHVILI, MERY
FROM:
START: 08/02/17-1400 STOP: 09/01/17 1359 SOFT STOP: 0
TO:
START: 08/02/17-1400 STOP: 08/08/17-1106 SOFT STOP:
08/08/17 1110 - DISCONTINUE by MELASHVI Eff: 08/08/17 1106
EDIT DOCTOR: ELASHVILI, MERY
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/08/17 1111 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01421460
08/08/17 1127 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by MELASHVI Eff: 08/08/17 1110
Discontinue by MELASHVI Eff: 08/08/17 1110
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

LEVA0.63 - LEVALBUTEROL HCL 0.63 MG/3 ML VIAL

Dose 0.63 MG (3 ML)

Admin Route NEBULIZER
Frequency EVERY 6 HOURS (SCH)
Start Date 08/08/17-1200 Stop Date 09/01/17 1359 DC: 08/28/17-0917
Ordering Doctor ELASHVILI, MERY
Total Dispensed 60 Total Costs $0.00 Total Charges $1112.40
Rx Number 01535115

History
08/08/17 1111 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01533616
Result of Frequency/Schedule Edit
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 08/08/17 - 0600
Last Actual Administration Time: 08/08/17 - 0623
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 6 HOURS (SCH)
Old Order Stop: 08/08/17 - 1106
New Order Start: 08/08/17 - 1200
New Order Stop: 09/01/17 - 1359
08/08/17 1127 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by MELASHVI Eff: 08/08/17 1111
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 08/08/17 - 0600
Last Actual Administration Time: 08/08/17 - 0623
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 6 HOURS (SCH)
Old Order Stop: 08/08/17 - 1106
New Order Start: 08/08/17 - 1200
New Order Stop: 09/01/17 - 1359
08/08/17 1127 - VERIFIED by EBALILO
Items Dispensed: 12 Doses Dispensed: 1
For: 08/08/17 - 1200
08/08/17 1128 - CREDIT by EBALILO
ITEMS: 1
08/15/17 0751 - DEBIT by AMOLINARI
ITEMS: 1
08/16/17 0731 - DEBIT by AMOLINARI
ITEMS: 1
08/21/17 1024 - DEBIT by EBALILO
ITEMS: 1
08/24/17 1907 - DEBIT by EBALILO
ITEMS: 1
08/28/17 0739 - DEBIT by AMOLINARI
ITEMS: 1
08/28/17 0919 - DISCONTINUE by YCHO Eff: 08/28/17 0917
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426687
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0919
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/02/17-2100 Stop Date 09/01/17 2059 DC: 08/11/17-1729
Ordering Doctor ELASHVILI, MERY
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01533617

History
08/02/17 1104 - POM ORDER by MELASHVI
08/02/17 1134 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 08/02/17 - 2100
08/11/17 1731 - DISCONTINUE by YCHO Eff: 08/11/17 1729
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/11/17 1731 - POM COPY AND EDIT by YCHO
TO: Rx #U01422577
08/11/17 1802 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by YCHO Eff: 08/11/17 1731

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/11/17-2100
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536221

History
08/11/17 1716 - POM ORDER by YCHO
08/11/17 1727 - DISCONTINUE by YCHO Eff: 08/11/17 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/11/17 1727 - VERIFIED by SYSTEM
Verified in order to DC
08/11/17 1727 - POM COPY AND EDIT by YCHO
TO: Rx #U01422575
08/11/17 1802 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by SYSTEM Eff: 08/11/17 1727
Discontinue by YCHO Eff: 08/11/17 1727
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions to the back lower
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/25/17-1247
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01536258

Discontinued Comments pain resolved

History
08/11/17 1727 - POM COPY AND EDIT by YCHO
FROM: Rx #01536221
08/11/17 1803 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 1
For: 08/11/17 - 2100
08/12/17 0946 - DEBIT by AMACCA
ITEMS: 1
08/25/17 1251 - DISCONTINUE by YCHO Eff: 08/25/17 1247
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
pain resolved
08/25/17 1252 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/25/17 1251
pain resolved
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions left ankle
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/25/17-1247
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01536259

Discontinued Comments pain resolved

History
08/11/17 1731 - POM COPY AND EDIT by YCHO
FROM: Rx #01533617
08/11/17 1803 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 1
For: 08/11/17 - 2100
08/25/17 1251 - DISCONTINUE by YCHO Eff: 08/25/17 1247
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
pain resolved
08/25/17 1252 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/25/17 1251
pain resolved
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 3 EA (0 EACHS)
Admin Route ORAL
Frequency 7 TIMES A DAY (SCH)
Start Date 08/01/17-1500 Stop Date 08/31/17 1459 DC: 08/28/17-0917
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533382

History
08/01/17 1247 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01533066
08/01/17 1249 - EDIT by AMACCA
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
LABEL COMMENTS:
TO:
ORDER TYPE: BULK - BULK ORDER
LABEL COMMENTS:
any liquids 3 OZ
08/01/17 1249 - VERIFIED by AMACCA
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0920 - POM COPY AND EDIT by YCHO
TO: Rx #U01426694
08/28/17 1201 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

SLFL50500 - SALMETEROL XINAF/FLUTICASONE 50-500 MCG/DOSE DISK

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 07/31/17-1700 Stop Date 08/30/17 1659 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $1646.28
Rx Number 01533074

History
07/31/17 1329 - POM ORDER by YCHO
07/31/17 1441 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 1700
08/07/17 1834 - DEBIT by AMACCA
ITEMS: 1
08/19/17 1222 - DEBIT by JSATTARELL
ITEMS: 1
08/25/17 1408 - DEBIT by AADEGBAMIG
ITEMS: 1
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0920 - POM COPY AND EDIT by YCHO
TO: Rx #U01426692
08/28/17 1201 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 07/31/17-1230 Stop Date 08/30/17 1229 DC: 08/04/17-1958
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01533061

History
07/31/17 1221 - POM ORDER by YCHO
07/31/17 1440 - VERIFIED by AADEGBAMIG
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 1959 - DISCONTINUE by JRUSSO Eff: 08/04/17 1958
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/04/17 1959 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01420882
08/04/17 2019 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by JRUSSO Eff: 08/04/17 1959
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY@0700,1200 (SCH)
Start Date 08/01/17-0700 Stop Date 08/31/17 0659 DC: 08/04/17-1952
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01533075

History
07/31/17 1436 - POM ORDER by MELASHVI
07/31/17 1441 - VERIFIED by AADEGBAMIG
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 1200
For: 08/05/17 - 0700
For: 08/05/17 - 1200
For: 08/06/17 - 0700
For: 08/06/17 - 1200
For: 08/07/17 - 0700
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 1200
For: 08/08/17 - 0700
For: 08/08/17 - 1200
For: 08/09/17 - 0700
08/04/17 1954 - DISCONTINUE by SDAS Eff: 08/04/17 1952
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/04/17 2019 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SDAS Eff: 08/04/17 1954
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD, MODERATE AND SEVERE PAIN
Start Date 08/04/17-2000 Stop Date 09/03/17 1959 DC: 08/28/17-0917
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $11.25
Rx Number 01534531

History
08/04/17 1959 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01533061
08/04/17 2019 - VERIFIED by MHAIMOWITZ
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0919 - DISCONTINUE by YCHO Eff: 08/28/17 0917
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426676
08/28/17 1159 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0919
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/31/17 0859 DC: 08/01/17-1018
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01533068

History
07/31/17 1329 - POM ORDER by YCHO
07/31/17 1440 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/01/17 1021 - DISCONTINUE by YCHO Eff: 08/01/17 1018
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/01/17 1048 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/01/17 1021
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/02/17-0900 Stop Date 09/01/17 0859 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 27 Total Costs $0.00 Total Charges $2.80
Rx Number 01533336

History
08/01/17 1022 - POM ORDER by YCHO
08/01/17 1025 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 08/23/17 - 0900

For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426677
08/28/17 1159 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/31/17-2100 Stop Date 08/30/17 2059 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 56 Total Costs $0.00 Total Charges $1882.90
Rx Number 01533069

History
07/31/17 1329 - POM ORDER by YCHO
07/31/17 1440 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 07/31/17 - 2100
For: 08/01/17 - 2100
For: 08/02/17 - 2100
For: 08/03/17 - 2100
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

08/21/17 0830 - FILL by AMOLINARI

Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426678
08/28/17 1159 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/31/17-1230 Stop Date 08/30/17 1229 DC: 07/31/17-1611
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533062

History
07/31/17 1222 - POM ORDER by YCHO
07/31/17 1440 - VERIFIED by AADEGBAMIG
07/31/17 1614 - DISCONTINUE by MELASHVI Eff: 07/31/17 1611
EDIT DOCTOR: ELASHVILI, MERY
07/31/17 1614 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01419605
08/01/17 1048 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by MELASHVI Eff: 07/31/17 1614
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/31/17-1615 Stop Date 08/30/17 1614 DC: 08/17/17-1031
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01533173

History
07/31/17 1614 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01533062
07/31/17 1615 - VERIFIED by AADEGBAMIG
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/17/17 1033 - DISCONTINUE by MELASHVI Eff: 08/17/17 1031
EDIT DOCTOR: ELASHVILI, MERY
08/17/17 1033 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01423781
08/17/17 1038 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by MELASHVI Eff: 08/17/17 1033
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency 1611 (ONE)
Start Date 07/31/17-1611 Stop Date 07/31/17 1612 DC: 07/31/17-1612
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01533175

Discontinued Comments Reached Stop Date

History
07/31/17 1614 - POM ORDER by MELASHVI
07/31/17 1615 - VERIFIED by AADEGBAMIG
07/31/17 1615 - DISCONTINUE by PHABKGJOB Eff: 07/31/17 1612
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency 1800 (ONE)
Start Date 08/17/17-1800 Stop Date 08/17/17 1801 DC: 08/17/17-1801
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537525

Discontinued Comments Reached Stop Date

History
08/17/17 1033 - POM ORDER by MELASHVI
08/17/17 1037 - VERIFIED by AMOLINARI
08/17/17 1801 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 1801
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 08/21/17-1700 Stop Date 08/21/17 1701 DC: 08/21/17-1701
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538492

Discontinued Comments Reached Stop Date

History
08/21/17 0935 - POM ORDER by YCHO
08/21/17 1025 - VERIFIED by EBALILO
08/21/17 1701 - DISCONTINUE by PHABKGJOB Eff: 08/21/17 1701
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 08/25/17-1730 Stop Date 08/25/17 1731 DC: 08/25/17-1730
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540019

Discontinued Comments wrong time

History
08/25/17 1248 - POM ORDER by YCHO
08/25/17 1252 - VERIFIED by AMOLINARI
08/25/17 1301 - DISCONTINUE by YCHO Eff: 08/25/17 1730
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
wrong time
08/28/17 0739 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/25/17 1301
wrong time
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 08/25/17-1600 Stop Date 08/25/17 1601 DC: 08/25/17-1601
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540027

Discontinued Comments Reached Stop Date

History
08/25/17 1302 - POM ORDER by YCHO
08/25/17 1315 - VERIFIED by AADEGBAMIG
08/25/17 1602 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 1601
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 1,000 UNIT (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/05/17-0900 Stop Date 09/04/17 0859 DC: 09/01/17-1158
Ordering Doctor ELASHVILI, MERY
Total Dispensed 28 Total Costs $0.00 Total Charges $3.64
Rx Number 01534342

History
08/04/17 1547 - POM ORDER by MELASHVI
08/04/17 1549 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

08/25/17 0836 - FILL by AMOLINARI

Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 1159 - DISCONTINUE by EALEXEEV Eff: 09/01/17 1158
Items Auto Credited: 2 Doses Auto Credited: 2
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
09/01/17 1159 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427938
09/01/17 1210 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 09/01/17 1159

CLNZ.5T - CLONAZEPAM 0.5 MG TAB

Dose 0.125 MG (0.25 TABLETS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: anxiety or crying
Start Date 08/21/17-1230 Stop Date 08/28/17 1229 DC: 08/21/17-1434
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538615

History
08/21/17 1224 - POM ORDER by YCHO
08/21/17 1435 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 1434
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/21/17 1435 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

CLON0.126 - CLONAZEPAM 0.125 MG ORALLY DISINTEGRATING TAB

Dose 0.125 MG (1 TAB.RAPDIS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: anxiety or crying
Start Date 08/21/17-1445 Stop Date 08/28/17 1444 DC: 08/25/17-0844
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538614

History
08/21/17 1434 - ENTER by AADEGBAMIG
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0845 - DISCONTINUE by YCHO Eff: 08/25/17 0844
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/25/17 0845 - POM COPY AND EDIT by YCHO
TO: Rx #U01426054
08/25/17 1222 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/25/17 0845
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

CLON0.126 - CLONAZEPAM 0.125 MG ORALLY DISINTEGRATING TAB

Dose 0.125 MG (1 TAB.RAPDIS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: anxiety or crying
Start Date 08/25/17-0845 Stop Date 08/25/17 1300 DC: 08/25/17-1300
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539919

History
08/25/17 0845 - POM COPY AND EDIT by YCHO
FROM: Rx #01538614
08/25/17 1222 - EDIT by AMOLINARI
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-0845 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-0845 STOP: 09/01/17-0844 SOFT STOP: 0
08/25/17 1222 - VERIFIED by AMOLINARI
08/25/17 1301 - DISCONTINUE by YCHO Eff: 08/25/17 1300
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/25/17 1301 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/25/17-0845 STOP: 09/01/17 0844 SOFT STOP: 0
TO:
START: 08/25/17-0845 STOP: 08/25/17-1300 SOFT STOP:
08/25/17 1301 - POM COPY AND EDIT by YCHO
TO: Rx #U01426204
08/28/17 0739 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YCHO Eff: 08/25/17 1301
Discontinue by YCHO Eff: 08/25/17 1301
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

CLON0.126 - CLONAZEPAM 0.125 MG ORALLY DISINTEGRATING TAB

Dose 0.125 MG (1 TAB.RAPDIS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/01/17 0844 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540026

History
08/25/17 1301 - POM COPY AND EDIT by YCHO
FROM: Rx #01539919
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/25/17 - 1300
New Order Start: 08/26/17 - 0900
New Order Stop: 09/01/17 - 0844
08/25/17 1314 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by YCHO Eff: 08/25/17 1301
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/25/17 - 1300
New Order Start: 08/26/17 - 0900
New Order Stop: 09/01/17 - 0844
08/25/17 1314 - VERIFIED by AADEGBAMIG
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/28/17 0919 - DISCONTINUE by YCHO Eff: 08/28/17 0917
For: 08/28/17 - 1600
For: 08/29/17 - 1600
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426679
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0919
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

CLON0.126 - CLONAZEPAM 0.125 MG ORALLY DISINTEGRATING TAB

Dose 0.125 MG (1 TAB.RAPDIS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/02/17 0859 DC: 08/31/17-1007
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540594

History
08/28/17 0919 - POM COPY AND EDIT by YCHO
FROM: Rx #01540026
08/28/17 1144 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0900 STOP: 09/02/17 SOFT STOP:
TO:
START: 08/29/17-0900 STOP: 09/02/17-0859 SOFT STOP: 0
08/28/17 1144 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0900
08/31/17 1008 - DISCONTINUE by YCHO Eff: 08/31/17 1007
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/31/17 1008 - POM COPY AND EDIT by YCHO
TO: Rx #U01427602
08/31/17 1019 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/31/17 1008
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 1,000 MCG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/01/17-2100 Stop Date 08/31/17 2059 DC: 08/28/17-0917
Ordering Doctor ELASHVILI, MERY
Total Dispensed 27 Total Costs $0.00 Total Charges $2.16
Rx Number 01533371

History
08/01/17 1223 - POM ORDER by MELASHVI
08/01/17 1224 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 2100
For: 08/02/17 - 2100
For: 08/03/17 - 2100
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 2100
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426680
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

DLT90T - DILTIAZEM HCL 90 MG TAB

Dose 90 MG (1 TABLET)
Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 07/31/17-1700 Stop Date 08/30/17 1659 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 111 Total Costs $0.00 Total Charges $103.23
Rx Number 01533070

History
07/31/17 1329 - POM ORDER by YCHO
07/31/17 1440 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 07/31/17 - 1700
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 1300
For: 08/01/17 - 1700
For: 08/01/17 - 2100
For: 08/02/17 - 0900
For: 08/02/17 - 1300
For: 08/02/17 - 1700
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 1300
For: 08/03/17 - 1700
For: 08/03/17 - 2100
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 12
For: 08/04/17 - 0900
For: 08/04/17 - 1300
For: 08/04/17 - 1700
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

Items Dispensed: 8 Doses Dispensed: 8

For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
For: 08/10/17 - 2100
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 08/11/17 - 0900
For: 08/11/17 - 1300
For: 08/11/17 - 1700
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
For: 08/13/17 - 2100
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/14/17 - 0900
For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 08/20/17 - 1700

For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 12
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/30/17 - 1300
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/28/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 08/29/17 - 0900

For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 1300
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426681
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/31/17 0859 DC: 08/28/17-0917
Ordering Doctor ELASHVILI, MERY
Total Dispensed 28 Total Costs $0.00 Total Charges $2386.44
Rx Number 01533076

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.47
MG/KG/DAY is below the Low Daily Dose.

History
07/31/17 1436 - POM ORDER by MELASHVI
07/31/17 1441 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 08/18/17 - 0900

For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/29/17 - 0900
For: 08/30/17 - 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426682
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

ESCI10TA - ESCITALOPRAM OXALATE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/31/17 0859 DC: 08/02/17-1056
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $38.06
Rx Number 01533071

History
07/31/17 1329 - POM ORDER by YCHO
07/31/17 1441 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/02/17 1101 - DISCONTINUE by MELASHVI Eff: 08/02/17 1056
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/03/17 - 0900
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
EDIT DOCTOR: ELASHVILI, MERY
08/03/17 0747 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by MELASHVI Eff: 08/02/17 1101
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

FLX10C - FLUOXETINE HCL 10 MG CAP

Dose 10 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/03/17-1800 Stop Date 09/02/17 1759 DC: 08/14/17-1440
Ordering Doctor ELASHVILI, MERY
Total Dispensed 11 Total Costs $0.00 Total Charges $3.85
Rx Number 01533926

History
08/03/17 1128 - POM ORDER by MELASHVI
08/03/17 1136 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/03/17 - 1800
For: 08/04/17 - 1800
For: 08/05/17 - 1800
For: 08/06/17 - 1800
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 1800
For: 08/08/17 - 1800
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 1800
For: 08/10/17 - 1800
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 1800
For: 08/12/17 - 1800
For: 08/13/17 - 1800
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1800
For: 08/15/17 - 1800
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 1800
For: 08/17/17 - 1800
08/14/17 1444 - DISCONTINUE by MELASHVI Eff: 08/14/17 1440
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/14/17 - 1800
For: 08/15/17 - 1800
For: 08/16/17 - 1800
For: 08/17/17 - 1800
EDIT DOCTOR: ELASHVILI, MERY
08/14/17 1445 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01422878
08/14/17 1445 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 08/14/17 1444
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

FLX10C - FLUOXETINE HCL 10 MG CAP

Dose 20 MG (2 CAPSULES)
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/14/17-1800 Stop Date 09/13/17 1759 DC: 08/14/17-1800
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536576

History
08/14/17 1445 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01533926
08/14/17 1448 - DISCONTINUE by AMACCA Eff: 08/14/17 1800
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/14/17 1448 - VERIFIED by SYSTEM
Verified in order to DC

FLX20C - FLUOXETINE HCL 20 MG CAP

Dose 20 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/14/17-1800 Stop Date 09/13/17 1759 DC: 08/14/17-1800
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536578

History
08/14/17 1449 - ENTER by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 1800
For: 08/15/17 - 1800
For: 08/16/17 - 1800
For: 08/17/17 - 1800
08/14/17 1452 - DISCONTINUE by AMACCA Eff: 08/14/17 1800
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/14/17 - 1800
For: 08/15/17 - 1800
For: 08/16/17 - 1800
For: 08/17/17 - 1800
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/01/17-2100 Stop Date 08/31/17 2059 DC: 08/28/17-0917
Ordering Doctor ELASHVILI, MERY
Total Dispensed 27 Total Costs $0.00 Total Charges $8.10
Rx Number 01533372

History
08/01/17 1223 - POM ORDER by MELASHVI
08/01/17 1224 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 2100
For: 08/02/17 - 2100
For: 08/03/17 - 2100
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 2100
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426683
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918

IBP600T - IBUPROFEN 600 MG TAB

Dose 600 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 07/31/17-1330 Stop Date 08/30/17 1329 DC: 07/31/17-1427
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533059

History
07/31/17 1329 - POM ORDER by YCHO
07/31/17 1436 - VERIFIED by SYSTEM
Verified in order to DC
07/31/17 1436 - DISCONTINUE by MELASHVI Eff: 07/31/17 1427
EDIT DOCTOR: ELASHVILI, MERY
07/31/17 1440 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SYSTEM Eff: 07/31/17 1436
Discontinue by MELASHVI Eff: 07/31/17 1436
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency EVERY 4 HOURS (PRN) PRN REASON: SOB - For Shortness of Breath
Start Date 07/31/17-1330 Stop Date 08/30/17 1329 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533072

History
07/31/17 1329 - POM ORDER by YCHO
07/31/17 1441 - VERIFIED by AADEGBAMIG
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 1300
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426685
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

LVF500T - LEVOFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/02/17-2100 Stop Date 08/09/17 2059 DC: 08/02/17-2100
Ordering Doctor ELASHVILI, MERY
Clinical Indication PNEUMONIA
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533641

History
08/02/17 1104 - POM ORDER by MELASHVI
08/02/17 1204 - DISCONTINUE by AADEGBAMIG Eff: 08/02/17 2100
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/02/17 1204 - VERIFIED by SYSTEM
Verified in order to DC

LVF250T - LEVOFLOXACIN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/02/17-2100 Stop Date 08/09/17 2059 DC: 08/02/17-2100
Ordering Doctor ELASHVILI, MERY
Clinical Indication PNEUMONIA
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533642

History
08/02/17 1104 - POM ORDER by MELASHVI
08/02/17 1204 - DISCONTINUE by AADEGBAMIG Eff: 08/02/17 2100
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/02/17 1204 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 07/31/17-1230 Stop Date 08/30/17 1229 DC: 08/01/17-1018
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533064

History
07/31/17 1222 - POM ORDER by YCHO
07/31/17 1440 - VERIFIED by AADEGBAMIG
08/01/17 1021 - DISCONTINUE by YCHO Eff: 08/01/17 1018
For: 08/01/17 - 2100
For: 08/02/17 - 2100
For: 08/03/17 - 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/01/17 1048 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/01/17 1021
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/31/17-1230 Stop Date 08/30/17 1229 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01533063

History
07/31/17 1222 - POM ORDER by YCHO
07/31/17 1440 - VERIFIED by AADEGBAMIG
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426688
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MGX400T - MAGNESIUM OXIDE 400 MG TAB

Dose 400 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/04/17-2100 Stop Date 08/07/17 1104 DC: 08/07/17-1104
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $0.39
Rx Number 01534436

History
08/04/17 1717 - POM ORDER by YCHO
08/04/17 1719 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/07/17 1106 - EDIT by MELASHVI
EDIT DOCTOR: ELASHVILI, MERY
FROM:
START: 08/04/17-2100 STOP: 09/03/17 2059 SOFT STOP: 0
DISPENSE: 2
TO:
START: 08/04/17-2100 STOP: 08/07/17-1104 SOFT STOP:
DISPENSE: 3
08/07/17 1106 - DISCONTINUE by MELASHVI Eff: 08/07/17 1104
EDIT DOCTOR: ELASHVILI, MERY
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/07/17 1106 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01421146
08/07/17 1114 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by MELASHVI Eff: 08/07/17 1106
Discontinue by MELASHVI Eff: 08/07/17 1106
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MGX400T - MAGNESIUM OXIDE 400 MG TAB

Dose 400 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY@1800,2200 (SCH)
Start Date 08/07/17-1800 Stop Date 09/03/17 2059 DC: 08/28/17-0917
Ordering Doctor ELASHVILI, MERY
Total Dispensed 42 Total Costs $0.00 Total Charges $5.46
Rx Number 01534784

History
08/07/17 1106 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01534436
Result of Frequency/Schedule Edit
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 08/06/17 - 2100
Last Actual Administration Time: 08/06/17 - 2012
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: DAILY@1800,2200 (SCH)
Old Order Stop: 08/07/17 - 1104
New Order Start: 08/07/17 - 1800
New Order Stop: 09/03/17 - 2059
08/07/17 1113 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by MELASHVI Eff: 08/07/17 1106
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 08/06/17 - 2100
Last Actual Administration Time: 08/06/17 - 2012
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: DAILY@1800,2200 (SCH)
Old Order Stop: 08/07/17 - 1104
New Order Start: 08/07/17 - 1800
New Order Stop: 09/03/17 - 2059
08/07/17 1113 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 8
For: 08/07/17 - 1800
For: 08/07/17 - 2200
For: 08/08/17 - 1800
For: 08/08/17 - 2200
For: 08/09/17 - 1800
For: 08/09/17 - 2200
For: 08/10/17 - 1800
For: 08/10/17 - 2200
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 1800
For: 08/11/17 - 2200
For: 08/12/17 - 1800
For: 08/12/17 - 2200
For: 08/13/17 - 1800
For: 08/13/17 - 2200
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 08/14/17 - 2200

For: 08/15/17 - 1800
For: 08/15/17 - 2200
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 1800
For: 08/16/17 - 2200
For: 08/17/17 - 1800
For: 08/17/17 - 2200
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 1800
For: 08/18/17 - 2200
For: 08/19/17 - 1800
For: 08/19/17 - 2200
For: 08/20/17 - 1800
For: 08/20/17 - 2200
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 1800
For: 08/21/17 - 2200
For: 08/22/17 - 1800
For: 08/22/17 - 2200
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 1800
For: 08/23/17 - 2200
For: 08/24/17 - 1800
For: 08/24/17 - 2200
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 1800
For: 08/25/17 - 2200
For: 08/26/17 - 1800
For: 08/26/17 - 2200
For: 08/27/17 - 1800
For: 08/27/17 - 2200
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 1800
For: 08/28/17 - 2200
For: 08/29/17 - 1800
For: 08/29/17 - 2200
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 1800
For: 08/30/17 - 2200
For: 08/31/17 - 1800
For: 08/31/17 - 2200
08/28/17 0919 - DISCONTINUE by YCHO Eff: 08/28/17 0917
Items Auto Credited: 8 Doses Auto Credited: 8
For: 08/28/17 - 1800
For: 08/28/17 - 2200
For: 08/29/17 - 1800
For: 08/29/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 08/30/17 - 1800

For: 08/30/17 - 2200
For: 08/31/17 - 1800
For: 08/31/17 - 2200
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0919 - POM COPY AND EDIT by YCHO
TO: Rx #U01426689
08/28/17 1200 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0919

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/09/17-2100 Stop Date 09/08/17 2059 DC: 08/11/17-0944
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $0.40
Rx Number 01535375

History
08/09/17 1056 - POM ORDER by YCHO
08/09/17 1208 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/09/17 - 2100
For: 08/10/17 - 2100
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/11/17 0944 - DISCONTINUE by YCHO Eff: 08/11/17 0944
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
For: 08/14/17 - 2100
For: 08/15/17 - 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/11/17 0944 - POM COPY AND EDIT by YCHO
TO: Rx #U01422298
08/11/17 1147 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/11/17 0944
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/02/17-0900 Stop Date 09/01/17 0859 DC: 08/16/17-1557
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 15 Total Costs $0.00 Total Charges $28.00
Rx Number 01533337

History
08/01/17 1022 - POM ORDER by YCHO
08/01/17 1025 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/16/17 1558 - DISCONTINUE by MELASHVI Eff: 08/16/17 1557
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 83
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

EDIT DOCTOR: ELASHVILI, MERY

08/16/17 1558 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01423570
08/16/17 1559 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by MELASHVI Eff: 08/16/17 1558

MTF500TCR - METFORMIN HCL XR 500 MG TABCR

Dose 500 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/31/17 0859 DC: 08/01/17-1023
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01533067

History
07/31/17 1329 - POM ORDER by YCHO
07/31/17 1440 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/01/17 1023 - DISCONTINUE by YCHO Eff: 08/01/17 1023
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/01/17 1048 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YCHO Eff: 08/01/17 1023
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 84
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

NCT21TD - NICOTINE 21 MG/24 HR TDSY

Dose 1 EA (1 TRANSDERMAL SYSTEM)

Admin Route TRANSDERM.
Frequency DAILY@1800 (SCH)
Start Date 07/31/17-1800 Stop Date 08/30/17 1759 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 28 Total Costs $0.00 Total Charges $124.60
Rx Number 01533180

History
07/31/17 1617 - POM ORDER by YCHO
07/31/17 1618 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/17 - 1800
For: 08/01/17 - 1800
For: 08/02/17 - 1800
For: 08/03/17 - 1800
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 1800
For: 08/05/17 - 1800
For: 08/06/17 - 1800
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 1800
For: 08/08/17 - 1800
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 1800
For: 08/10/17 - 1800
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 1800
For: 08/12/17 - 1800
For: 08/13/17 - 1800
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1800
For: 08/15/17 - 1800
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 1800
For: 08/17/17 - 1800
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 1800
For: 08/19/17 - 1800
For: 08/20/17 - 1800
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 1800
For: 08/22/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 85
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

08/21/17 0830 - FILL by AMOLINARI

Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 1800
For: 08/24/17 - 1800
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1800
For: 08/26/17 - 1800
For: 08/27/17 - 1800
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1800
For: 08/29/17 - 1800
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/28/17 - 1800
For: 08/29/17 - 1800
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0920 - POM COPY AND EDIT by YCHO
TO: Rx #U01426690
08/28/17 1201 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 86
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DELLACAVA,JANE W00001217873 (Continued)

NCT21TD - NICOTINE 21 MG/24 HR TDSY

Dose 1 EA (1 TRANSDERMAL SYSTEM)

Admin Route TRANSDERM.
Frequency DAILY@1800 (SCH)
Start Date 08/28/17-1800 Stop Date 08/28/17 1800 DC: 08/28/17-1800
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01540609

History
08/28/17 0920 - POM COPY AND EDIT by YCHO
FROM: Rx #01533180
08/28/17 1157 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1800 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-1800 STOP: 09/27/17-1759 SOFT STOP: 0
08/28/17 1157 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 1800
For: 08/29/17 - 1800
For: 08/30/17 - 1800
For: 08/31/17 - 1800
08/28/17 1735 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/28/17-1800 STOP: 09/27/17 1759 SOFT STOP: 0
DISPENSE: 4
TO:
START: 08/28/17-1800 STOP: 08/28/17-1800 SOFT STOP:
DISPENSE: 0
08/28/17 1735 - DISCONTINUE by YCHO Eff: 08/28/17 1800
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 1739 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by YCHO Eff: 08/28/17 1735
Discontinue by YCHO Eff: 08/28/17 1735
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 87
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 3 EA (0 EACHS)
Admin Route ORAL
Frequency 7 TIMES A DAY (SCH)
Start Date 07/31/17-1500 Stop Date 08/30/17 1459 DC: 08/01/17-1246
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01533066

History
07/31/17 1240 - POM ORDER by MELASHVI
07/31/17 1440 - VERIFIED by AADEGBAMIG
08/01/17 1247 - DISCONTINUE by MELASHVI Eff: 08/01/17 1246
EDIT DOCTOR: ELASHVILI, MERY
08/01/17 1247 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01419790
08/01/17 1248 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 08/01/17 1247

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/04/17-2000 Stop Date 08/11/17 1959 DC: 08/08/17-1010
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534530

History
08/04/17 1954 - POM ORDER by SDAS
08/04/17 2019 - VERIFIED by MHAIMOWITZ
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/17 1011 - DISCONTINUE by YCHO Eff: 08/08/17 1010
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/08/17 1011 - POM COPY AND EDIT by YCHO
TO: Rx #U01421428
08/08/17 1014 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/08/17 1011
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 88
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/08/17-1015 Stop Date 08/15/17 1014 DC: 08/09/17-1114
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01535079

History
08/08/17 1011 - POM COPY AND EDIT by YCHO
FROM: Rx #01534530
08/08/17 1014 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-1015 STOP: 08/15/17 SOFT STOP:
TO:
START: 08/08/17-1015 STOP: 08/15/17-1014 SOFT STOP: 0
08/08/17 1014 - VERIFIED by MHAIMOWITZ
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 1117 - DISCONTINUE by MELASHVI Eff: 08/09/17 1114
EDIT DOCTOR: ELASHVILI, MERY
08/09/17 1209 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by MELASHVI Eff: 08/09/17 1117
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 89
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY@1300 (SCH)
Start Date 08/01/17-1300 Stop Date 09/02/17 1259 DC: 08/28/17-0917
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $4.50
Rx Number 01533370

History
08/01/17 1223 - POM ORDER by MELASHVI
08/01/17 1224 - VERIFIED by AMACCA
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 1300
For: 08/05/17 - 1300
For: 08/06/17 - 1300
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 1300
For: 08/08/17 - 1300
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 1300
For: 08/10/17 - 1300
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 1300
For: 08/12/17 - 1300
For: 08/13/17 - 1300
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1300
For: 08/15/17 - 1300
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 1300
For: 08/17/17 - 1300
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 1300
For: 08/19/17 - 1300
For: 08/20/17 - 1300
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 1300
For: 08/22/17 - 1300
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 1300
For: 08/24/17 - 1300
08/23/17 0823 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 90
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 08/25/17 - 1300
For: 08/26/17 - 1300
For: 08/27/17 - 1300
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1300
For: 08/29/17 - 1300
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1300
For: 08/31/17 - 1300
08/28/17 0918 - DISCONTINUE by YCHO Eff: 08/28/17 0917
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0920 - POM COPY AND EDIT by YCHO
TO: Rx #U01426691
08/28/17 1201 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0918
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 91
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DELLACAVA,JANE W00001217873 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/31/17-1230 Stop Date 07/31/17 1611 DC: 07/31/17-1611
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01533065

History
07/31/17 1222 - POM ORDER by YCHO
07/31/17 1440 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 07/31/17 - 1230
07/31/17 1614 - EDIT by MELASHVI
EDIT DOCTOR: ELASHVILI, MERY
FROM:
START: 07/31/17-1230 STOP: 08/30/17 1229 SOFT STOP: 0
DISPENSE: 4
TO:
START: 07/31/17-1230 STOP: 07/31/17-1611 SOFT STOP:
DISPENSE: 0
07/31/17 1614 - DISCONTINUE by MELASHVI Eff: 07/31/17 1611
EDIT DOCTOR: ELASHVILI, MERY
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
07/31/17 1614 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01419606
08/01/17 1048 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by MELASHVI Eff: 07/31/17 1614
Discontinue by MELASHVI Eff: 07/31/17 1614
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 92
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/31/17-2100 Stop Date 08/09/17 1054 DC: 08/09/17-1054
Ordering Doctor ELASHVILI, MERY
Total Dispensed 28 Total Costs $0.00 Total Charges $1.60
Rx Number 01533174

History
07/31/17 1614 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01533065
Result of Frequency/Schedule Edit
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: NIGHTLY (PRN)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 07/31/17 - 1611
New Order Start: 07/31/17 - 2100
New Order Stop: 08/30/17 - 1229
07/31/17 1615 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by MELASHVI Eff: 07/31/17 1614
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: NIGHTLY (PRN)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 07/31/17 - 1611
New Order Start: 07/31/17 - 2100
New Order Stop: 08/30/17 - 1229
07/31/17 1615 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 07/31/17 - 2100
For: 08/01/17 - 2100
For: 08/02/17 - 2100
For: 08/03/17 - 2100
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 93
Run Time 1513 PHA Profile

DELLACAVA,JANE W00001217873 (Continued)

For: 08/11/17 - 2100

For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/09/17 1056 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 07/31/17-2100 STOP: 08/30/17 1229 SOFT STOP:
DISPENSE: 6
TO:
START: 07/31/17-2100 STOP: 08/09/17-1054 SOFT STOP:
DISPENSE: 18
08/09/17 1056 - DISCONTINUE by YCHO Eff: 08/09/17 1054
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/09/17 1056 - POM COPY AND EDIT by YCHO
TO: Rx #U01421707
08/09/17 1209 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YCHO Eff: 08/09/17 1056
Discontinue by YCHO Eff: 08/09/17 1056
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 94
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DELLACAVA,JANE W00001217873 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@1600 (SCH)
Start Date 08/09/17-1600 Stop Date 08/30/17 1229 DC: 08/28/17-0917
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 38 Total Costs $0.00 Total Charges $3.20
Rx Number 01535376

History
08/09/17 1056 - POM COPY AND EDIT by YCHO
FROM: Rx #01533174
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/08/17 - 2100
Last Actual Administration Time: 08/08/17 - 2054
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: DAILY@1600 (SCH)
Old Order Stop: 08/09/17 - 1054
New Order Start: 08/09/17 - 1600
New Order Stop: 08/30/17 - 1229
08/09/17 1209 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by YCHO Eff: 08/09/17 1056
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/08/17 - 2100
Last Actual Administration Time: 08/08/17 - 2054
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: DAILY@1600 (SCH)
Old Order Stop: 08/09/17 - 1054
New Order Start: 08/09/17 - 1600
New Order Stop: 08/30/17 - 1229
08/09/17 1209 - VERIFIED by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 5
For: 08/09/17 - 1600
For: 08/10/17 - 1600
For: 08/11/17 - 1600
For: 08/12/17 - 1600
For: 08/13/17 - 1600
08/11/17 0812 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 1600
For: 08/15/17 - 1600
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 1600
For: 08/17/17 - 1600
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 1600
For: 08/19/17 - 1600
For: 08/20/17 - 1600
08/18/17 0819 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 95
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DELLACAVA,JANE W00001217873 (Continued)

Items Dispensed: 4 Doses Dispensed: 2

For: 08/21/17 - 1600
For: 08/22/17 - 1600
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1600
For: 08/24/17 - 1600
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1600
For: 08/26/17 - 1600
For: 08/27/17 - 1600
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1600
For: 08/29/17 - 1600
08/28/17 0919 - DISCONTINUE by YCHO Eff: 08/28/17 0917
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/28/17 - 1600
For: 08/29/17 - 1600
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/28/17 0920 - POM COPY AND EDIT by YCHO
TO: Rx #U01426693
08/28/17 1201 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/28/17 0919
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 96
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DELLACAVA,JANE W00001217873 (Continued)

LVF500T - LEVOFLOXACIN 500 MG TAB - 500 MG

LVF250T - LEVOFLOXACIN 250 MG TAB - 250 MG

Dose 750 MG (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/02/17-2100 Stop Date 08/09/17 2059 DC: 08/08/17-1110
Ordering Doctor ELASHVILI, MERY
Clinical Indication PNEUMONIA
Total Dispensed 12 Total Costs $0.00 Total Charges $803.10
Rx Number 01533640

History
08/02/17 1204 - ENTER by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 08/02/17 - 2100
For: 08/03/17 - 2100
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/08/17 1113 - DISCONTINUE by MELASHVI Eff: 08/08/17 1110
Items Auto Credited: 2 Doses Auto Credited: 1
For: 08/08/17 - 2100
EDIT DOCTOR: ELASHVILI, MERY
08/09/17 1209 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by MELASHVI Eff: 08/08/17 1113
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient DIGGS,PATRICIA A Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219571 Location B1WE Unit Number M000120481
Age/Sex 71/F Room 156 Registered Date 08/29/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 4.02 in 162.6 cm Body Surface Area 1.61 m2

Weight 127 lb oz 57.606 kg
Hem-Onc No

Drug Allergies [pcn, seafood], Penicillins, Shellfish (Shellfish)

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/29/17-1511 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies: SEAFOOD
Primary Diagnosis:
Secondary Diagnosis:

ALBU8HFA - ALBUTEROL SULFATE HFA 8 GM INH

Dose 2 ACTUATION (2 INHALER ACTUATIONS)

Admin Route INHALATION
Frequency EVERY 4 HOURS (PRN) PRN REASON: SOB - For Shortness of Breath
Start Date 08/29/17-1445 Stop Date 09/28/17 1444
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $57.24
Rx Number 01541027

History
08/29/17 1451 - POM ORDER by NBALCETIS
08/29/17 1507 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1445

FLUT1AER - FLUTICASONE/VILANTEROL 100MCG/25MCG INHALER

Dose 1 ACTUATION (1 AER.POW.BA)

Admin Route INHALATION
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541024

History
08/29/17 1504 - ENTER by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions APPLY TO L-HIP
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01541523

History
08/31/17 0954 - POM ORDER by NBALCETIS
08/31/17 0958 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
TO:
DOSE INSTRUCTIONS:
APPLY TO L-HIP
08/31/17 0958 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 09/01/17 - 0900
09/03/17 1230 - DEBIT by MHAIMOWITZ
ITEMS: 1

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1500 Stop Date 09/28/17 1459
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541045

History
08/29/17 1456 - POM ORDER by NBALCETIS
08/29/17 1510 - VERIFIED by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/31/17-1400 Stop Date 09/30/17 1359
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01541522

History
08/31/17 0955 - POM ORDER by NBALCETIS
08/31/17 0958 - VERIFIED by AMOLINARI
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 7 Total Costs $0.00 Total Charges $1.89
Rx Number 01541028

History
08/29/17 1451 - POM ORDER by NBALCETIS
08/29/17 1507 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

ASPI325T5 - ASPIRIN 325 MG TABEC

Dose 325 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 15 Total Costs $0.00 Total Charges $1.35
Rx Number 01541032

History
08/29/17 1451 - POM ORDER by NBALCETIS
08/29/17 1507 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CYAN1TAB4 - CYANOCOBALAMIN/FA/PYRIDOXINE (FOLTX) TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $5.96
Rx Number 01541901

History
09/01/17 1207 - POM ORDER by NBALCETIS
09/01/17 1210 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Patient may refuse
Hold for loose stools
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541040

History
08/29/17 1456 - POM ORDER by NBALCETIS
08/29/17 1510 - VERIFIED by AMACCA
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Dose Instructions Patient may refuse
Hold for loose stools
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541041

History
08/29/17 1456 - POM ORDER by NBALCETIS
08/29/17 1510 - VERIFIED by AMACCA
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

ERG50KC - ERGOCALCIFEROL 50,000 IUNITS CAP

Dose 50,000 IUNITS (1 CAPSULE)

Admin Route ORAL
Frequency We@0900 (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $3.03
Rx Number 01541117

History
08/29/17 1621 - POM ORDER by NBALCETIS
08/29/17 1622 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01541046

History
08/29/17 1456 - POM ORDER by NBALCETIS
08/29/17 1511 - VERIFIED by AMACCA
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

FLC100T - FLUCONAZOLE 100 MG TAB

Dose 400 MG (4 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 28 Total Costs $0.00 Total Charges $29.00
Rx Number 01541033

History
08/29/17 1451 - POM ORDER by NBALCETIS
08/29/17 1507 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/29/17-2200 Stop Date 09/28/17 2159
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 23 Total Costs $0.00 Total Charges $2.25
Rx Number 01541035

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/29/17 1451 - POM ORDER by NBALCETIS
08/29/17 1508 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 8
For: 08/29/17 - 2200
For: 08/30/17 - 0600
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HYDR4TAB8 - HYDROMORPHONE HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/29/17-1445 Stop Date 09/05/17 1444
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01541036

History
08/29/17 1451 - POM ORDER by NBALCETIS
08/29/17 1508 - REVIEW PROVIDER ACTIVITY by AMACCA
Administration of Unverified Order by NPHILLIPS Eff: 08/29/17 1500
08/29/17 1508 - VERIFIED by AMACCA
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 6 MG (3 TABLETS)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: FOR severe PAIN(P/SCALE 7-10)
Start Date 08/29/17-1445 Stop Date 09/05/17 1444
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.50
Rx Number 01541037

History
08/29/17 1451 - POM ORDER by NBALCETIS
08/29/17 1508 - VERIFIED by AMACCA
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1500 Stop Date 09/28/17 1459
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541042

History
08/29/17 1456 - POM ORDER by NBALCETIS
08/29/17 1510 - VERIFIED by AMACCA
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

NEBI10TA6 - NEBIVOLOL HCL 10 MG TABLET

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 7 Total Costs $0.00 Total Charges $49.75
Rx Number 01541021

History
08/29/17 1502 - ENTER by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency BEFORE BREAKFAST (SCH)
Start Date 08/30/17-0800 Stop Date 09/29/17 0759
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 7 Total Costs $0.00 Total Charges $4.40
Rx Number 01541047

History
08/29/17 1456 - POM ORDER by NBALCETIS
08/29/17 1511 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 10/01/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541039

History
08/29/17 1452 - POM ORDER by NBALCETIS
08/29/17 1510 - VERIFIED by AMACCA
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1500 Stop Date 09/28/17 1459
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01541044

History
08/29/17 1456 - POM ORDER by NBALCETIS
08/29/17 1510 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 08/29/17 - 1500
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

ALB6.7IN - ALBUTEROL SULF 120 MCG/ACT 1 INH INH

Admin Route INHALATION

Frequency EVERY 4 HOURS (PRN) PRN REASON: WHEEZE - for Wheezing
Start Date 09/26/09-1321 Stop Date 10/26/09 1320 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $17.07
Rx Number 00704452

Discontinued Comments DC'd by Discharge

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1332 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

ALBU8HFA - ALBUTEROL SULFATE HFA 8 GM INH

Dose 2 ACTUATION (2 INHALER ACTUATIONS)

Admin Route INHALATION
Frequency EVERY 4 HOURS (PRN) PRN REASON: SOB - For Shortness of Breath
Start Date 01/29/11-1715 Stop Date 02/28/11 1714 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $45.00
Rx Number 00861139

Discontinued Comments DC'd by Discharge

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1918 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 01/29/11 - 1715
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge

FLT447.9 - FLUTICASONE PROP INH 44 MCG 10.6 GM INH

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 02/16/11-0900 Stop Date 03/18/11 0859 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $295.38
Rx Number 00867265

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1743 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 02/16/11 - 0900
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose Instructions Apply to affected area

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/14/05-1324 Stop Date 09/21/05 1323 DC: 09/18/05-1032
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $4.77
Rx Number 00249130

Discontinued Comments Result of renew in POM

History
09/14/05 1325 - POM ORDER by SVAIDYA
09/14/05 1406 - VERIFIED by ECARPENT
09/18/05 1033 - DISCONTINUE by ARIOS Eff: 09/18/05 1032
DC COMMENTS:
Result of renew in POM

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose Instructions Apply to affected area

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/18/05-1030 Stop Date 09/25/05 1030 DC: 09/21/05-1027
Ordering Doctor Rios,Allan MD
Total Dispensed 1 Total Costs $0.00 Total Charges $4.77
Rx Number 00250601

History
09/18/05 1033 - POM ORDER by ARIOS
09/18/05 1050 - VERIFIED by ECARPENT
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 09/30/09-1026 Stop Date 10/30/09 1025 DC: 10/02/09-1056
Ordering Doctor NIAMEHR,NOURIEL DO
Total Dispensed 5 Total Costs $0.00 Total Charges $574.50
Rx Number 00705656

Discontinued Comments DC'd by Discharge

History
09/30/09 1027 - POM ORDER by NNIAMEHR
09/30/09 1035 - VERIFIED by AMADDALENA
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency 1026 (ONE)
Start Date 09/30/09-1026 Stop Date 09/30/09 1027 DC: 09/30/09-1027
Ordering Doctor NIAMEHR,NOURIEL DO
Total Dispensed 5 Total Costs $0.00 Total Charges $574.50
Rx Number 00705657

Discontinued Comments Reached Stop Date

History
09/30/09 1027 - POM ORDER by NNIAMEHR
09/30/09 1035 - VERIFIED by AMADDALENA
09/30/09 1036 - DISCONTINUE by PHABKGJOB Eff: 09/30/09 1027
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 2 EA (2 PATCHS)
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 02/04/11-0900 Stop Date 03/06/11 0859 DC: 02/07/11-1206
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 00862350

History
02/03/11 1035 - POM ORDER by ASTAMPAS
02/03/11 1056 - VERIFIED by AMADDALENA
Items Dispensed: 5 Doses Dispensed: 1
For: 02/04/11 - 0900
02/07/11 1208 - DISCONTINUE by ASTAMPAS Eff: 02/07/11 1206
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/07/11 1336 - REVIEW PROVIDER ACTIVITY by AMOLINARI
RS - Discontinue by ASTAMPAS Eff: 02/07/11 1208

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions Posterior neck; peri-incisional. (not over wound)
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 02/11/11-0900 Stop Date 03/13/11 0859 DC: 02/11/11-2222
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 00865165

Discontinued Comments DC'd by Discharge

History
02/10/11 1303 - POM ORDER by AMARTINEZ
02/10/11 1444 - REVIEW PROVIDER ACTIVITY by ECARPENT
RAD - Administration of Unverified Order by JROSSMAN Eff: 02/10/11 1322
02/10/11 1444 - VERIFIED by ECARPENT
Items Dispensed: 5 Doses Dispensed: 1
For: 02/11/11 - 0900
02/11/11 2223 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 02/12/11-0900 Stop Date 03/14/11 0859 DC: 02/12/11-0900
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 00865439

Discontinued Comments DC'd by Discharge

History
02/11/11 0934 - POM ORDER by ASTAMPAS
02/11/11 1215 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 02/12/11 - 0900
02/11/11 2223 - DISCONTINUE by DISCHARGE Eff: 02/12/11 0900
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency 0932 (ONE)
Start Date 02/11/11-0945 Stop Date 02/11/11 0946 DC: 02/11/11-0946
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 00865440

Discontinued Comments Reached Stop Date

History
02/11/11 0934 - POM ORDER by ASTAMPAS
02/11/11 1215 - REVIEW PROVIDER ACTIVITY by AMOLINARI
RAD - Administration of Unverified Order by SITHOMAS Eff: 02/11/11 1006
02/11/11 1215 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 02/11/11 - 0945
02/11/11 1215 - DISCONTINUE by PHABKGJOB Eff: 02/11/11 0946
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
02/11/11 1447 - CREDIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions apply over scar on back of her neck
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 02/16/11-0900 Stop Date 03/18/11 0859 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 00867261

Discontinued Comments DC'd by Discharge

History
02/15/11 1727 - POM ORDER by CDOHLE
02/15/11 1743 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 1
For: 02/16/11 - 0900
02/17/11 0932 - DEBIT by BGIRLING
ITEMS: 1
DEBIT COMMENTS:
sent up 2/17/11
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions APPLY TO L-HIP
Admin Route TOPICALLY
Frequency 0952 (ONE)
Start Date 08/31/17-0952 Stop Date 08/31/17 0953 DC: 08/31/17-0953
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541524

Discontinued Comments Reached Stop Date

History
08/31/17 0955 - POM ORDER by NBALCETIS
08/31/17 0958 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
TO:
DOSE INSTRUCTIONS:
APPLY TO L-HIP
08/31/17 0958 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 08/31/17 - 0952
08/31/17 0958 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 0953
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/31/17 0959 - CREDIT by AMOLINARI
ITEMS: 1

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $9.00
Rx Number 00248836

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $9.00
Rx Number 00704453

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1332 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

SILV85CR - SILVER SULFADIAZINE 85 GM TUBE

Dose Instructions No Dose

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/13/05-1501 Stop Date 09/20/05 1500 DC: 09/17/05-1001
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $47.67
Rx Number 00248850

Discontinued Comments Result of renew in POM

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1513 - VERIFIED by EBALILO
09/17/05 1001 - DISCONTINUE by ARIOS Eff: 09/17/05 1001
DC COMMENTS:
Result of renew in POM
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

SILV85CR - SILVER SULFADIAZINE 85 GM TUBE

Dose Instructions No Dose

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/17/05-0958 Stop Date 09/24/05 0958 DC: 09/18/05-1032
Ordering Doctor Rios,Allan MD
Total Dispensed 1 Total Costs $0.00 Total Charges $47.67
Rx Number 00250361

Discontinued Comments Result of renew in POM

History
09/17/05 1002 - POM ORDER by ARIOS
09/17/05 1255 - VERIFIED by ECARPENT
09/18/05 1033 - DISCONTINUE by ARIOS Eff: 09/18/05 1032
DC COMMENTS:
Result of renew in POM

SILV85CR - SILVER SULFADIAZINE 85 GM TUBE

Dose Instructions No Dose

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/18/05-1030 Stop Date 09/25/05 1031 DC: 09/21/05-1027
Ordering Doctor Rios,Allan MD
Total Dispensed 1 Total Costs $0.00 Total Charges $47.67
Rx Number 00250602

History
09/18/05 1034 - POM ORDER by ARIOS
09/18/05 1051 - VERIFIED by ECARPENT
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (0.992481 BOTTLES)

Admin Route RECTALLY
Frequency EVERY OTHER DAY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $3.99
Rx Number 00248837

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (0.9924812 BOTTLES)

Admin Route RECTALLY
Frequency EVERY OTHER DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $3.99
Rx Number 00704454

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1332 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

TIOT18CA6 - TIOTROPIUM BROMIDE 18 MCG BOX

Dose 18 MCG (1 BOX)

Admin Route INHALATION
Frequency DAILY (SCH)
Start Date 01/30/11-0900 Stop Date 03/01/11 0859 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $183.27
Rx Number 00861138

Discontinued Comments DC'd by Discharge

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1918 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 01/30/11 - 0900
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $0.25
Rx Number 00248838

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 00248839

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 6 Total Costs $ Total Charges $
Rx Number 00248840

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 20 Total Costs $ Total Charges $
Rx Number 00704455

Warnings
Type: MAINTENANCE
Range: ACETAMINOPHEN (325 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 6 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1332 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 7 Total Costs $ Total Charges $
Rx Number 00704456

Warnings
Type: MAINTENANCE
Range: ACETAMINOPHEN (500 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 4 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1332 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $ Total Charges $
Rx Number 00704457

Warnings
Type: MAINTENANCE
Range: ACETAMINOPHEN (500 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 4 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1333 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: FEVER - Fever
Start Date 01/29/11-2115 Stop Date 02/28/11 2114 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 16 Total Costs $0.00 Total Charges $1.00
Rx Number 00861160

Discontinued Comments DC'd by Discharge

History
01/29/11 2102 - POM ORDER by NBALCETIS
01/29/11 2242 - VERIFIED by EBALILO
Items Dispensed: 16 Doses Dispensed: 8
For: 01/29/11 - 2115
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 02/15/11-1730 Stop Date 03/17/11 1729 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 6 Total Costs $0.00 Total Charges $0.75
Rx Number 00867250

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1735 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 02/15/11 - 1730
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 975 MG (3 TABLETS)

Dose Instructions PRN Pain
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/29/17-1500 Stop Date 09/28/17 1459 DC: 08/31/17-0957
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541043

Discontinued Comments dc

History
08/29/17 1456 - POM ORDER by NBALCETIS
08/29/17 1510 - VERIFIED by AMACCA
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/31/17 0958 - DISCONTINUE by NBALCETIS Eff: 08/31/17 0957
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/31/17 0958 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/31/17 0958
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/13/05-1530 Stop Date 10/13/05 1529 DC: 09/14/05-1025
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $4.75
Rx Number 00248864

Discontinued Comments Result of edit in POM

History
09/13/05 1515 - ENTER by EBALILO
09/14/05 1026 - DISCONTINUE by SVAIDYA Eff: 09/14/05 1025
DC COMMENTS:
Result of edit in POM

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/14/05-1025 Stop Date 10/14/05 1024 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 11 Total Costs $0.00 Total Charges $24.36
Rx Number 00249097

History
09/14/05 1148 - ENTER by AMADDALENA
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/26/09-1321 Stop Date 10/26/09 1320 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $27.30
Rx Number 00704458

Discontinued Comments DC'd by Discharge

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1333 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 01/30/11-0900 Stop Date 03/01/11 0859 DC: 01/31/11-1332
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $9.60
Rx Number 00861127

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1913 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 01/30/11 - 0900
For: 01/31/11 - 0900
For: 02/01/11 - 0900
01/31/11 1334 - DISCONTINUE by AMARTINEZ Eff: 01/31/11 1332
Items Auto Credited: 3 Doses Auto Credited: 3
For: 02/01/11 - 0900
For: 02/02/11 - 0900
For: 02/03/11 - 0900
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
EDIT SOURCE: Written
01/31/11 1334 - POM COPY AND EDIT by AMARTINEZ
TO: Rx #U00758990
01/31/11 1409 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
RS - Discontinue by AMARTINEZ Eff: 01/31/11 1334
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions hold for SBP < 110, DBP < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 02/01/11-0900 Stop Date 03/03/11 0859 DC: 02/11/11-2222
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 11 Total Costs $0.00 Total Charges $5.04
Rx Number 00861426

Discontinued Comments DC'd by Discharge

History
01/31/11 1408 - ENTER by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 02/01/11 - 0900
For: 02/02/11 - 0900
For: 02/03/11 - 0900
02/03/11 2118 - EDIT by CDOHLE
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: Written
FROM:
DOSE INSTRUCTIONS:
LABEL COMMENTS:
amLODIPine
HOLD SBP < 110
TO:
DOSE INSTRUCTIONS:
hold for SBP < 110, DBP < 60
LABEL COMMENTS:
amLODIPine
HOLD SBP < 110
02/04/11 0743 - REVIEW PROVIDER ACTIVITY by AMOLINARI
RE - Edit by CDOHLE Eff: 02/03/11 2118
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/12/11 - 0900
For: 02/13/11 - 0900
For: 02/14/11 - 0900
For: 02/15/11 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

C500T - ASCORBIC ACID 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $1.50
Rx Number 00248841

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

C500T - ASCORBIC ACID 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 01/30/11-0900 Stop Date 03/01/11 0859 DC: 01/30/11-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00861104

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1849 - VERIFIED by SYSTEM
Verified in order to DC
Items Dispensed: 0 Doses Dispensed: 0
01/29/11 1849 - DISCONTINUE by NBALCETIS Eff: 01/30/11 0900
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: Written
01/29/11 1849 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U00758738
01/29/11 1919 - REVIEW PROVIDER ACTIVITY by EBALILO
RE - Edit by SYSTEM Eff: 01/29/11 1849
RS - Discontinue by NBALCETIS Eff: 01/29/11 1849
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

C500T - ASCORBIC ACID 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 01/30/11-0900 Stop Date 03/01/11 0859 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 26 Total Costs $0.00 Total Charges $4.50
Rx Number 00861128

Discontinued Comments DC'd by Discharge

History
01/29/11 1849 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #00861104
Result of Sig/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Dose: 01/30/11 - 0900
Last Administration:
Old Sig/Sch: DAILY (SCH)
New Sig/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 01/30/11 - 0900
New Order Start: 01/30/11 - 0900
01/29/11 1914 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 6
For: 01/30/11 - 0900
For: 01/30/11 - 1700
For: 01/31/11 - 0900
For: 01/31/11 - 1700
For: 02/01/11 - 0900
For: 02/01/11 - 1700
01/29/11 1914 - REVIEW PROVIDER ACTIVITY by EBALILO
RFS - Freq/Sch Edit by NBALCETIS Eff: 01/29/11 1849
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Dose: 01/30/11 - 0900
Last Administration:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 01/30/11 - 0900
New Order Start: 01/30/11 - 0900
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 8 Doses Auto Credited: 8
For: 02/12/11 - 0900
For: 02/12/11 - 1700
For: 02/13/11 - 0900
For: 02/13/11 - 1700
For: 02/14/11 - 0900
For: 02/14/11 - 1700
For: 02/15/11 - 0900
For: 02/15/11 - 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

ATN50T - ATENOLOL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/26/09-1321 Stop Date 10/26/09 1320 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $23.58
Rx Number 00704459

Discontinued Comments DC'd by Discharge

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1333 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

ATN50T - ATENOLOL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions hold for SBP< 110, DBP< 60, HR< 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 02/16/11-0900 Stop Date 03/18/11 0859 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.46
Rx Number 00867257

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1739 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 02/16/11 - 0900
For: 02/17/11 - 0900
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/19/11 - 0900
For: 02/20/11 - 0900
For: 02/21/11 - 0900
For: 02/22/11 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00248842

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 5 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00248843

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 10 MG (2 TABLET, ENTERIC COATEDS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00248844

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00704460

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1333 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 5 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00704461

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1333 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 10 MG (2 TABLET, ENTERIC COATEDS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00704462

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1333 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME (SCH)
Start Date 02/08/11-1600 Stop Date 03/10/11 1559 DC: 02/08/11-1600
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00864204

History
02/08/11 1220 - POM ORDER by AMARTINEZ
02/08/11 1220 - NOW DOSE by AMARTINEZ
Now Dose: 02/08/11 1600
02/08/11 1220 - KEEP NEXT DOSE by AMARTINEZ
Keep Next Dose: 02/08/11 2100
02/08/11 1252 - VERIFIED by ECARPENT
Items Dispensed: 4 Doses Dispensed: 4
For: 02/08/11 - 1600
For: 02/08/11 - 2100
For: 02/09/11 - 2100
For: 02/10/11 - 2100
02/08/11 1252 - NOW DOSE by ECARPENT
Now Dose: 02/08/11 1600
02/08/11 1252 - KEEP NEXT DOSE by ECARPENT
Keep Next Dose: 02/08/11 2100
02/08/11 1252 - REVIEW PROVIDER ACTIVITY by ECARPENT
RND - Now Dose by AMARTINEZ Eff: 02/08/11 1220
Now Dose 02/08/11 - 1600
Keep Next Dose 02/08/11 - 2100
02/08/11 1335 - DISCONTINUE by ASTAMPAS Eff: 02/08/11 1600
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/08/11 - 1600
For: 02/08/11 - 2100
For: 02/09/11 - 2100
For: 02/10/11 - 2100
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/08/11 1335 - POM COPY AND EDIT by ASTAMPAS
TO: Rx #U00761778
02/09/11 0731 - REVIEW PROVIDER ACTIVITY by AMOLINARI
RS - Discontinue by ASTAMPAS Eff: 02/08/11 1335
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 02/08/11-1800 Stop Date 02/08/11 1801 DC: 02/08/11-1801
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00864499

Discontinued Comments Reached Stop Date

History
02/08/11 1335 - POM COPY AND EDIT by ASTAMPAS
FROM: Rx #00864204
02/08/11 1618 - VERIFIED by ECARPENT
Items Dispensed: 1 Doses Dispensed: 1
For: 02/08/11 - 1800
02/08/11 1801 - DISCONTINUE by PHABKGJOB Eff: 02/08/11 1801
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 02/09/11-1700 Stop Date 02/09/11 1701 DC: 02/09/11-1701
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00864617

Discontinued Comments Reached Stop Date

History
02/09/11 1118 - POM ORDER by AMARTINEZ
02/09/11 1156 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 02/09/11 - 1700
02/09/11 1701 - DISCONTINUE by PHABKGJOB Eff: 02/09/11 1701
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 02/15/11-1730 Stop Date 03/17/11 1729 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00867249

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1735 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 02/15/11 - 1730
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge

CARI350T32 - CARISOPRODOL 350 MG TAB

Dose 350 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/26/09-1334 Stop Date 10/26/09 1333 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $7.98
Rx Number 00704483

Warnings
Type: MAINTENANCE
Range: CARISOPRODOL (350 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 1 per day is below the administration frequency
range of 3 - 3 per day.
Daily Dose Dosing range is 750 MG/DAY - 1400 MG/DAY. Ordered dose of 350 MG/DAY
is below the daily dose range.

Discontinued Comments DC'd by Discharge

History
09/26/09 1337 - POM ORDER by NBALCETIS
09/26/09 1351 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CLCX100C - CELECOXIB 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 08/31/17 1700 DC: 08/31/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 6 Total Costs $ Total Charges $
Rx Number 01541520

Discontinued Comments dc

History
08/31/17 0955 - POM ORDER by NBALCETIS
08/31/17 0956 - VERIFIED by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
08/31/17 1044 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/31/17-1700 STOP: 09/03/17 1659 SOFT STOP:
DISPENSE: 6
DC COMMENTS:
TO:
START: 08/31/17-1700 STOP: 08/31/17-1700 SOFT STOP:
DISPENSE: 0
DC COMMENTS:
dc
08/31/17 1044 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
DC COMMENTS:
dc
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/31/17 1305 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Edit by NBALCETIS Eff: 08/31/17 1044
Discontinue by NBALCETIS Eff: 08/31/17 1044
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CLCX100C - CELECOXIB 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 0952 (ONE)
Start Date 08/31/17-0952 Stop Date 08/31/17 0953 DC: 08/31/17-0953
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $16.80
Rx Number 01541521

Discontinued Comments Reached Stop Date

History
08/31/17 0955 - POM ORDER by NBALCETIS
08/31/17 0956 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 0952
08/31/17 0956 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 0953
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CEPH250C7 - CEPHALEXIN MONOHYDRATE 250 MG CAP

Dose 500 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 01/31/11-2100 Stop Date 01/31/11 2100 DC: 01/31/11-2100
Ordering Doctor MARTINEZ,ALEXANDER MD
Clinical Indication URINARY TRACT INFECTION
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00861420

Discontinued Comments CHANGE STRENGTH

History
01/31/11 1328 - POM ORDER by AMARTINEZ
01/31/11 1405 - VERIFIED by MHAIMOWITZ
Items Dispensed: 14 Doses Dispensed: 7
For: 01/31/11 - 2100
For: 02/01/11 - 0900
For: 02/01/11 - 2100
For: 02/02/11 - 0900
For: 02/02/11 - 2100
For: 02/03/11 - 0900
For: 02/03/11 - 2100
01/31/11 1412 - DISCONTINUE by MHAIMOWITZ Eff: 01/31/11 2100
Items Auto Credited: 14 Doses Auto Credited: 7
For: 01/31/11 - 2100
For: 02/01/11 - 0900
For: 02/01/11 - 2100
For: 02/02/11 - 0900
For: 02/02/11 - 2100
For: 02/03/11 - 0900
For: 02/03/11 - 2100
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
CHANGE STRENGTH
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CPH500C - CEPHALEXIN MONOHYDRATE 500 MG CAP

Dose 500 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 01/31/11-2100 Stop Date 03/04/11 2059 DC: 02/02/11-1215
Ordering Doctor MARTINEZ,ALEXANDER MD
Clinical Indication URINARY TRACT INFECTION
Total Dispensed 4 Total Costs $0.00 Total Charges $2.92
Rx Number 00861445

History
01/31/11 1414 - ENTER by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 01/31/11 - 2100
For: 02/01/11 - 0900
For: 02/01/11 - 2100
For: 02/02/11 - 0900
For: 02/02/11 - 2100
For: 02/03/11 - 0900
For: 02/03/11 - 2100
02/02/11 1218 - DISCONTINUE by ASTAMPAS Eff: 02/02/11 1215
Items Auto Credited: 9 Doses Auto Credited: 9
For: 02/02/11 - 2100
For: 02/03/11 - 0900
For: 02/03/11 - 2100
For: 02/04/11 - 0900
For: 02/04/11 - 2100
For: 02/05/11 - 0900
For: 02/05/11 - 2100
For: 02/06/11 - 0900
For: 02/06/11 - 2100
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/02/11 1328 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
RS - Discontinue by ASTAMPAS Eff: 02/02/11 1218
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CPR500T - CIPROFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 02/02/11-2100 Stop Date 03/06/11 2059 DC: 02/04/11-1131
Ordering Doctor STAMPAS,ARGYRIOS MD
Clinical Indication URINARY TRACT INFECTION
Total Dispensed 4 Total Costs $0.00 Total Charges $3.32
Rx Number 00862105

History
02/02/11 1218 - POM ORDER by ASTAMPAS
02/02/11 1325 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 02/02/11 - 2100
For: 02/03/11 - 0900
For: 02/03/11 - 2100
For: 02/04/11 - 0900
For: 02/04/11 - 2100
For: 02/05/11 - 0900
For: 02/05/11 - 2100
For: 02/06/11 - 0900
For: 02/06/11 - 2100
02/04/11 1135 - DISCONTINUE by ASTAMPAS Eff: 02/04/11 1131
Items Auto Credited: 9 Doses Auto Credited: 9
For: 02/04/11 - 2100
For: 02/05/11 - 0900
For: 02/05/11 - 2100
For: 02/06/11 - 0900
For: 02/06/11 - 2100
For: 02/07/11 - 0900
For: 02/07/11 - 2100
For: 02/08/11 - 0900
For: 02/08/11 - 2100
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/04/11 1135 - POM COPY AND EDIT by ASTAMPAS
TO: Rx #U00760352
02/04/11 1225 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
RS - Discontinue by ASTAMPAS Eff: 02/04/11 1135
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CPR500T - CIPROFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency 1215 (ONE)
Start Date 02/02/11-1215 Stop Date 02/02/11 1216 DC: 02/02/11-1216
Ordering Doctor STAMPAS,ARGYRIOS MD
Clinical Indication URINARY TRACT INFECTION
Total Dispensed 1 Total Costs $0.00 Total Charges $0.83
Rx Number 00862106

Discontinued Comments Reached Stop Date

History
02/02/11 1218 - POM ORDER by ASTAMPAS
02/02/11 1325 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 02/02/11 - 1215
02/02/11 1325 - DISCONTINUE by PHABKGJOB Eff: 02/02/11 1216
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CPR500T - CIPROFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 02/04/11-2100 Stop Date 02/11/11 2059 DC: 02/11/11-2059
Ordering Doctor STAMPAS,ARGYRIOS MD
Clinical Indication URINARY TRACT INFECTION
Total Dispensed 14 Total Costs $0.00 Total Charges $11.62
Rx Number 00862818

Discontinued Comments Reached Stop Date

History
02/04/11 1135 - POM COPY AND EDIT by ASTAMPAS
FROM: Rx #00862105
02/04/11 1214 - VERIFIED by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 02/04/11 - 2100
For: 02/05/11 - 0900
For: 02/05/11 - 2100
For: 02/06/11 - 0900
For: 02/06/11 - 2100
For: 02/07/11 - 0900
For: 02/07/11 - 2100
For: 02/08/11 - 0900
For: 02/08/11 - 2100
02/11/11 2059 - DISCONTINUE by PHABKGJOB Eff: 02/11/11 2059
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CYAN1TAB4 - CYANOCOBALAMIN/FA/PYRIDOXINE (FOLTX) TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency 1205 (ONE)
Start Date 09/01/17-1205 Stop Date 09/01/17 1206 DC: 09/01/17-1206
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $2.98
Rx Number 01541902

Discontinued Comments Reached Stop Date

History
09/01/17 1207 - POM ORDER by NBALCETIS
09/01/17 1210 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1205
09/01/17 1210 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 1206
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

CCLB10T - CYCLOBENZAPRINE HCL 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NOW (SCH)
Start Date 02/09/11-1215 Stop Date 03/11/11 1214 DC: 02/11/11-2222
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.30
Rx Number 00864880

Discontinued Comments DC'd by Discharge

History
02/09/11 1216 - POM ORDER by AMARTINEZ
02/09/11 1604 - VERIFIED by ECARPENT
Items Dispensed: 0 Doses Dispensed: 0
02/11/11 2223 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CCLB10T - CYCLOBENZAPRINE HCL 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 02/09/11-2100 Stop Date 03/11/11 2059 DC: 02/09/11-2100
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00864881

History
02/09/11 1216 - POM ORDER by AMARTINEZ
02/09/11 1604 - VERIFIED by ECARPENT
Items Dispensed: 5 Doses Dispensed: 5
For: 02/09/11 - 2100
For: 02/10/11 - 2100
For: 02/11/11 - 2100
For: 02/12/11 - 2100
For: 02/13/11 - 2100
02/09/11 1645 - DISCONTINUE by ASTAMPAS Eff: 02/09/11 2100
Items Auto Credited: 5 Doses Auto Credited: 5
For: 02/09/11 - 2100
For: 02/10/11 - 2100
For: 02/11/11 - 2100
For: 02/12/11 - 2100
For: 02/13/11 - 2100
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/09/11 1645 - POM COPY AND EDIT by ASTAMPAS
TO: Rx #U00762483
02/09/11 1734 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
RS - Discontinue by ASTAMPAS Eff: 02/09/11 1645
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

CCLB10T - CYCLOBENZAPRINE HCL 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 02/09/11-2100 Stop Date 03/11/11 2059 DC: 02/11/11-2222
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.60
Rx Number 00864945

Discontinued Comments DC'd by Discharge

History
02/09/11 1645 - POM COPY AND EDIT by ASTAMPAS
FROM: Rx #00864881
02/09/11 1734 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 02/09/11 - 2100
For: 02/10/11 - 2100
For: 02/11/11 - 2100
For: 02/12/11 - 2100
For: 02/13/11 - 2100
02/11/11 2223 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/12/11 - 2100
For: 02/13/11 - 2100
For: 02/14/11 - 2100
For: 02/15/11 - 2100
DC COMMENTS:
DC'd by Discharge

DLTP5KI - DALTEPARIN SODIUM 5,000 IUNITS/0.2 ML SYR

Dose 5,000 IUNITS (0.2 ML)

Dose Instructions Change to ECASA 325 mg po qd upon discharge unless
contraindicated.
Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $476.91
Rx Number 00248851

History
09/13/05 1506 - POM ORDER by SVAIDYA
09/13/05 1513 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00248845

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: ITCH - Itching
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00704463

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1333 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 300 MG (3 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 39 Total Costs $0.00 Total Charges $1.50
Rx Number 00248852

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1513 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 300 MG (3 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 33 Total Costs $ Total Charges $
Rx Number 00704464

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1334 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 01/30/11-0900 Stop Date 03/01/11 0859 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 39 Total Costs $0.00 Total Charges $6.25
Rx Number 00861130

Discontinued Comments DC'd by Discharge

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1914 - VERIFIED by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 01/30/11 - 0900
For: 01/30/11 - 1300
For: 01/30/11 - 1700
For: 01/31/11 - 0900
For: 01/31/11 - 1300
For: 01/31/11 - 1700
For: 02/01/11 - 0900
For: 02/01/11 - 1300
For: 02/01/11 - 1700
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 12 Doses Auto Credited: 12
For: 02/12/11 - 0900
For: 02/12/11 - 1300
For: 02/12/11 - 1700
For: 02/13/11 - 0900
For: 02/13/11 - 1300
For: 02/13/11 - 1700
For: 02/14/11 - 0900
For: 02/14/11 - 1300
For: 02/14/11 - 1700
For: 02/15/11 - 0900
For: 02/15/11 - 1300
For: 02/15/11 - 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 02/16/11-0900 Stop Date 03/18/11 0859 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $0.25
Rx Number 00867248

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1735 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 02/16/11 - 0900
For: 02/16/11 - 1700
For: 02/17/11 - 0900
For: 02/17/11 - 1700
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 9 Doses Auto Credited: 9
For: 02/18/11 - 1700
For: 02/19/11 - 0900
For: 02/19/11 - 1700
For: 02/20/11 - 0900
For: 02/20/11 - 1700
For: 02/21/11 - 0900
For: 02/21/11 - 1700
For: 02/22/11 - 0900
For: 02/22/11 - 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

ENXP30I.3 - ENOXAPARIN 30 MG/0.3 ML SYR

Dose 30 MG (0.3 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 09/26/09-1321 Stop Date 10/26/09 1320 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 21 Total Costs $0.00 Total Charges $703.23
Rx Number 00704465

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.85
MG/KG/DAY is below the daily dose range.

Discontinued Comments DC'd by Discharge

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1334 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $1.50
Rx Number 00248846

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 11 Total Costs $0.00 Total Charges $1.50
Rx Number 00704466

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1334 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 01/30/11-0900 Stop Date 03/01/11 0859 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 39 Total Costs $0.00 Total Charges $4.50
Rx Number 00861129

Discontinued Comments DC'd by Discharge

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1914 - VERIFIED by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 01/30/11 - 0900
For: 01/30/11 - 1300
For: 01/30/11 - 1700
For: 01/31/11 - 0900
For: 01/31/11 - 1300
For: 01/31/11 - 1700
For: 02/01/11 - 0900
For: 02/01/11 - 1300
For: 02/01/11 - 1700
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 12 Doses Auto Credited: 12
For: 02/12/11 - 0900
For: 02/12/11 - 1300
For: 02/12/11 - 1700
For: 02/13/11 - 0900
For: 02/13/11 - 1300
For: 02/13/11 - 1700
For: 02/14/11 - 0900
For: 02/14/11 - 1300
For: 02/14/11 - 1700
For: 02/15/11 - 0900
For: 02/15/11 - 1300
For: 02/15/11 - 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $2.64
Rx Number 00248853

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1513 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Dose Instructions Hold if SBP less than 100
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $1.60
Rx Number 00248854

History
09/13/05 1506 - POM ORDER by SVAIDYA
09/13/05 1513 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/26/09-1321 Stop Date 10/26/09 1320 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $0.18
Rx Number 00704467

Discontinued Comments DC'd by Discharge

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1334 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 01/30/11-0900 Stop Date 03/01/11 0859 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $0.36
Rx Number 00861134

Discontinued Comments DC'd by Discharge

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1916 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 01/30/11 - 0900
For: 01/31/11 - 0900
For: 02/01/11 - 0900
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/12/11 - 0900
For: 02/13/11 - 0900
For: 02/14/11 - 0900
For: 02/15/11 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 02/16/11-0900 Stop Date 03/18/11 0859 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.06
Rx Number 00867258

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1739 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 02/16/11 - 0900
For: 02/17/11 - 0900
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/19/11 - 0900
For: 02/20/11 - 0900
For: 02/21/11 - 0900
For: 02/22/11 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 01/31/11-2100 Stop Date 03/02/11 2059 DC: 02/02/11-1215
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.70
Rx Number 00861417

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
01/31/11 1336 - POM ORDER by AMARTINEZ
01/31/11 1405 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 01/31/11 - 2100
For: 02/01/11 - 2100
For: 02/02/11 - 2100
For: 02/03/11 - 2100
02/02/11 1218 - DISCONTINUE by ASTAMPAS Eff: 02/02/11 1215
Items Auto Credited: 5 Doses Auto Credited: 5
For: 02/02/11 - 2100
For: 02/03/11 - 2100
For: 02/04/11 - 2100
For: 02/05/11 - 2100
For: 02/06/11 - 2100
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/02/11 1328 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
RS - Discontinue by ASTAMPAS Eff: 02/02/11 1218
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 02/02/11-1400 Stop Date 03/04/11 1359 DC: 02/03/11-1033
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 3 Total Costs $0.00 Total Charges $1.05
Rx Number 00862107

History
02/02/11 1218 - POM ORDER by ASTAMPAS
02/02/11 1325 - VERIFIED by MHAIMOWITZ
Items Dispensed: 15 Doses Dispensed: 15
For: 02/02/11 - 1400
For: 02/02/11 - 2200
For: 02/03/11 - 0600
For: 02/03/11 - 1400
For: 02/03/11 - 2200
For: 02/04/11 - 0600
For: 02/04/11 - 1400
For: 02/04/11 - 2200
For: 02/05/11 - 0600
For: 02/05/11 - 1400
For: 02/05/11 - 2200
For: 02/06/11 - 0600
For: 02/06/11 - 1400
For: 02/06/11 - 2200
For: 02/07/11 - 0600
02/02/11 1325 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
RAD - Administration of Unverified Order by MGAJ Eff: 02/02/11 1257
02/03/11 1035 - DISCONTINUE by ASTAMPAS Eff: 02/03/11 1033
Items Auto Credited: 12 Doses Auto Credited: 12
For: 02/03/11 - 1400
For: 02/03/11 - 2200
For: 02/04/11 - 0600
For: 02/04/11 - 1400
For: 02/04/11 - 2200
For: 02/05/11 - 0600
For: 02/05/11 - 1400
For: 02/05/11 - 2200
For: 02/06/11 - 0600
For: 02/06/11 - 1400
For: 02/06/11 - 2200
For: 02/07/11 - 0600
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/03/11 1056 - REVIEW PROVIDER ACTIVITY by AMADDALENA
RS - Discontinue by ASTAMPAS Eff: 02/03/11 1035
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 400 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 02/03/11-1400 Stop Date 03/05/11 1359 DC: 02/11/11-2222
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 26 Total Costs $0.00 Total Charges $11.04
Rx Number 00862351

Discontinued Comments DC'd by Discharge

History
02/03/11 1035 - POM ORDER by ASTAMPAS
02/03/11 1056 - VERIFIED by AMADDALENA
Items Dispensed: 12 Doses Dispensed: 12
For: 02/03/11 - 1400
For: 02/03/11 - 2200
For: 02/04/11 - 0600
For: 02/04/11 - 1400
For: 02/04/11 - 2200
For: 02/05/11 - 0600
For: 02/05/11 - 1400
For: 02/05/11 - 2200
For: 02/06/11 - 0600
For: 02/06/11 - 1400
For: 02/06/11 - 2200
For: 02/07/11 - 0600
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 13 Doses Auto Credited: 13
For: 02/12/11 - 0600
For: 02/12/11 - 1400
For: 02/12/11 - 2200
For: 02/13/11 - 0600
For: 02/13/11 - 1400
For: 02/13/11 - 2200
For: 02/14/11 - 0600
For: 02/14/11 - 1400
For: 02/14/11 - 2200
For: 02/15/11 - 0600
For: 02/15/11 - 1400
For: 02/15/11 - 2200
For: 02/16/11 - 0600
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 400 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 02/15/11-2200 Stop Date 03/17/11 2159 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 8 Total Costs $0.00 Total Charges $3.84
Rx Number 00867282

Discontinued Comments DC'd by Discharge

History
02/15/11 1752 - POM ORDER by CDOHLE
02/15/11 1810 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 8
For: 02/15/11 - 2200
For: 02/16/11 - 0600
For: 02/16/11 - 1400
For: 02/16/11 - 2200
For: 02/17/11 - 0600
For: 02/17/11 - 1400
For: 02/17/11 - 2200
For: 02/18/11 - 0600
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 15 Doses Auto Credited: 15
For: 02/18/11 - 1400
For: 02/18/11 - 2200
For: 02/19/11 - 0600
For: 02/19/11 - 1400
For: 02/19/11 - 2200
For: 02/20/11 - 0600
For: 02/20/11 - 1400
For: 02/20/11 - 2200
For: 02/21/11 - 0600
For: 02/21/11 - 1400
For: 02/21/11 - 2200
For: 02/22/11 - 0600
For: 02/22/11 - 1400
For: 02/22/11 - 2200
For: 02/23/11 - 0600
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 01/31/11-1400 Stop Date 03/02/11 1359 DC: 02/11/11-2222
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 35 Total Costs $0.00 Total Charges $306.24
Rx Number 00861361

Discontinued Comments DC'd by Discharge

History
01/31/11 1136 - POM ORDER by AMARTINEZ
01/31/11 1200 - VERIFIED by AMADDALENA
Items Dispensed: 12 Doses Dispensed: 12
For: 01/31/11 - 1400
For: 01/31/11 - 2200
For: 02/01/11 - 0600
For: 02/01/11 - 1400
For: 02/01/11 - 2200
For: 02/02/11 - 0600
For: 02/02/11 - 1400
For: 02/02/11 - 2200
For: 02/03/11 - 0600
For: 02/03/11 - 1400
For: 02/03/11 - 2200
For: 02/04/11 - 0600
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 13 Doses Auto Credited: 13
For: 02/12/11 - 0600
For: 02/12/11 - 1400
For: 02/12/11 - 2200
For: 02/13/11 - 0600
For: 02/13/11 - 1400
For: 02/13/11 - 2200
For: 02/14/11 - 0600
For: 02/14/11 - 1400
For: 02/14/11 - 2200
For: 02/15/11 - 0600
For: 02/15/11 - 1400
For: 02/15/11 - 2200
For: 02/16/11 - 0600
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 4 MG (2 TABLETS)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/26/09-1321 Stop Date 10/03/09 1320 DC: 09/30/09-1435
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 20 Total Costs $0.00 Total Charges $1.75
Rx Number 00704468

Warnings
Type: MAINTENANCE
Range: HYDROMORPHONE HCL (2 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 6 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments Result of renew in POM

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1334 - VERIFIED by MHAIMOWITZ
09/30/09 1436 - DISCONTINUE by SVAIDYA Eff: 09/30/09 1435
EDIT DOCTOR: VAIDYA, SUDHIR M.D.
EDIT SOURCE: Written
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Result of renew in POM
09/30/09 1437 - POM COPY AND EDIT by SVAIDYA
TO: Rx #U00603268
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 6 MG (3 TABLETS)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/26/09-1321 Stop Date 10/03/09 1320 DC: 09/30/09-1435
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 30 Total Costs $0.00 Total Charges $2.75
Rx Number 00704469

Warnings
Type: MAINTENANCE
Range: HYDROMORPHONE HCL (2 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 6 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments Result of renew in POM

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1334 - VERIFIED by MHAIMOWITZ
09/30/09 1436 - DISCONTINUE by SVAIDYA Eff: 09/30/09 1435
EDIT DOCTOR: VAIDYA, SUDHIR M.D.
EDIT SOURCE: Written
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Result of renew in POM
09/30/09 1437 - POM COPY AND EDIT by SVAIDYA
TO: Rx #U00603269
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 4 MG (2 TABLETS)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/30/09-1435 Stop Date 10/07/09 1434 DC: 10/02/09-1056
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 20 Total Costs $0.00 Total Charges $1.50
Rx Number 00705920

Warnings
Type: MAINTENANCE
Range: HYDROMORPHONE HCL (2 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 6 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments DC'd by Discharge

History
09/30/09 1437 - POM COPY AND EDIT by SVAIDYA
FROM: Rx #00704468
09/30/09 1440 - VERIFIED by AMADDALENA
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 6 MG (3 TABLETS)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/30/09-1435 Stop Date 10/07/09 1434 DC: 10/02/09-1056
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 30 Total Costs $ Total Charges $
Rx Number 00705921

Warnings
Type: MAINTENANCE
Range: HYDROMORPHONE HCL (2 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 6 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments DC'd by Discharge

History
09/30/09 1437 - POM COPY AND EDIT by SVAIDYA
FROM: Rx #00704469
09/30/09 1440 - VERIFIED by AMADDALENA
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 4 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 01/29/11-1715 Stop Date 02/05/11 1714 DC: 02/03/11-1035
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 26 Total Costs $0.00 Total Charges $6.25
Rx Number 00861131

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1914 - VERIFIED by EBALILO
Items Dispensed: 26 Doses Dispensed: 13
For: 01/29/11 - 1715
02/03/11 1035 - DISCONTINUE by ASTAMPAS Eff: 02/03/11 1035
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/03/11 1035 - POM COPY AND EDIT by ASTAMPAS
TO: Rx #U00759908
02/03/11 1056 - REVIEW PROVIDER ACTIVITY by AMADDALENA
RS - Discontinue by ASTAMPAS Eff: 02/03/11 1035

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 6 MG (3 TABLETS)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 01/29/11-1715 Stop Date 02/05/11 1714 DC: 02/03/11-1035
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 39 Total Costs $0.00 Total Charges $0.25
Rx Number 00861132

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1914 - VERIFIED by EBALILO
Items Dispensed: 39 Doses Dispensed: 13
For: 01/29/11 - 1715
02/03/11 1035 - DISCONTINUE by ASTAMPAS Eff: 02/03/11 1035
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/03/11 1035 - POM COPY AND EDIT by ASTAMPAS
TO: Rx #U00759909
02/03/11 1056 - REVIEW PROVIDER ACTIVITY by AMADDALENA
RS - Discontinue by ASTAMPAS Eff: 02/03/11 1035
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 4 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: FOR SIGNIFICANT PAIN
Start Date 02/03/11-1045 Stop Date 02/10/11 1044 DC: 02/09/11-1643
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 14 Total Costs $0.00 Total Charges $6.25
Rx Number 00862347

History
02/03/11 1035 - POM COPY AND EDIT by ASTAMPAS
FROM: Rx #00861131
02/03/11 1056 - VERIFIED by AMADDALENA
Items Dispensed: 14 Doses Dispensed: 7
For: 02/03/11 - 1045
02/09/11 1644 - DISCONTINUE by ASTAMPAS Eff: 02/09/11 1643
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/09/11 1644 - POM COPY AND EDIT by ASTAMPAS
TO: Rx #U00762482
02/09/11 1734 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
RS - Discontinue by ASTAMPAS Eff: 02/09/11 1644
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 6 MG (3 TABLETS)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: FOR MODERATE PAIN
Start Date 02/03/11-1045 Stop Date 02/10/11 1044 DC: 02/07/11-1115
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 21 Total Costs $ Total Charges $
Rx Number 00862348

History
02/03/11 1035 - POM COPY AND EDIT by ASTAMPAS
FROM: Rx #00861132
02/03/11 1056 - VERIFIED by AMADDALENA
Items Dispensed: 21 Doses Dispensed: 7
For: 02/03/11 - 1045
02/07/11 1116 - DISCONTINUE by AMARTINEZ Eff: 02/07/11 1115
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
EDIT SOURCE: Written
02/07/11 1116 - POM COPY AND EDIT by AMARTINEZ
TO: Rx #U00761273
02/07/11 1128 - REVIEW PROVIDER ACTIVITY by AMADDALENA
RS - Discontinue by AMARTINEZ Eff: 02/07/11 1116

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 2 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: FOR MODERATE PAIN
Start Date 02/07/11-1115 Stop Date 02/14/11 1114 DC: 02/11/11-2222
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 15 Total Costs $0.00 Total Charges $0.25
Rx Number 00863706

Discontinued Comments DC'd by Discharge

History
02/07/11 1116 - POM COPY AND EDIT by AMARTINEZ
FROM: Rx #00862348
02/07/11 1127 - VERIFIED by AMADDALENA
Items Dispensed: 15 Doses Dispensed: 15
For: 02/07/11 - 1115
02/11/11 2223 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 4 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: FOR SIGNIFICANT PAIN
Start Date 02/09/11-1645 Stop Date 02/16/11 1644 DC: 02/11/11-2222
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 26 Total Costs $0.00 Total Charges $1.00
Rx Number 00864946

Discontinued Comments DC'd by Discharge

History
02/09/11 1644 - POM COPY AND EDIT by ASTAMPAS
FROM: Rx #00862347
02/09/11 1734 - VERIFIED by MHAIMOWITZ
Items Dispensed: 26 Doses Dispensed: 13
For: 02/09/11 - 1645
02/11/11 2223 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 4 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 02/15/11-1730 Stop Date 02/22/11 1729 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 6 Total Costs $0.00 Total Charges $2.50
Rx Number 00867251

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1737 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 02/15/11 - 1730
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

INDO25CA6 - INDOMETHACIN 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00248855

History
09/13/05 1506 - POM ORDER by SVAIDYA
09/13/05 1513 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

INFL45DI36 - INFLUENZA TVS 10-11 VACCINE/PF 0.5 ML SYRINGE

Dose 0.5 ML (1 SYRINGE)

Admin Route INTRAMUSC.
Frequency ONETIME (ONE)
Start Date 02/15/11-1730 Stop Date 02/15/11 1731 DC: 02/15/11-1731
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00867267

Discontinued Comments Reached Stop Date

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1744 - REVIEW PROVIDER ACTIVITY by EBALILO
RAD - Administration of Unverified Order by SITHOMAS Eff: 02/15/11 1728
02/15/11 1744 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 02/15/11 - 1730
02/15/11 1744 - DISCONTINUE by PHABKGJOB Eff: 02/15/11 1731
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LACT10SY31 - LACTULOSE 20 GM/30 ML UDC

Dose 20 GM (30 ML)

Admin Route ORAL
Frequency ONETIME (SCH)
Start Date 02/08/11-1600 Stop Date 03/10/11 1559 DC: 02/08/11-1600
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00864206

History
02/08/11 1219 - POM ORDER by AMARTINEZ
02/08/11 1219 - NOW DOSE by AMARTINEZ
Now Dose: 02/08/11 1600
02/08/11 1219 - KEEP NEXT DOSE by AMARTINEZ
Keep Next Dose: 02/08/11 2100
02/08/11 1253 - VERIFIED by ECARPENT
Items Dispensed: 4 Doses Dispensed: 4
For: 02/08/11 - 1600
For: 02/08/11 - 2100
For: 02/09/11 - 2100
For: 02/10/11 - 2100
02/08/11 1253 - NOW DOSE by ECARPENT
Now Dose: 02/08/11 1600
02/08/11 1253 - KEEP NEXT DOSE by ECARPENT
Keep Next Dose: 02/08/11 2100
02/08/11 1253 - REVIEW PROVIDER ACTIVITY by ECARPENT
RND - Now Dose by AMARTINEZ Eff: 02/08/11 1220
Now Dose 02/08/11 - 1600
Keep Next Dose 02/08/11 - 2100
02/08/11 1335 - DISCONTINUE by ASTAMPAS Eff: 02/08/11 1600
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/08/11 - 1600
For: 02/08/11 - 2100
For: 02/09/11 - 2100
For: 02/10/11 - 2100
EDIT DOCTOR: STAMPAS,ARGYRIOS MD
EDIT SOURCE: Written
02/08/11 1335 - POM COPY AND EDIT by ASTAMPAS
TO: Rx #U00761779
02/09/11 0731 - REVIEW PROVIDER ACTIVITY by AMOLINARI
RS - Discontinue by ASTAMPAS Eff: 02/08/11 1335
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LACT10SY31 - LACTULOSE 20 GM/30 ML UDC

Dose 20 GM (30 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 02/08/11-1600 Stop Date 02/08/11 1601 DC: 02/08/11-1601
Ordering Doctor STAMPAS,ARGYRIOS MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00864498

Discontinued Comments Reached Stop Date

History
02/08/11 1335 - POM COPY AND EDIT by ASTAMPAS
FROM: Rx #00864206
02/08/11 1617 - VERIFIED by ECARPENT
Items Dispensed: 1 Doses Dispensed: 1
For: 02/08/11 - 1600
02/08/11 1618 - DISCONTINUE by PHABKGJOB Eff: 02/08/11 1601
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LACT10SY31 - LACTULOSE 20 GM/30 ML UDC

Dose 20 GM (30 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 02/09/11-1700 Stop Date 02/09/11 1701 DC: 02/09/11-1701
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00864616

Warnings
Type: MAINTENANCE
Range:
Condition: ALL COMMON INDICATIONS
Warnings LACT10SY31: Unable to check dose ranges for G/DAY (Dose Units).

Type: MAINTENANCE
Range:
Condition: ALL COMMON INDICATIONS
Warnings LACT10SY31: Unable to check dose ranges for G/DAY (Dose Units).

Type: MAINTENANCE
Range: LACTULOSE (10 GM/15 ML)
Condition: ALL COMMON INDICATIONS
Warnings LACT10SY31: Unable to check dose ranges for G/DAY (Dose Units).

Discontinued Comments Reached Stop Date

History
02/09/11 1118 - POM ORDER by AMARTINEZ
02/09/11 1155 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 02/09/11 - 1700
02/09/11 1701 - DISCONTINUE by PHABKGJOB Eff: 02/09/11 1701
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LNS30CCR - LANSOPRAZOLE 30 MG CAPCR

Dose 30 MG (1 CAPSULE CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/18/05-1834 Stop Date 10/18/05 1833 DC: 09/21/05-1027
Ordering Doctor Rios,Allan MD
Total Dispensed 7 Total Costs $0.00 Total Charges $30.84
Rx Number 00250738

History
09/18/05 1836 - POM ORDER by ARIOS
09/18/05 1843 - VERIFIED by ECARPENT
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

LNS30CCR - LANSOPRAZOLE 30 MG CAPCR

Dose 30 MG (1 CAPSULE CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 1834 (ONE)
Start Date 09/18/05-1834 Stop Date 09/18/05 1835 DC: 09/18/05-1835
Ordering Doctor Rios,Allan MD
Total Dispensed 1 Total Costs $0.00 Total Charges $10.28
Rx Number 00250737

History
09/18/05 1836 - POM ORDER by ARIOS
09/18/05 1843 - VERIFIED by ECARPENT
09/18/05 1844 - DISCONTINUE by PHABKGJOB Eff: 09/18/05 1835

LVF500T - LEVOFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/14/05-1026 Stop Date 09/21/05 1025 DC: 09/19/05-1022
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 7 Total Costs $0.00 Total Charges $117.75
Rx Number 00249081

Discontinued Comments Result of renew in POM

History
09/14/05 1027 - POM ORDER by SVAIDYA
09/14/05 1031 - VERIFIED by AMADDALENA
09/19/05 1023 - DISCONTINUE by SVAIDYA Eff: 09/19/05 1022
DC COMMENTS:
Result of renew in POM
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LVF500T - LEVOFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency 1026 (ONE)
Start Date 09/14/05-1026 Stop Date 09/14/05 1027 DC: 09/14/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $23.55
Rx Number 00249080

History
09/14/05 1027 - POM ORDER by SVAIDYA
09/14/05 1029 - VERIFIED by AMADDALENA
09/14/05 1031 - DISCONTINUE by PHABKGJOB Eff: 09/14/05 1027

LVF500T - LEVOFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/19/05-1022 Stop Date 09/26/05 1022 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 6 Total Costs $0.00 Total Charges $47.10
Rx Number 00250828

History
09/19/05 1023 - POM ORDER by SVAIDYA
09/19/05 1052 - VERIFIED by AMOLINARI
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LVF250T - LEVOFLOXACIN 250 MG TAB

Dose 750 MG (3 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 08/30/17 0901 DC: 08/30/17-0901
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication SEE PROGRESS NOTES
Total Dispensed 3 Total Costs $0.00 Total Charges $196.58
Rx Number 01541038

Warnings
Type: BURKE
Range: LEVOFLOXACIN (250 MG)
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 125 MG/DAY - 750 MG/DAY. Ordered dose of 0 MG/DAY is
below the Low Daily Dose.

Discontinued Comments Reached Stop Date

History
08/29/17 1452 - POM ORDER by NBALCETIS
08/29/17 1510 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 1
For: 08/30/17 - 0900
08/30/17 0901 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 0901
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD IF SBP LESS THAN 100
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 24 Total Costs $0.00 Total Charges $34.40
Rx Number 00248856

History
09/13/05 1506 - POM ORDER by SVAIDYA
09/13/05 1513 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/26/09-1321 Stop Date 10/26/09 1320 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $15.30
Rx Number 00704470

Discontinued Comments DC'd by Discharge

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1334 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 01/30/11-0900 Stop Date 03/01/11 0859 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $7.30
Rx Number 00861133

Discontinued Comments DC'd by Discharge

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1916 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 01/30/11 - 0900
For: 01/31/11 - 0900
For: 02/01/11 - 0900
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/12/11 - 0900
For: 02/13/11 - 0900
For: 02/14/11 - 0900
For: 02/15/11 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions hold for SBP< 110, DBP < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 02/16/11-0900 Stop Date 03/18/11 0859 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $1.46
Rx Number 00867259

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1740 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 02/16/11 - 0900
For: 02/17/11 - 0900
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/19/11 - 0900
For: 02/20/11 - 0900
For: 02/21/11 - 0900
For: 02/22/11 - 0900
DC COMMENTS:
DC'd by Discharge

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.50
Rx Number 00248847

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 10 Total Costs $ Total Charges $
Rx Number 00704471

Warnings
Type: MAINTENANCE
Range: MAG HYDROX/ALUMINUM HYD/SIMETH (355 ML)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 6 per day is above the administration frequency
range of 1 - 1 per day.
Duration Ordered duration of 30 days is above the duration range of 1 - 14
days. Maximum duration checking is not available.

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1334 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 02/15/11-1730 Stop Date 03/17/11 1729 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 00867252

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1738 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 02/15/11 - 1730
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 83
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 00248848

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00704472

Warnings
Type: MAINTENANCE
Range: MAGNESIUM HYDROXIDE (400 MG/5 ML)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 1 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1335 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 84
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 02/15/11-1730 Stop Date 03/17/11 1729 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 00867254

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1738 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 02/15/11 - 1730
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 85
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions hold for SBP < 110, DBP < 60, HR < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 01/29/11-2100 Stop Date 02/28/11 2059 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 27 Total Costs $0.00 Total Charges $5.00
Rx Number 00861135

Discontinued Comments DC'd by Discharge

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1917 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 01/29/11 - 2100
For: 01/30/11 - 0900
For: 01/30/11 - 2100
For: 01/31/11 - 0900
For: 01/31/11 - 2100
For: 02/01/11 - 0900
For: 02/01/11 - 2100
02/03/11 2118 - EDIT by CDOHLE
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: Written
FROM:
DOSE INSTRUCTIONS:
TO:
DOSE INSTRUCTIONS:
hold for SBP < 110, DBP < 60, HR < 60
02/04/11 0743 - REVIEW PROVIDER ACTIVITY by AMOLINARI
RE - Edit by CDOHLE Eff: 02/03/11 2118
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 8 Doses Auto Credited: 8
For: 02/12/11 - 0900
For: 02/12/11 - 2100
For: 02/13/11 - 0900
For: 02/13/11 - 2100
For: 02/14/11 - 0900
For: 02/14/11 - 2100
For: 02/15/11 - 0900
For: 02/15/11 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 86
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $1.75
Rx Number 00248849

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1511 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 11 Total Costs $0.00 Total Charges $1.50
Rx Number 00704473

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1335 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 87
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 02/16/11-0900 Stop Date 03/18/11 0859 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.50
Rx Number 00867253

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1738 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 02/16/11 - 0900
For: 02/17/11 - 0900
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/19/11 - 0900
For: 02/20/11 - 0900
For: 02/21/11 - 0900
For: 02/22/11 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 88
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

NAPR250T20 - NAPROXEN 250 MG TAB

Dose 500 MG (2 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/26/09-1321 Stop Date 10/26/09 1320 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 20 Total Costs $0.00 Total Charges $32.10
Rx Number 00704474

Warnings
Type: MAINTENANCE
Range: NAPROXEN (250 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 1 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments DC'd by Discharge

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1335 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 89
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

NAPR250T20 - NAPROXEN 250 MG TAB

Dose 500 MG (2 TABLETS)

Admin Route ORAL
Frequency 2X DAILY BRKFST/DIN (SCH)
Start Date 02/03/11-1700 Stop Date 02/08/11 1659 DC: 02/04/11-1212
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 4 Total Costs $0.00 Total Charges $1.60
Rx Number 00862671

History
02/03/11 1631 - POM ORDER by AMARTINEZ
02/03/11 1656 - VERIFIED by EBALILO
Items Dispensed: 14 Doses Dispensed: 7
For: 02/03/11 - 1700
For: 02/04/11 - 0800
For: 02/04/11 - 1700
For: 02/05/11 - 0800
For: 02/05/11 - 1700
For: 02/06/11 - 0800
For: 02/06/11 - 1700
02/04/11 1214 - DISCONTINUE by AMARTINEZ Eff: 02/04/11 1212
Items Auto Credited: 16 Doses Auto Credited: 8
For: 02/04/11 - 1700
For: 02/05/11 - 0800
For: 02/05/11 - 1700
For: 02/06/11 - 0800
For: 02/06/11 - 1700
For: 02/07/11 - 0800
For: 02/07/11 - 1700
For: 02/08/11 - 0800
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
EDIT SOURCE: Written
02/04/11 1225 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
RS - Discontinue by AMARTINEZ Eff: 02/04/11 1214
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 90
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

NAPR250T20 - NAPROXEN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 02/15/11-1730 Stop Date 03/17/11 1729 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00867260

Discontinued Comments DC'd by Discharge

History
02/15/11 1727 - POM ORDER by CDOHLE
02/15/11 1740 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 02/15/11 - 1730
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 91
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (1 EACH)
Dose Instructions ADDERRAL 50 mg po
may take her own
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 01/30/11-0900 Stop Date 03/01/11 0859 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00865937

Discontinued Comments DC'd by Discharge

History
01/29/11 1723 - POM ORDER by NBALCETIS
01/29/11 1828 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: Written
FROM:
DOSE INSTRUCTIONS:
ADDERRAL 5 mg po
may take her own
TO:
DOSE INSTRUCTIONS:
ADDERRAL 50 mg po
may take her own
01/30/11 1946 - EDIT by EBALILO
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
LABEL COMMENTS:
TO:
LABEL COMMENTS:
ADDERALL 50MG
PT'S FAMILY WILL BRING IN OWN MEDS PER RN
02/03/11 1056 - REVIEW PROVIDER ACTIVITY by AMADDALENA
RE - Edit by NBALCETIS Eff: 01/29/11 1828
RAD - Administration of Unverified Order by BANSELM Eff: 01/30/11 1015
RAD - Administration of Unverified Order by BANSELM Eff: 01/31/11 0806
RAD - Administration of Unverified Order by MGAJ Eff: 02/01/11 0926
RAD - Administration of Unverified Order by MGAJ Eff: 02/02/11 0945
RAD - Administration of Unverified Order by JROSSMAN Eff: 02/03/11 0947
02/11/11 2222 - VERIFIED by SYSTEM
Verified in order to DC
Items Dispensed: 0 Doses Dispensed: 0
02/11/11 2222 - REVIEW PROVIDER ACTIVITY by SYSTEM
RAD - Administration of Unverified Order by JROSSMAN Eff: 02/04/11 0839
RAD - Administration of Unverified Order by BANSELM Eff: 02/05/11 0927
RAD - Administration of Unverified Order by CPAYEN Eff: 02/06/11 0916
RAD - Administration of Unverified Order by BANSELM Eff: 02/07/11 0823
RAD - Administration of Unverified Order by DCALLAHAN Eff: 02/08/11 0816
RAD - Administration of Unverified Order by DCALLAHAN Eff: 02/09/11 0809
RAD - Administration of Unverified Order by JROSSMAN Eff: 02/10/11 0859
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 92
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

RAD - Administration of Unverified Order by SITHOMAS Eff: 02/11/11 0957

02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 0 Doses Auto Credited: 0
DC COMMENTS:
DC'd by Discharge

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Breo Ellipta 100-25mg inhal. daily

Admin Route XX
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859 DC: 08/30/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541022

History
08/29/17 1451 - POM ORDER by NBALCETIS
08/29/17 1503 - DISCONTINUE by AMACCA Eff: 08/30/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1503 - VERIFIED by SYSTEM
Verified in order to DC

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Bystolic 10mg po daily

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859 DC: 08/30/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541019

History
08/29/17 1451 - POM ORDER by NBALCETIS
08/29/17 1501 - VERIFIED by SYSTEM
Verified in order to DC
08/29/17 1501 - DISCONTINUE by AMACCA Eff: 08/30/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 93
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency BEFORE BREAKFAST (SCH)
Start Date 09/26/09-1321 Stop Date 10/26/09 1320 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $74.28
Rx Number 00704475

Discontinued Comments DC'd by Discharge

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1335 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency BEFORE BREAKFAST (SCH)
Start Date 01/30/11-0800 Stop Date 03/01/11 0759 DC: 01/30/11-0800
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00861098

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1828 - VERIFIED by SYSTEM
Verified in order to DC
Items Dispensed: 0 Doses Dispensed: 0
01/29/11 1828 - DISCONTINUE by NBALCETIS Eff: 01/30/11 0800
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: Written
01/29/11 1828 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U00758737
01/29/11 1919 - REVIEW PROVIDER ACTIVITY by EBALILO
RE - Edit by SYSTEM Eff: 01/29/11 1828
RS - Discontinue by NBALCETIS Eff: 01/29/11 1828
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 94
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 01/29/11-2100 Stop Date 02/28/11 2059 DC: 02/11/11-2222
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 27 Total Costs $0.00 Total Charges $39.00
Rx Number 00861137

Discontinued Comments DC'd by Discharge

History
01/29/11 1828 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #00861098
Result of Sig/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Dose: 01/30/11 - 0800
Last Administration:
Old Sig/Sch: BEFORE BREAKFAST (SCH)
New Sig/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 01/30/11 - 0800
New Order Start: 01/29/11 - 2100
01/29/11 1917 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 01/29/11 - 2100
For: 01/30/11 - 0900
For: 01/30/11 - 2100
For: 01/31/11 - 0900
For: 01/31/11 - 2100
For: 02/01/11 - 0900
For: 02/01/11 - 2100
01/29/11 1917 - REVIEW PROVIDER ACTIVITY by EBALILO
RFS - Freq/Sch Edit by NBALCETIS Eff: 01/29/11 1828
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Dose: 01/30/11 - 0800
Last Administration:
Old Freq/Sch: BEFORE BREAKFAST (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 01/30/11 - 0800
New Order Start: 01/29/11 - 2100
02/11/11 2222 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 8 Doses Auto Credited: 8
For: 02/12/11 - 0900
For: 02/12/11 - 2100
For: 02/13/11 - 0900
For: 02/13/11 - 2100
For: 02/14/11 - 0900
For: 02/14/11 - 2100
For: 02/15/11 - 0900
For: 02/15/11 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 95
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OXYC20TA2 - OXYCODONE HCL 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/15/05-1001 Stop Date 09/22/05 1000 DC: 09/17/05-1001
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 11 Total Costs $0.00 Total Charges $1.00
Rx Number 00249402

Discontinued Comments Result of renew in POM

History
09/15/05 1002 - POM ORDER by SVAIDYA
09/15/05 1005 - VERIFIED by AMADDALENA
09/17/05 1001 - DISCONTINUE by ARIOS Eff: 09/17/05 1001
DC COMMENTS:
Result of renew in POM

OXYC20TA2 - OXYCODONE HCL 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 1002 (ONE)
Start Date 09/15/05-1002 Stop Date 09/15/05 1003 DC: 09/15/05-1003
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $0.25
Rx Number 00249403

History
09/15/05 1002 - POM ORDER by SVAIDYA
09/15/05 1005 - VERIFIED by AMADDALENA
09/15/05 1005 - DISCONTINUE by PHABKGJOB Eff: 09/15/05 1003
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 96
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OXYC20TA2 - OXYCODONE HCL 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/17/05-0958 Stop Date 09/24/05 0958 DC: 09/18/05-1032
Ordering Doctor Rios,Allan MD
Total Dispensed 7 Total Costs $0.00 Total Charges $0.50
Rx Number 00250362

Discontinued Comments Result of renew in POM

History
09/17/05 1002 - POM ORDER by ARIOS
09/17/05 1256 - VERIFIED by ECARPENT
09/18/05 1033 - DISCONTINUE by ARIOS Eff: 09/18/05 1032
DC COMMENTS:
Result of renew in POM

OXYC20TA2 - OXYCODONE HCL 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/18/05-1030 Stop Date 09/25/05 1031 DC: 09/21/05-1027
Ordering Doctor Rios,Allan MD
Total Dispensed 14 Total Costs $0.00 Total Charges $1.50
Rx Number 00250603

History
09/18/05 1033 - POM ORDER by ARIOS
09/18/05 1051 - VERIFIED by ECARPENT
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 97
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OXYC20TA2 - OXYCODONE HCL 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/28/09-1116 Stop Date 10/05/09 1115 DC: 09/30/09-1435
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $1.00
Rx Number 00704800

Warnings
Type: MAINTENANCE
Range:
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 2 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments Result of renew in POM

History
09/28/09 1121 - POM ORDER by SVAIDYA
09/28/09 1130 - VERIFIED by EBALILO
09/30/09 1436 - DISCONTINUE by SVAIDYA Eff: 09/30/09 1435
EDIT DOCTOR: VAIDYA, SUDHIR M.D.
EDIT SOURCE: Written
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Result of renew in POM
09/30/09 1437 - POM COPY AND EDIT by SVAIDYA
TO: Rx #U00603270
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 98
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OXYC20TA2 - OXYCODONE HCL 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 1116 (ONE)
Start Date 09/28/09-1116 Stop Date 09/28/09 1117 DC: 09/28/09-1117
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $0.25
Rx Number 00704801

Warnings
Type: MAINTENANCE
Range:
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 1 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments Reached Stop Date

History
09/28/09 1122 - POM ORDER by SVAIDYA
09/28/09 1130 - VERIFIED by EBALILO
09/28/09 1131 - DISCONTINUE by PHABKGJOB Eff: 09/28/09 1117
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 99
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OXYC20TA2 - OXYCODONE HCL 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/30/09-1435 Stop Date 10/07/09 1434 DC: 10/02/09-1056
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $1.00
Rx Number 00705922

Warnings
Type: MAINTENANCE
Range:
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 2 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments DC'd by Discharge

History
09/30/09 1437 - POM COPY AND EDIT by SVAIDYA
FROM: Rx #00704800
09/30/09 1440 - VERIFIED by AMADDALENA
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 100
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OXYC20TA2 - OXYCODONE HCL 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 02/01/11-2100 Stop Date 02/07/11 1114 DC: 02/07/11-1114
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 14 Total Costs $0.00 Total Charges $3.00
Rx Number 00862030

History
02/01/11 1839 - POM ORDER by CDOHLE
02/02/11 0730 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 02/01/11 - 2100
For: 02/02/11 - 0900
For: 02/02/11 - 2100
For: 02/03/11 - 0900
For: 02/03/11 - 2100
02/02/11 0730 - REVIEW PROVIDER ACTIVITY by AMOLINARI
RAD - Administration of Unverified Order by DSWILLIAMS Eff: 02/01/11 2041
02/07/11 1115 - EDIT by AMARTINEZ
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
EDIT SOURCE: Written
FROM:
START: 02/01/11-2100 STOP: 02/08/11 2059 SOFT STOP: 0
TO:
START: 02/01/11-2100 STOP: 02/07/11-1114 SOFT STOP:
02/07/11 1115 - DISCONTINUE by AMARTINEZ Eff: 02/07/11 1114
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
EDIT SOURCE: Written
02/07/11 1115 - POM COPY AND EDIT by AMARTINEZ
TO: Rx #U00761271
02/07/11 1128 - REVIEW PROVIDER ACTIVITY by AMADDALENA
RE - Edit by AMARTINEZ Eff: 02/07/11 1115
RS - Discontinue by AMARTINEZ Eff: 02/07/11 1115
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 101
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OXYC20TA2 - OXYCODONE HCL 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 02/07/11-1400 Stop Date 02/14/11 1359 DC: 02/11/11-2222
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 14 Total Costs $0.00 Total Charges $3.00
Rx Number 00863705

Discontinued Comments DC'd by Discharge

History
02/07/11 1115 - POM COPY AND EDIT by AMARTINEZ
FROM: Rx #00862030
Result of Sig/Schedule Edit
Ordering Doctor: MARTINEZ,ALEXANDER MD
Last Scheduled Dose: 02/07/11 - 0900
Last Administration: 02/07/11 - 0836
Old Sig/Sch: EVERY 12 HOURS (SCH)
New Sig/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 02/07/11 - 1114
New Order Start: 02/07/11 - 1400
02/07/11 1127 - VERIFIED by AMADDALENA
Items Dispensed: 12 Doses Dispensed: 12
For: 02/07/11 - 1400
For: 02/07/11 - 2200
For: 02/08/11 - 0600
For: 02/08/11 - 1400
For: 02/08/11 - 2200
For: 02/09/11 - 0600
For: 02/09/11 - 1400
For: 02/09/11 - 2200
For: 02/10/11 - 0600
For: 02/10/11 - 1400
For: 02/10/11 - 2200
For: 02/11/11 - 0600
02/07/11 1127 - REVIEW PROVIDER ACTIVITY by AMADDALENA
RFS - Freq/Sch Edit by AMARTINEZ Eff: 02/07/11 1115
Ordering Doctor: MARTINEZ,ALEXANDER MD
Last Scheduled Dose: 02/07/11 - 0900
Last Administration: 02/07/11 - 0836
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 02/07/11 - 1114
New Order Start: 02/07/11 - 1400
02/11/11 2223 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 7 Doses Auto Credited: 7
For: 02/12/11 - 0600
For: 02/12/11 - 1400
For: 02/12/11 - 2200
For: 02/13/11 - 0600
For: 02/13/11 - 1400
For: 02/13/11 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 102
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

For: 02/14/11 - 0600

DC COMMENTS:
DC'd by Discharge

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 09/20/05 1500 DC: 09/17/05-1001
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 00248858

Discontinued Comments Result of renew in POM

History
09/13/05 1506 - POM ORDER by SVAIDYA
09/13/05 1514 - VERIFIED by EBALILO
09/17/05 1001 - DISCONTINUE by ARIOS Eff: 09/17/05 1001
DC COMMENTS:
Result of renew in POM

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SEVERE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 09/20/05 1500 DC: 09/17/05-1001
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $3.50
Rx Number 00248859

Discontinued Comments Result of renew in POM

History
09/13/05 1506 - POM ORDER by SVAIDYA
09/13/05 1514 - VERIFIED by EBALILO
09/17/05 1001 - DISCONTINUE by ARIOS Eff: 09/17/05 1001
DC COMMENTS:
Result of renew in POM
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 103
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: -
Start Date 09/17/05-0958 Stop Date 09/24/05 0958 DC: 09/18/05-1032
Ordering Doctor Rios,Allan MD
Total Dispensed 15 Total Costs $ Total Charges $
Rx Number 00250363

Discontinued Comments Result of renew in POM

History
09/17/05 1002 - POM ORDER by ARIOS
09/17/05 1256 - VERIFIED by ECARPENT
09/18/05 1033 - DISCONTINUE by ARIOS Eff: 09/18/05 1032
DC COMMENTS:
Result of renew in POM

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SEVERE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: -
Start Date 09/17/05-0958 Stop Date 09/24/05 0958 DC: 09/18/05-1032
Ordering Doctor Rios,Allan MD
Total Dispensed 30 Total Costs $0.00 Total Charges $1.00
Rx Number 00250364

Discontinued Comments Result of renew in POM

History
09/17/05 1002 - POM ORDER by ARIOS
09/17/05 1256 - VERIFIED by ECARPENT
09/18/05 1033 - DISCONTINUE by ARIOS Eff: 09/18/05 1032
DC COMMENTS:
Result of renew in POM
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 104
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: -
Start Date 09/18/05-1030 Stop Date 09/25/05 1031 DC: 09/21/05-1027
Ordering Doctor Rios,Allan MD
Total Dispensed 7 Total Costs $ Total Charges $
Rx Number 00250604

History
09/18/05 1033 - POM ORDER by ARIOS
09/18/05 1051 - VERIFIED by ECARPENT
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SEVERE PAIN
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: -
Start Date 09/18/05-1030 Stop Date 09/25/05 1031 DC: 09/21/05-1027
Ordering Doctor Rios,Allan MD
Total Dispensed 14 Total Costs $0.00 Total Charges $2.25
Rx Number 00250605

History
09/18/05 1033 - POM ORDER by ARIOS
09/18/05 1051 - VERIFIED by ECARPENT
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 105
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 02/16/11-0900 Stop Date 03/18/11 0859 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $32.64
Rx Number 00867256

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1739 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 02/16/11 - 0900
For: 02/17/11 - 0900
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/19/11 - 0900
For: 02/20/11 - 0900
For: 02/21/11 - 0900
For: 02/22/11 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 106
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions Stop after moderate-large bowel movement.
Admin Route ORAL
Frequency DAILY@16 (SCH)
Start Date 02/07/11-1600 Stop Date 02/10/11 1559 DC: 02/08/11-1207
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 1 Total Costs $0.00 Total Charges $3.43
Rx Number 00863707

History
02/07/11 1119 - POM ORDER by AMARTINEZ
02/07/11 1127 - VERIFIED by AMADDALENA
Items Dispensed: 3 Doses Dispensed: 3
For: 02/07/11 - 1600
For: 02/08/11 - 1600
For: 02/09/11 - 1600
02/08/11 1219 - DISCONTINUE by AMARTINEZ Eff: 02/08/11 1207
Items Auto Credited: 2 Doses Auto Credited: 2
For: 02/08/11 - 1600
For: 02/09/11 - 1600
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
EDIT SOURCE: Written
02/09/11 0730 - REVIEW PROVIDER ACTIVITY by AMOLINARI
RS - Discontinue by AMARTINEZ Eff: 02/08/11 1219
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 107
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

NFR150C - POLYSACCHARIDE IRON COMPLEX 150 MG CAP

Dose 150 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 02/16/11-0900 Stop Date 03/18/11 0859 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $5.70
Rx Number 00867262

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1743 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 02/16/11 - 0900
For: 02/17/11 - 0900
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 4 Doses Auto Credited: 4
For: 02/19/11 - 0900
For: 02/20/11 - 0900
For: 02/21/11 - 0900
For: 02/22/11 - 0900
DC COMMENTS:
DC'd by Discharge

PRC5T - PROCHLORPERAZINE MALEATE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: -
Start Date 09/18/05-1834 Stop Date 10/18/05 1833 DC: 09/21/05-1027
Ordering Doctor Rios,Allan MD
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00250739

History
09/18/05 1836 - POM ORDER by ARIOS
09/18/05 1844 - VERIFIED by ECARPENT
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 108
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

PSYL1PAC15 - PSYLLIUM SEED 1 EA PKT

Dose 1 EA (1 PACKET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $4.20
Rx Number 00248857

History
09/13/05 1506 - POM ORDER by SVAIDYA
09/13/05 1513 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 187 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00248860

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1514 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 374 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 DC: 09/21/05-1027
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 00248861

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1514 - VERIFIED by EBALILO
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 109
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 187 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00704476

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1335 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 374 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/26/09-1317 Stop Date 10/26/09 1316 DC: 10/02/09-1056
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00704477

Discontinued Comments DC'd by Discharge

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1335 - VERIFIED by MHAIMOWITZ
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 110
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 374 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 01/29/11-1715 Stop Date 02/08/11 1026 DC: 02/08/11-1026
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 00861136

History
01/29/11 1724 - POM ORDER by NBALCETIS
01/29/11 1917 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 2
For: 01/29/11 - 1715
02/08/11 1028 - EDIT by AMARTINEZ
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
EDIT SOURCE: Written
FROM:
START: 01/29/11-1715 STOP: 02/28/11 1714 SOFT STOP: 0
TO:
START: 01/29/11-1715 STOP: 02/08/11-1026 SOFT STOP:
02/08/11 1028 - DISCONTINUE by AMARTINEZ Eff: 02/08/11 1026
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
EDIT SOURCE: Written
02/08/11 1029 - POM COPY AND EDIT by AMARTINEZ
TO: Rx #U00761708
02/09/11 0730 - REVIEW PROVIDER ACTIVITY by AMOLINARI
RE - Edit by AMARTINEZ Eff: 02/08/11 1028
RS - Discontinue by AMARTINEZ Eff: 02/08/11 1028
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 111
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 374 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 02/08/11-2100 Stop Date 03/10/11 2059 DC: 02/11/11-2222
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed 8 Total Costs $0.00 Total Charges $0.45
Rx Number 00864207

Discontinued Comments DC'd by Discharge

History
02/08/11 1029 - POM COPY AND EDIT by AMARTINEZ
FROM: Rx #00861136
Result of Sig/Schedule Edit
Ordering Doctor: MARTINEZ,ALEXANDER MD
Last Scheduled Dose: As Needed
Last Administration:
Old Sig/Sch: NIGHTLY (PRN)
New Sig/Sch: NIGHTLY (SCH)
Old Order Stop: 02/08/11 - 1026
New Order Start: 02/08/11 - 2100
02/08/11 1257 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 02/08/11 - 2100
For: 02/09/11 - 2100
For: 02/10/11 - 2100
02/08/11 1257 - REVIEW PROVIDER ACTIVITY by EBALILO
RFS - Freq/Sch Edit by AMARTINEZ Eff: 02/08/11 1029
Ordering Doctor: MARTINEZ,ALEXANDER MD
Last Scheduled Dose: As Needed
Last Administration:
Old Freq/Sch: NIGHTLY (PRN)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 02/08/11 - 1026
New Order Start: 02/08/11 - 2100
02/11/11 2223 - DISCONTINUE by DISCHARGE Eff: 02/11/11 2222
Items Auto Credited: 8 Doses Auto Credited: 4
For: 02/12/11 - 2100
For: 02/13/11 - 2100
For: 02/14/11 - 2100
For: 02/15/11 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 112
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 187 EACH (1 TABLET)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 02/16/11-1700 Stop Date 03/18/11 1659 DC: 02/18/11-1032
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00867255

Discontinued Comments DC'd by Discharge

History
02/15/11 1726 - POM ORDER by CDOHLE
02/15/11 1738 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 02/16/11 - 1700
For: 02/17/11 - 1700
02/18/11 1032 - DISCONTINUE by DISCHARGE Eff: 02/18/11 1032
Items Auto Credited: 5 Doses Auto Credited: 5
For: 02/18/11 - 1700
For: 02/19/11 - 1700
For: 02/20/11 - 1700
For: 02/21/11 - 1700
For: 02/22/11 - 1700
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 113
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

SCR1T - SUCRALFATE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 09/26/09-1321 Stop Date 10/26/09 1320 DC: 09/26/09-1408
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $ Total Charges $
Rx Number 00704478

Warnings
Type: MAINTENANCE
Range: SUCRALFATE (1 GM)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 4 per day is above the administration frequency
range of 2 - 2 per day.

Discontinued Comments cancel

History
09/26/09 1326 - POM ORDER by NBALCETIS
09/26/09 1335 - VERIFIED by MHAIMOWITZ
09/26/09 1410 - DISCONTINUE by NBALCETIS Eff: 09/26/09 1408
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: Written
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
cancel

ZLP5T - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 09/20/05 1500 DC: 09/17/05-1001
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00248862

Discontinued Comments Result of renew in POM

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1514 - VERIFIED by EBALILO
09/17/05 1001 - DISCONTINUE by ARIOS Eff: 09/17/05 1001
DC COMMENTS:
Result of renew in POM
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 114
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

ZLP5T - ZOLPIDEM TARTRATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: -
Start Date 09/13/05-1501 Stop Date 09/20/05 1500 DC: 09/17/05-1001
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00248863

Discontinued Comments Result of renew in POM

History
09/13/05 1505 - POM ORDER by SVAIDYA
09/13/05 1514 - VERIFIED by EBALILO
09/17/05 1001 - DISCONTINUE by ARIOS Eff: 09/17/05 1001
DC COMMENTS:
Result of renew in POM

ZLP5T - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: -
Start Date 09/17/05-0958 Stop Date 09/24/05 0958 DC: 09/18/05-1032
Ordering Doctor Rios,Allan MD
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00250365

Discontinued Comments Result of renew in POM

History
09/17/05 1002 - POM ORDER by ARIOS
09/17/05 1256 - VERIFIED by ECARPENT
09/18/05 1033 - DISCONTINUE by ARIOS Eff: 09/18/05 1032
DC COMMENTS:
Result of renew in POM
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 115
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

ZLP5T - ZOLPIDEM TARTRATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: -
Start Date 09/17/05-0958 Stop Date 09/24/05 0958 DC: 09/18/05-1032
Ordering Doctor Rios,Allan MD
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 00250366

Discontinued Comments Result of renew in POM

History
09/17/05 1002 - POM ORDER by ARIOS
09/17/05 1256 - VERIFIED by ECARPENT
09/18/05 1033 - DISCONTINUE by ARIOS Eff: 09/18/05 1032
DC COMMENTS:
Result of renew in POM

ZLP5T - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: -
Start Date 09/18/05-1030 Stop Date 09/25/05 1031 DC: 09/21/05-1027
Ordering Doctor Rios,Allan MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 00250606

History
09/18/05 1034 - POM ORDER by ARIOS
09/18/05 1052 - VERIFIED by ECARPENT
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027

ZLP5T - ZOLPIDEM TARTRATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: -
Start Date 09/18/05-1030 Stop Date 09/25/05 1031 DC: 09/21/05-1027
Ordering Doctor Rios,Allan MD
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00250607

History
09/18/05 1034 - POM ORDER by ARIOS
09/18/05 1052 - VERIFIED by ECARPENT
09/21/05 1027 - DISCONTINUE by DISCHARGE Eff: 09/21/05 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 116
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness/Insomnia
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 09/26/09-1317 Stop Date 10/03/09 1316 DC: 09/30/09-1435
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00704479

Warnings
Type: MAINTENANCE
Range: ZOLPIDEM TARTRATE (5 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 1 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments Result of renew in POM

History
09/26/09 1321 - POM ORDER by NBALCETIS
09/26/09 1335 - VERIFIED by MHAIMOWITZ
09/30/09 1436 - DISCONTINUE by SVAIDYA Eff: 09/30/09 1435
EDIT DOCTOR: VAIDYA, SUDHIR M.D.
EDIT SOURCE: Written
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Result of renew in POM
09/30/09 1437 - POM COPY AND EDIT by SVAIDYA
TO: Rx #U00603271
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 117
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness/Insomnia
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 09/30/09-1435 Stop Date 10/07/09 1434 DC: 10/02/09-1056
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 00705923

Warnings
Type: MAINTENANCE
Range: ZOLPIDEM TARTRATE (5 MG)
Condition: ALL COMMON INDICATIONS
Frequency Ordered frequency of 1 per day is above the administration frequency
range of 1 - 1 per day.

Discontinued Comments DC'd by Discharge

History
09/30/09 1437 - POM COPY AND EDIT by SVAIDYA
FROM: Rx #00704479
09/30/09 1440 - VERIFIED by AMADDALENA
10/02/09 1056 - DISCONTINUE by DISCHARGE Eff: 10/02/09 1056
DC COMMENTS:
DC'd by Discharge

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions Hold if SBP less than 100
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/13/05-1501 Stop Date 10/13/05 1500 CAN: 09/13/05-1515
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed Total Costs $ Total Charges $
Rx Number U00147462

History
09/13/05 1506 - POM ORDER by SVAIDYA
09/13/05 1515 - CANCEL by EBALILO
CANCELLATION COMMENTS:
CHANGED USING 10mg STRENGTH
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 118
Run Time 1513 PHA Profile

DIGGS,PATRICIA A W00001219571 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/14/05-1025 Stop Date 10/14/05 1025 CAN: 09/14/05-1029
Ordering Doctor VAIDYA, SUDHIR M.D.
Total Dispensed Total Costs $ Total Charges $
Rx Number U00147685

History
09/14/05 1026 - POM ORDER by SVAIDYA
09/14/05 1029 - CANCEL by AMADDALENA

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 02/01/11-0900 Stop Date 03/03/11 0859 CAN: 01/31/11-1406
Ordering Doctor MARTINEZ,ALEXANDER MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U00758990

History
01/31/11 1334 - POM COPY AND EDIT by AMARTINEZ
FROM: Rx #00861127
01/31/11 1406 - CANCEL by MHAIMOWITZ
Items Auto Credited: 0 Doses Auto Credited: 0
EDIT DOCTOR: MARTINEZ,ALEXANDER MD
CANCELLATION COMMENTS:
change strength
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient DIRKS,DONALD N Responsible Doctor VALLES,JENNIE MD

Account Number W00001219184 Location B1NN Unit Number M000209089
Age/Sex 85/M Room 134 Registered Date 08/16/17
Status ADM IN Bed 01 Discharged Date

Height 6 ft 0.24 in 183.5 cm Body Surface Area 2.08 m2

Weight 188 lb 8 oz 85.502 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: T9 FX
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/16/17-1600 Stop Date 09/15/17 1559
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537278

History
08/16/17 1550 - POM ORDER by EALEXEEV
08/16/17 1552 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 12 Total Costs $0.00 Total Charges $6.30
Rx Number 01539759

History
08/24/17 1658 - ENTER by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency EVERY OTHER NIGHT (SCH)
Start Date 08/16/17-2100 Stop Date 09/15/17 2059
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01537277

History
08/16/17 1550 - POM ORDER by EALEXEEV
08/16/17 1552 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 2100
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 2100
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/26/17 - 2100
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 2100
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/01/17 - 2100
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/16/17-1700 Stop Date 09/15/17 1659
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $9.50
Rx Number 01537282

History
08/16/17 1550 - POM ORDER by EALEXEEV
08/16/17 1553 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

For: 08/31/17 - 0900

For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

FNST5T - FINASTERIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 20 Total Costs $0.00 Total Charges $56.70
Rx Number 01537298

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1609 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

FLDR.1T - FLUDROCORTISONE ACETATE 0.1 MG TAB

Dose 0.1 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/05/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $4.14
Rx Number 01541817

History
08/31/17 1722 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540681
08/31/17 1723 - EDIT by AMACCA
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-0900 STOP: 09/05/17 SOFT STOP:
TO:
START: 09/01/17-0900 STOP: 09/05/17-0859 SOFT STOP:
08/31/17 1723 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 20 Total Costs $0.00 Total Charges $5.40
Rx Number 01537289

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1605 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/16/17-2200 Stop Date 09/15/17 1659
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 62 Total Costs $0.00 Total Charges $8.10
Rx Number 01537364

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/16/17 1659 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01537291
Result of Frequency/Schedule Edit
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 08/16/17 - 1700
Last Actual Administration Time:
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 08/16/17 - 1700
New Order Start: 08/16/17 - 2200
New Order Stop: 09/15/17 - 1659
08/16/17 1704 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by EALEXEEV Eff: 08/16/17 1659
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 08/16/17 - 1700
Last Actual Administration Time:
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 08/16/17 - 1700
New Order Start: 08/16/17 - 2200
New Order Stop: 09/15/17 - 1659
08/16/17 1704 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
For: 08/18/17 - 1400
For: 08/18/17 - 2200
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

For: 08/20/17 - 1400

For: 08/20/17 - 2200
For: 08/21/17 - 0600
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 1400
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

For: 09/03/17 - 2200

For: 09/04/17 - 0600
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/16/17-1600 Stop Date 09/15/17 1559
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537283

History
08/16/17 1550 - POM ORDER by EALEXEEV
08/16/17 1553 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1600 Stop Date 09/15/17 1559
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01537284

History
08/16/17 1550 - POM ORDER by EALEXEEV
08/16/17 1554 - EDIT by EBALILO
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
SIG: EVERY 4 HOURS
TO:
SIG: DAILY
08/16/17 1554 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency NIGHTLY@2100 (SCH)
Start Date 08/22/17-2100 Stop Date 09/16/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 15 Total Costs $0.00 Total Charges $22.56
Rx Number 01538506

History
08/21/17 1136 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01537294
Result of Frequency/Schedule Edit
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 08/21/17 - 0900
Last Actual Administration Time: 08/21/17 - 0840
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: NIGHTLY@2100 (SCH)
Old Order Stop: 08/22/17 - 2100
New Order Start: 08/22/17 - 2100
New Order Stop: 09/16/17 - 0859
08/21/17 1208 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by EALEXEEV Eff: 08/21/17 1136
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 08/21/17 - 0900
Last Actual Administration Time: 08/21/17 - 0840
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: NIGHTLY@2100 (SCH)
Old Order Stop: 08/22/17 - 2100
New Order Start: 08/22/17 - 2100
New Order Stop: 09/16/17 - 0859
08/21/17 1208 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

For: 09/01/17 - 2100

For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN SEVERE PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: FOR SEVERE PAIN(P/SCALE 7-10)
Start Date 09/03/17-1430 Stop Date 09/10/17 1429
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542319

History
09/03/17 1425 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540905
09/03/17 1429 - EDIT by MHAIMOWITZ
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/03/17-1430 STOP: 09/10/17 SOFT STOP:
TO:
START: 09/03/17-1430 STOP: 09/10/17-1429 SOFT STOP: 0
09/03/17 1429 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01537288

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1604 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

RIVA10TA - RIVAROXABAN 10 MG TABLET

Dose 20 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 40 Total Costs $0.00 Total Charges $1163.70
Rx Number 01537295

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1608 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@13 (SCH)
Start Date 08/17/17-1300 Stop Date 09/16/17 1259
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 40 Total Costs $0.00 Total Charges $1.20
Rx Number 01537286

History
08/16/17 1550 - POM ORDER by EALEXEEV
08/16/17 1554 - EDIT by EBALILO
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE: 374 EACH (374 TABLETS)
DISPENSE: 1496
CHARGE: $37.40
TO:
DOSE: 2 EACH (2 TABLETS)
DISPENSE: 8
CHARGE: $0.20
08/16/17 1554 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/17/17 - 1300
For: 08/18/17 - 1300
For: 08/19/17 - 1300
For: 08/20/17 - 1300
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 1300
For: 08/22/17 - 1300
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1300
For: 08/24/17 - 1300
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1300
For: 08/26/17 - 1300
For: 08/27/17 - 1300
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1300
For: 08/29/17 - 1300
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1300
For: 08/31/17 - 1300
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

For: 09/02/17 - 1300

For: 09/03/17 - 1300
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1300
For: 09/05/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.8 MG (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 40 Total Costs $0.00 Total Charges $621.00
Rx Number 01537426

History
08/16/17 1727 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01537299
08/16/17 1746 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 20 Total Costs $0.00 Total Charges $0.90
Rx Number 01537297

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1609 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859 DC: 08/20/17-0946
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $1.72
Rx Number 01537292

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1607 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/20/17 0949 - DISCONTINUE by SMOHAMED Eff: 08/20/17 0946
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/20/17 0949 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424593
08/20/17 1011 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/20/17 0949
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 5 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/20/17-0930 Stop Date 08/20/17 0931 DC: 08/20/17-0931
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538373

History
08/20/17 0928 - POM ORDER by RSHARMA
08/20/17 1011 - DISCONTINUE by AADEGBAMIG Eff: 08/20/17 0931
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/20/17 1011 - VERIFIED by SYSTEM
Verified in order to DC

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 5 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859 DC: 08/21/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538374

History
08/20/17 0949 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01537292
08/20/17 1011 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/20/17 1011 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859 DC: 08/24/17-1617
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $42.60
Rx Number 01538371

History
08/20/17 1009 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/24/17 1618 - DISCONTINUE by EALEXEEV Eff: 08/24/17 1617
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/24/17 1619 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01425917
08/24/17 1658 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EALEXEEV Eff: 08/24/17 1618
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/20/17-1015 Stop Date 08/20/17 1016 DC: 08/20/17-1016
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $14.20
Rx Number 01538372

Discontinued Comments Reached Stop Date

History
08/20/17 1010 - ENTER by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/20/17 - 1015
08/20/17 1016 - DISCONTINUE by PHABKGJOB Eff: 08/20/17 1016
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

C500T - ASCORBIC ACID 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/16/17-1700 Stop Date 08/16/17 1700 DC: 08/16/17-1700
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537281

History
08/16/17 1550 - POM ORDER by EALEXEEV
08/16/17 1553 - VERIFIED by EBALILO
08/16/17 1658 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/16/17-1700 STOP: 09/15/17 1659 SOFT STOP: 0
TO:
START: 08/16/17-1700 STOP: 08/16/17-1700 SOFT STOP:
08/16/17 1658 - DISCONTINUE by EALEXEEV Eff: 08/16/17 1700
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/16/17 1704 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by EALEXEEV Eff: 08/16/17 1658
Discontinue by EALEXEEV Eff: 08/16/17 1658
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/16/17-1600 Stop Date 09/15/17 1559 DC: 08/23/17-1612
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01537290

History
08/16/17 1601 - POM ORDER by EALEXEEV
08/16/17 1607 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 1600
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 1615 - DISCONTINUE by JVALLES Eff: 08/23/17 1612
EDIT DOCTOR: VALLES,JENNIE MD
08/24/17 0943 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JVALLES Eff: 08/23/17 1615

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME@2000 (ONE)
Start Date 08/24/17-2000 Stop Date 08/24/17 2001 DC: 08/24/17-2000
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539693

History
08/24/17 1558 - POM ORDER by EALEXEEV
08/24/17 1600 - VERIFIED by EBALILO
08/24/17 1616 - DISCONTINUE by EALEXEEV Eff: 08/24/17 2000
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/24/17 1635 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EALEXEEV Eff: 08/24/17 1616
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

FLDR.1T - FLUDROCORTISONE ACETATE 0.1 MG TAB

Dose 0.1 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 08/24/17 0859 DC: 08/21/17-1547
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 5 Total Costs $0.00 Total Charges $6.90
Rx Number 01537293

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1607 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 0900
08/21/17 1547 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1547
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/22/17 - 0900
For: 08/23/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/21/17 1547 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424897
08/21/17 1554 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/21/17 1547
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

FLDR.1T - FLUDROCORTISONE ACETATE 0.1 MG TAB

Dose 0.1 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/28/17 0859 DC: 08/25/17-0845
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $4.14
Rx Number 01538675

History
08/21/17 1547 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01537293
08/21/17 1552 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/22/17-0900 STOP: 08/28/17 SOFT STOP:
TO:
START: 08/22/17-0900 STOP: 08/28/17-0859 SOFT STOP:
08/21/17 1553 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0846 - DISCONTINUE by EALEXEEV Eff: 08/25/17 0845
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/25/17 0846 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426056
08/25/17 1250 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/25/17 0846
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

FLDR.1T - FLUDROCORTISONE ACETATE 0.1 MG TAB

Dose 0.1 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 08/31/17 0859 DC: 08/28/17-1232
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $2.76
Rx Number 01540013

History
08/25/17 0846 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01538675
08/25/17 1249 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-0900 STOP: 08/31/17 SOFT STOP:
TO:
START: 08/25/17-0900 STOP: 08/31/17-0859 SOFT STOP: 0
08/25/17 1249 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by ABLAKE Eff: 08/25/17 0943
08/25/17 1249 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
08/28/17 1232 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1232
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/29/17 - 0900
For: 08/30/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1232 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426795
08/28/17 1329 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EALEXEEV Eff: 08/28/17 1232
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

FLDR.1T - FLUDROCORTISONE ACETATE 0.1 MG TAB

Dose 0.1 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/03/17 0859 DC: 08/31/17-1721
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 3 Total Costs $0.00 Total Charges $4.14
Rx Number 01540681

History
08/28/17 1232 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540013
08/28/17 1328 - EDIT by AADEGBAMIG
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0900 STOP: 09/03/17 SOFT STOP:
TO:
START: 08/29/17-0900 STOP: 09/03/17-0859 SOFT STOP:
08/28/17 1328 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/01/17 - 0900
For: 09/02/17 - 0900
08/31/17 1722 - DISCONTINUE by EALEXEEV Eff: 08/31/17 1721
Items Auto Credited: 2 Doses Auto Credited: 2
For: 09/01/17 - 0900
For: 09/02/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/31/17 1722 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427864
08/31/17 1723 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/31/17 1722
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/16/17-1700 Stop Date 09/15/17 1659 DC: 08/16/17-1700
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537291

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1607 - VERIFIED by EBALILO
Items Dispensed: 13 Doses Dispensed: 13
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/16/17 1659 - DISCONTINUE by EALEXEEV Eff: 08/16/17 1700
Items Auto Credited: 13 Doses Auto Credited: 13
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/16/17 1659 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01423646
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

08/16/17 1704 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG

Discontinue by EALEXEEV Eff: 08/16/17 1659

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 08/22/17 2100 DC: 08/21/17-1547
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 7 Total Costs $0.00 Total Charges $9.40
Rx Number 01537294

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1608 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/21/17 1136 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/17/17-0900 STOP: 09/16/17 0859 SOFT STOP: 0
DISPENSE: 2
TO:
START: 08/17/17-0900 STOP: 08/22/17-2100 SOFT STOP:
DISPENSE: 6
08/21/17 1136 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01424749
08/21/17 1208 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by EALEXEEV Eff: 08/21/17 1136
08/21/17 1547 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1547
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/22/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/21/17 1547 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424898
08/21/17 1554 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/21/17 1547
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/26/17 0859 DC: 08/25/17-0845
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $3.76
Rx Number 01538676

History
08/21/17 1547 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01537294
08/21/17 1552 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/22/17-0900 STOP: 08/26/17 SOFT STOP:
TO:
START: 08/22/17-0900 STOP: 08/26/17-0859 SOFT STOP:
08/21/17 1554 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 0900
08/25/17 0846 - DISCONTINUE by EALEXEEV Eff: 08/25/17 0845
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/25/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/25/17 0846 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426057
08/25/17 1250 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/25/17 0846
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 08/29/17 0859 DC: 08/28/17-1232
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $7.52
Rx Number 01540014

History
08/25/17 0846 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01538676
08/25/17 1249 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-0900 STOP: 08/29/17 SOFT STOP:
TO:
START: 08/25/17-0900 STOP: 08/29/17-0859 SOFT STOP: 0
08/25/17 1249 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by ABLAKE Eff: 08/25/17 0943
08/25/17 1249 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
08/28/17 1232 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1232
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1232 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426796
08/28/17 1431 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EALEXEEV Eff: 08/28/17 1232
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/01/17 0859 DC: 08/30/17-0943
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 2 Total Costs $0.00 Total Charges $3.76
Rx Number 01540727

History
08/28/17 1232 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540014
08/28/17 1328 - EDIT by AADEGBAMIG
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0900 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/29/17-0900 STOP: 09/01/17-0859 SOFT STOP:
08/28/17 1431 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0944 - DISCONTINUE by EALEXEEV Eff: 08/30/17 0943
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/31/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/30/17 0944 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427335
08/30/17 1153 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/30/17 0944
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/02/17 0859 DC: 08/31/17-1721
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $1.88
Rx Number 01541259

History
08/30/17 0944 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540727
08/30/17 1153 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-0900 STOP: 09/02/17 SOFT STOP:
TO:
START: 08/31/17-0900 STOP: 09/02/17-0859 SOFT STOP: 0
08/30/17 1153 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/31/17 - 0900
For: 09/01/17 - 0900
08/31/17 1722 - DISCONTINUE by EALEXEEV Eff: 08/31/17 1721
Items Auto Credited: 1 Doses Auto Credited: 1
For: 09/01/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/31/17 1722 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427865
08/31/17 1723 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/31/17 1722
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/02/17 0859 DC: 09/02/17-0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $1.88
Rx Number 01541818

Discontinued Comments Reached Stop Date

History
08/31/17 1722 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01541259
08/31/17 1723 - EDIT by AMACCA
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-0900 STOP: 09/02/17 SOFT STOP:
TO:
START: 09/01/17-0900 STOP: 09/02/17-0859 SOFT STOP:
08/31/17 1723 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0900
09/02/17 0859 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 08/17/17 0900 DC: 08/17/17-0900
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537285

History
08/16/17 1550 - POM ORDER by EALEXEEV
08/16/17 1554 - VERIFIED by EBALILO
08/16/17 1658 - DISCONTINUE by EALEXEEV Eff: 08/17/17 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/16/17 1658 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/17/17-0900 STOP: 09/16/17 0859 SOFT STOP: 0
TO:
START: 08/17/17-0900 STOP: 08/17/17-0900 SOFT STOP:
08/16/17 1704 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by EALEXEEV Eff: 08/16/17 1658
Discontinue by EALEXEEV Eff: 08/16/17 1658
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN SEVERE PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: FOR SEVERE PAIN(P/SCALE 7-10)
Start Date 08/16/17-1600 Stop Date 08/23/17 1559 DC: 08/21/17-1547
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01537301

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1612 - EDIT by EBALILO
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
TO:
PRN REASON: FOR SEVERE PAIN(P/SCALE 7-10)
08/16/17 1612 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 1547 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1547
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/21/17 1547 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424899
08/21/17 1554 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/21/17 1547
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN SEVERE PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: FOR SEVERE PAIN(P/SCALE 7-10)
Start Date 08/21/17-1600 Stop Date 08/28/17 1559 DC: 08/25/17-0845
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01538677

History
08/21/17 1547 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01537301
08/21/17 1553 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/21/17-1600 STOP: 08/28/17 SOFT STOP:
TO:
START: 08/21/17-1600 STOP: 08/28/17-1559 SOFT STOP:
08/21/17 1554 - VERIFIED by AADEGBAMIG
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0846 - DISCONTINUE by EALEXEEV Eff: 08/25/17 0845
For: 08/25/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/25/17 0846 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426058
08/25/17 1250 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/25/17 0846
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN SEVERE PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: FOR SEVERE PAIN(P/SCALE 7-10)
Start Date 08/25/17-0845 Stop Date 09/01/17 0844 DC: 08/29/17-0937
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540015

History
08/25/17 0846 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01538677
08/25/17 1249 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-0845 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-0845 STOP: 09/01/17-0844 SOFT STOP: 0
08/25/17 1249 - VERIFIED by AMOLINARI
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/29/17 0938 - DISCONTINUE by EALEXEEV Eff: 08/29/17 0937
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/29/17 0938 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427009
08/29/17 0939 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/29/17 0938
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN SEVERE PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: FOR SEVERE PAIN(P/SCALE 7-10)
Start Date 08/29/17-0945 Stop Date 09/05/17 0944 DC: 09/03/17-1424
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540905

History
08/29/17 0938 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540015
08/29/17 0940 - EDIT by AMACCA
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0945 STOP: 09/05/17 SOFT STOP:
TO:
START: 08/29/17-0945 STOP: 09/05/17-0944 SOFT STOP:
08/29/17 0940 - VERIFIED by AMACCA
08/30/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/03/17 1425 - DISCONTINUE by JRUSSO Eff: 09/03/17 1424
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/03/17 1425 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01428359
09/03/17 1429 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by JRUSSO Eff: 09/03/17 1425
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859 DC: 08/17/17-0900
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537299

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1609 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/16/17 1727 - DISCONTINUE by EALEXEEV Eff: 08/17/17 0900
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/16/17 1727 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01423678
08/16/17 1746 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/16/17 1727
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/16/17-1600 Stop Date 08/23/17 1559 DC: 08/21/17-1547
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537300

History
08/16/17 1602 - POM ORDER by EALEXEEV
08/16/17 1611 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0828 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 1547 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1547
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/21/17 1547 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424900
08/21/17 1554 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/21/17 1547
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/21/17-1600 Stop Date 08/25/17 0800 DC: 08/25/17-0800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538678

Discontinued Comments Reached Stop Date

History
08/21/17 1547 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01537300
08/21/17 1553 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/21/17-1600 STOP: 08/28/17 SOFT STOP:
TO:
START: 08/21/17-1600 STOP: 08/28/17-1559 SOFT STOP:
08/21/17 1554 - VERIFIED by AADEGBAMIG
08/23/17 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/24/17 0941 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/21/17-1600 STOP: 08/28/17 1559 SOFT STOP:
TO:
START: 08/21/17-1600 STOP: 08/25/17-0800 SOFT STOP:
08/24/17 0941 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01425694
08/24/17 0943 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by EALEXEEV Eff: 08/24/17 0941
08/25/17 0800 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 0800
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency DAILY@0800 (SCH)
Start Date 08/25/17-0800 Stop Date 08/28/17 1559 DC: 08/25/17-0845
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539523

History
08/24/17 0941 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01538678
Result of Frequency/Schedule Edit
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: 3 TIMES A DAY (PRN)
New Freq/Sch: DAILY@0800 (SCH)
Old Order Stop: 08/25/17 - 0800
New Order Start: 08/25/17 - 0800
New Order Stop: 08/28/17 - 1559
08/24/17 0943 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by EALEXEEV Eff: 08/24/17 0941
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: 3 TIMES A DAY (PRN)
New Freq/Sch: DAILY@0800 (SCH)
Old Order Stop: 08/25/17 - 0800
New Order Start: 08/25/17 - 0800
New Order Stop: 08/28/17 - 1559
08/24/17 0943 - VERIFIED by AMOLINARI
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 0800
08/25/17 0846 - DISCONTINUE by EALEXEEV Eff: 08/25/17 0845
For: 08/25/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/25/17 0846 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426059
08/25/17 1250 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/25/17 0846
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency DAILY@0800 (SCH)
Start Date 08/26/17-0800 Stop Date 08/28/17 0759 DC: 08/28/17-0759
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540016

Discontinued Comments Reached Stop Date

History
08/25/17 0846 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539523
08/25/17 1250 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/26/17-0800 STOP: 08/28/17 SOFT STOP:
TO:
START: 08/26/17-0800 STOP: 08/28/17-0759 SOFT STOP: 0
08/25/17 1250 - VERIFIED by AMOLINARI
08/28/17 0759 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 0759
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

DIRKS,DONALD N W00001219184 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859 CAN: 08/24/17-1656
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01425917

History
08/24/17 1619 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01538371
08/24/17 1656 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
NEW STRENGTH
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient DUNBAR,RALPH Responsible Doctor VALLES,JENNIE MD

Account Number W00001219279 Location B1NN Unit Number M000209149
Age/Sex 76/M Room 121 Registered Date 08/18/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 2.03 m2

Weight 202 lb 4.8 oz 91.762 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions APPLY TO MID BACK
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01541279

History
08/30/17 1151 - POM ORDER by SMOHAMED
08/30/17 1208 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
TO:
DOSE INSTRUCTIONS:
APPLY TO MID BACK
08/30/17 1208 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 08/31/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/18/17-1545 Stop Date 09/17/17 1544
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538114

History
08/18/17 1548 - POM ORDER by SMOHAMED
08/18/17 1550 - VERIFIED by AADEGBAMIG
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $10.08
Rx Number 01538126

History
08/18/17 1552 - POM ORDER by SMOHAMED
08/18/17 1554 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $0.48
Rx Number 01538121

History
08/18/17 1552 - POM ORDER by SMOHAMED
08/18/17 1553 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/18/17-2000 Stop Date 09/17/17 1959
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01538113

History
08/18/17 1548 - POM ORDER by SMOHAMED
08/18/17 1550 - VERIFIED by AADEGBAMIG
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2000
For: 08/24/17 - 2000
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2000
For: 08/26/17 - 2000
For: 08/27/17 - 2000
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2000
For: 08/29/17 - 2000
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2000
For: 08/31/17 - 2000
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2000
For: 09/02/17 - 2000
For: 09/03/17 - 2000
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2000
For: 09/05/17 - 2000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 08/18/17-1545 Stop Date 09/17/17 1544
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538117

History
08/18/17 1548 - POM ORDER by SMOHAMED
08/18/17 1550 - VERIFIED by AADEGBAMIG
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/18/17-1700 Stop Date 09/17/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $10.75
Rx Number 01538110

History
08/18/17 1548 - POM ORDER by SMOHAMED
08/18/17 1549 - VERIFIED by AADEGBAMIG
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

For: 09/02/17 - 0900

For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $1363.68
Rx Number 01538127

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.44
MG/KG/DAY is below the Low Daily Dose.

History
08/18/17 1552 - POM ORDER by SMOHAMED
08/18/17 1554 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

FNST5T - FINASTERIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $50.40
Rx Number 01538122

History
08/18/17 1552 - POM ORDER by SMOHAMED
08/18/17 1553 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $4.80
Rx Number 01538123

History
08/18/17 1552 - POM ORDER by SMOHAMED
08/18/17 1553 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor VALLES,JENNIE MD
Total Dispensed 4 Total Costs $0.00 Total Charges $0.20
Rx Number 01542088

History
09/01/17 1617 - POM ORDER by JVALLES
09/01/17 1712 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 10 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $4.80
Rx Number 01538125

History
08/18/17 1552 - POM ORDER by SMOHAMED
08/18/17 1554 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/18/17-1545 Stop Date 09/17/17 1544
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538115

History
08/18/17 1548 - POM ORDER by SMOHAMED
08/18/17 1550 - VERIFIED by AADEGBAMIG
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/18/17-1545 Stop Date 09/17/17 1544
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538116

History
08/18/17 1548 - POM ORDER by SMOHAMED
08/18/17 1550 - VERIFIED by AADEGBAMIG
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/31/17-1400 Stop Date 09/08/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01541506

History
08/31/17 0821 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01541500
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 09/01/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: 2 TIMES A WEEK (SCH)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 09/01/17 - 0900
New Order Start: 08/31/17 - 1400
New Order Stop: 09/08/17 - 0859
08/31/17 0833 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by SMOHAMED Eff: 08/31/17 0821
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 09/01/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: 2 TIMES A WEEK (SCH)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 09/01/17 - 0900
New Order Start: 08/31/17 - 1400
New Order Stop: 09/08/17 - 0859
08/31/17 0833 - VERIFIED by AMOLINARI
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

OMEP10CA3 - OMEPRAZOLE 10 MG CPDR

Dose 10 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/24/17-0800 Stop Date 09/23/17 0759
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 13 Total Costs $0.00 Total Charges $23.30
Rx Number 01539245

History
08/23/17 0901 - POM ORDER by SMOHAMED
08/23/17 1216 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0800
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/18/17-1545 Stop Date 09/17/17 1544
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 8 Total Costs $ Total Charges $
Rx Number 01538111

History
08/18/17 1548 - POM ORDER by SMOHAMED
08/18/17 1549 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 8
For: 08/18/17 - 1545
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

OXYC-362 - OXYCODONE HCL/ACETAMINOPHEN 7.5/325 TABLET

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/01/17-1715 Stop Date 09/08/17 1714
Ordering Doctor VALLES,JENNIE MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01542087

History
09/01/17 1710 - POM COPY AND EDIT by JVALLES
FROM: Rx #01540635
09/01/17 1711 - EDIT by AADEGBAMIG
EDIT DOCTOR: VALLES,JENNIE MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1715 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1715 STOP: 09/08/17-1714 SOFT STOP:
09/01/17 1711 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

PRMP.125T - PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG TAB

Dose 0.125 MG (1 TABLET)

Dose Instructions Shoudl take it 2 hours prior to bed time
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-1800 Stop Date 09/29/17 1759
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $76.65
Rx Number 01541278

Warnings
Type: BURKE
Range: PRAMIPEXOLE DIHYDROCHLORIDE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1.5 MG/DAY - 4.5 MG/DAY. Ordered dose of 0.125 MG/DAY
is below the Low Daily Dose.

History
08/30/17 1153 - POM ORDER by SMOHAMED
08/30/17 1153 - NOW DOSE by SMOHAMED
Now Dose: 08/30/17 1800
08/30/17 1153 - KEEP NEXT DOSE by System
Keep Next Dose: 08/30/17 2100
08/30/17 1207 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Now Dose by SMOHAMED Eff: 08/30/17 1153
Now Dose 08/30/17 - 1800
Keep Next Dose 08/30/17 - 2100
08/30/17 1207 - VERIFIED by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1800
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 08/19/17-1200 Stop Date 09/18/17 1159
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 36 Total Costs $0.00 Total Charges $2.60
Rx Number 01538112

History
08/18/17 1548 - POM ORDER by SMOHAMED
08/18/17 1550 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/19/17 - 1200
For: 08/20/17 - 1200
For: 08/21/17 - 1200
For: 08/22/17 - 1200
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1200
For: 08/24/17 - 1200
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1200
For: 08/26/17 - 1200
For: 08/27/17 - 1200
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1200
For: 08/29/17 - 1200
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1200
For: 08/31/17 - 1200
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1200
For: 09/05/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

INSHRV - INSULIN HUMAN REGULAR 100 UNIT/ML VIAL

Dose 10 UNIT (0.1 ML)

Dose Instructions To be given IV after dextrose 50%
Admin Route XX
Frequency ONETIME (ONE)
Start Date 08/19/17-1430 Stop Date 08/19/17 1431 DC: 08/19/17-1431
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $446.10
Rx Number 01538312

Discontinued Comments Reached Stop Date

History
08/19/17 1423 - POM ORDER by HAZIZI
08/19/17 1430 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 1430
08/19/17 1431 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 1431
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

INSHRV - INSULIN HUMAN REGULAR 100 UNIT/ML VIAL

Dose 5 UNIT (0.05 ML)

Dose Instructions 5 units IV after dextrose
Admin Route SUBCUTAN.
Frequency ONETIME (ONE)
Start Date 08/19/17-1545 Stop Date 08/19/17 1546 DC: 08/19/17-1546
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $446.10
Rx Number 01538322

Discontinued Comments Reached Stop Date

History
08/19/17 1547 - POM ORDER by HAZIZI
08/19/17 1547 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 1545
08/19/17 1547 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 1546
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions APPLY TO MID BACK
Admin Route TOPICALLY
Frequency 1150 (ONE)
Start Date 08/30/17-1150 Stop Date 08/30/17 1151 DC: 08/30/17-1151
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541280

Discontinued Comments Reached Stop Date

History
08/30/17 1151 - POM ORDER by SMOHAMED
08/30/17 1209 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
TO:
DOSE INSTRUCTIONS:
APPLY TO MID BACK
08/30/17 1209 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 08/30/17 - 1150
08/30/17 1209 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 1151
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/30/17 1209 - CREDIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 30 GM (120 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/19/17-1415 Stop Date 08/19/17 1416 DC: 08/19/17-1416
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01538309

History
08/19/17 1415 - POM ORDER by HAZIZI
08/19/17 1419 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 1415
08/19/17 1419 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 1416
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/19/17 1423 - DISCONTINUE by HAZIZI Eff: 08/19/17 1416
EDIT DOCTOR: AZIZI,HANA MD
FROM:
DC COMMENTS:
Reached Stop Date
TO:
DC COMMENTS:
08/19/17 1548 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HAZIZI Eff: 08/19/17 1423
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/19/17-1430 Stop Date 08/19/17 1431 DC: 08/19/17-1431
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01538311

Discontinued Comments Reached Stop Date

History
08/19/17 1423 - POM ORDER by HAZIZI
08/19/17 1428 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 1430
08/19/17 1431 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 1431
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route ORAL
Frequency NOW (ONE)
Start Date 08/20/17-0730 Stop Date 08/20/17 0731 DC: 08/20/17-0731
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01538354

Discontinued Comments Reached Stop Date

History
08/20/17 0727 - POM ORDER by HAZIZI
08/20/17 0957 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by JLAYUG Eff: 08/20/17 0835
08/20/17 0957 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/20/17 - 0730
08/20/17 0957 - DISCONTINUE by PHABKGJOB Eff: 08/20/17 0731
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 30 GM (120 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 09/02/17-1415 Stop Date 09/02/17 1416 DC: 09/02/17-1416
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01542205

Discontinued Comments Reached Stop Date

History
09/02/17 1411 - POM ORDER by HAZIZI
09/02/17 1415 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 1415
09/02/17 1417 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 1416
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

D50I50 - DEXTROSE 50% 50 ML SYR

Dose 50 ML (1 SYRINGE)
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/19/17-1430 Stop Date 08/19/17 1431 DC: 08/19/17-1431
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $18.30
Rx Number 01538313

Discontinued Comments Reached Stop Date

History
08/19/17 1423 - POM ORDER by HAZIZI
08/19/17 1431 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/19/17 - 1430
08/19/17 1431 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 1431
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/31/17-1145 Stop Date 08/31/17 1146 DC: 08/31/17-1146
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.43
Rx Number 01541561

Discontinued Comments Reached Stop Date

History
08/31/17 1137 - POM ORDER by SMOHAMED
08/31/17 1146 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1145
08/31/17 1146 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 1146
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 09/01/17-1700 Stop Date 09/01/17 1701 DC: 09/01/17-1701
Ordering Doctor VALLES,JENNIE MD
Total Dispensed 1 Total Costs $0.00 Total Charges $0.43
Rx Number 01542025

Discontinued Comments Reached Stop Date

History
09/01/17 1617 - POM ORDER by JVALLES
09/01/17 1621 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1700
09/01/17 1701 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 1701
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059 DC: 08/30/17-1132
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $0.60
Rx Number 01540748

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 200 MG/DAY
is below the Low Daily Dose.

History
08/28/17 1513 - POM ORDER by SMOHAMED
08/28/17 1513 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/30/17 1132 - DISCONTINUE by SMOHAMED Eff: 08/30/17 1132
Items Auto Credited: 10 Doses Auto Credited: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/30/17 1209 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/30/17 1132
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 DC: 09/01/17-1712
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $0.60
Rx Number 01538124

History
08/18/17 1552 - POM ORDER by SMOHAMED
08/18/17 1554 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/24/17 1611 - HOLD by SMOHAMED Eff: 08/24/17 1611
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 1514 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Hold/Resume by SMOHAMED Eff: 08/24/17 1611
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 1712 - DISCONTINUE by AADEGBAMIG Eff: 09/01/17 1712
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 2 TIMES A WEEK (SCH)
Start Date 09/01/17-0900 Stop Date 09/08/17 0859 DC: 09/01/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541500

History
08/31/17 0810 - POM ORDER by SMOHAMED
08/31/17 0821 - DISCONTINUE by SMOHAMED Eff: 09/01/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/31/17 0821 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01427580
08/31/17 0821 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 0833 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 08/31/17 0821
Discontinue by SMOHAMED Eff: 08/31/17 0821

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 0807 (ONE)
Start Date 08/31/17-0807 Stop Date 08/31/17 0808 DC: 08/31/17-0808
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541505

Discontinued Comments Reached Stop Date

History
08/31/17 0810 - POM ORDER by SMOHAMED
08/31/17 0833 - VERIFIED by AMOLINARI
08/31/17 0833 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 0808
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

OXYC-362 - OXYCODONE HCL/ACETAMINOPHEN 7.5/325 TABLET

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/18/17-1600 Stop Date 08/23/17 0859 DC: 08/23/17-0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $3.75
Rx Number 01538120

History
08/18/17 1552 - POM ORDER by SMOHAMED
08/18/17 1553 - VERIFIED by AADEGBAMIG
08/21/17 0826 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0901 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/18/17-1600 STOP: 08/25/17 1559 SOFT STOP: 0
TO:
START: 08/18/17-1600 STOP: 08/23/17-0859 SOFT STOP:
08/23/17 0901 - DISCONTINUE by SMOHAMED Eff: 08/23/17 0859
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/23/17 0901 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01425404
08/23/17 1216 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SMOHAMED Eff: 08/23/17 0901
Discontinue by SMOHAMED Eff: 08/23/17 0901
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

OXYC-362 - OXYCODONE HCL/ACETAMINOPHEN 7.5/325 TABLET

Dose 1 TAB (1 TABLET)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/23/17-1300 Stop Date 08/25/17 1559 DC: 08/23/17-1323
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539198

History
08/23/17 0901 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538120
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/23/17 - 0622
Old Freq/Sch: EVERY 6 HOURS (PRN)
New Freq/Sch: EVERY 4 HOURS (PRN)
Old Order Stop: 08/23/17 - 0859
New Order Start: 08/23/17 - 1300
New Order Stop: 08/25/17 - 1559
08/23/17 1048 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by SMOHAMED Eff: 08/23/17 0901
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/23/17 - 0622
Old Freq/Sch: EVERY 6 HOURS (PRN)
New Freq/Sch: EVERY 4 HOURS (PRN)
Old Order Stop: 08/23/17 - 0859
New Order Start: 08/23/17 - 1300
New Order Stop: 08/25/17 - 1559
08/23/17 1048 - VERIFIED by AMOLINARI
08/23/17 1324 - DISCONTINUE by SMOHAMED Eff: 08/23/17 1323
For: 08/23/17 - 1700
For: 08/23/17 - 2100
For: 08/24/17 - 0100
For: 08/24/17 - 0500
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/23/17 1324 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01425441
08/23/17 1337 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SMOHAMED Eff: 08/23/17 1324
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

OXYC-362 - OXYCODONE HCL/ACETAMINOPHEN 7.5/325 TABLET

Dose 1 TAB (1 TABLET)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/23/17-1045 Stop Date 08/23/17 1046 DC: 08/23/17-1046
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539197

Discontinued Comments Reached Stop Date

History
08/23/17 1045 - POM ORDER by SMOHAMED
08/23/17 1048 - VERIFIED by AMOLINARI
08/23/17 1048 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 1046
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

OXYC-362 - OXYCODONE HCL/ACETAMINOPHEN 7.5/325 TABLET

Dose 1 TAB (1 TABLET)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/23/17-1330 Stop Date 09/22/17 1329 DC: 08/23/17-1702
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539263

History
08/23/17 1324 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01539198
08/23/17 1337 - VERIFIED by MHAIMOWITZ
08/23/17 1703 - DISCONTINUE by SMOHAMED Eff: 08/23/17 1702
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/23/17 1703 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01425614
08/23/17 1703 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/23/17 1703
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

OXYC-362 - OXYCODONE HCL/ACETAMINOPHEN 7.5/325 TABLET

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/23/17-1715 Stop Date 08/30/17 1714 DC: 08/28/17-1233
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $6.50
Rx Number 01539414

History
08/23/17 1703 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01539263
08/23/17 1703 - VERIFIED by AMACCA
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 1234 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1233
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1234 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426797
08/28/17 1234 - REVIEW PROVIDER ACTIVITY by YLEE
Discontinue by EALEXEEV Eff: 08/28/17 1234
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

DUNBAR,RALPH W00001219279 (Continued)

OXYC-362 - OXYCODONE HCL/ACETAMINOPHEN 7.5/325 TABLET

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/28/17-1245 Stop Date 09/04/17 1244 DC: 09/01/17-1710
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $5.50
Rx Number 01540635

History
08/28/17 1234 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539414
08/28/17 1235 - VERIFIED by YLEE
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 1337 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1245 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-1245 STOP: 09/04/17-1244 SOFT STOP:
09/01/17 1710 - DISCONTINUE by JVALLES Eff: 09/01/17 1710
EDIT DOCTOR: VALLES,JENNIE MD
09/01/17 1710 - POM COPY AND EDIT by JVALLES
TO: Rx #U01428128
09/01/17 1711 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JVALLES Eff: 09/01/17 1710
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient EAPEN,EZHAMALIL I Responsible Doctor VAIDYA, SUDHIR M.D.

Account Number W00001219163 Location B1NN Unit Number M000208620
Age/Sex 75/M Room 126 Registered Date 08/16/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 1.80 m2

Weight 152 lb 11.2 oz 69.264 kg
Hem-Onc No

Drug Allergies Penicillins

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CAUDA EQUINA SYNDROME S/P L4-5 LAMI FUSION
Secondary Diagnosis:

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/16/17-2200 Stop Date 09/15/17 2159
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01537428

History
08/16/17 1735 - POM ORDER by RSHARMA
08/16/17 1800 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/16/17-1245 Stop Date 09/15/17 1244
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537218

History
08/16/17 1248 - POM ORDER by RSHARMA
08/16/17 1347 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/16/17-2000 Stop Date 09/15/17 1959
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537219

History
08/16/17 1248 - POM ORDER by RSHARMA
08/16/17 1349 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2000
For: 08/22/17 - 2000
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2000
For: 08/24/17 - 2000
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2000
For: 08/26/17 - 2000
For: 08/27/17 - 2000
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2000
For: 08/29/17 - 2000
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2000
For: 08/31/17 - 2000
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2000
For: 09/02/17 - 2000
For: 09/03/17 - 2000
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2000
For: 09/05/17 - 2000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CPR500T - CIPROFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-2100 Stop Date 09/05/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Clinical Indication COMPLICATED UTI
Total Dispensed 28 Total Costs $0.00 Total Charges $10.80
Rx Number 01539086

History
08/22/17 1714 - POM ORDER by RSHARMA
08/22/17 1715 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CLCH.6T - COLCHICINE 0.6 MG TAB

Dose 0.6 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $261.90
Rx Number 01537226

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1350 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 08/16/17-1245 Stop Date 09/15/17 1244
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537220

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1349 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/16/17-1300 Stop Date 09/15/17 1259
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $11.00
Rx Number 01537215

History
08/16/17 1248 - POM ORDER by RSHARMA
08/16/17 1344 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

For: 08/31/17 - 0900

For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/16/17-1300 Stop Date 09/15/17 1259
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 62 Total Costs $0.00 Total Charges $11.00
Rx Number 01537216

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1344 - VERIFIED by EBALILO
Items Dispensed: 14 Doses Dispensed: 14
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

For: 08/27/17 - 1300

For: 08/27/17 - 1700
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 50 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/26/17-0900 Stop Date 09/23/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 66 Total Costs $0.00 Total Charges $15.60
Rx Number 01540214

History
08/25/17 1737 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01539538
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/25/17 - 0900
Last Actual Administration Time: 08/25/17 - 0812
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/25/17 - 1733
New Order Start: 08/26/17 - 0900
New Order Stop: 09/23/17 - 2059
08/25/17 1744 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SMOHAMED Eff: 08/25/17 1737
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/25/17 - 0900
Last Actual Administration Time: 08/25/17 - 0812
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/25/17 - 1733
New Order Start: 08/26/17 - 0900
New Order Stop: 09/23/17 - 2059
08/25/17 1744 - VERIFIED by MHAIMOWITZ
Items Dispensed: 24 Doses Dispensed: 12
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

For: 08/31/17 - 1300

For: 08/31/17 - 1700
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LVT.075T1 - LEVOTHYROXINE SODIUM 75 MCG (SYNTHROID) TAB

Dose 75 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/17/17-0700 Stop Date 09/16/17 0659
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 21 Total Costs $0.00 Total Charges $54.00
Rx Number 01537227

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1351 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/17/17 - 0700
For: 08/18/17 - 0700
For: 08/19/17 - 0700
For: 08/20/17 - 0700
For: 08/21/17 - 0700
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/22/17 - 0700
For: 08/23/17 - 0700
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/24/17 - 0700
For: 08/25/17 - 0700
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/26/17 - 0700
For: 08/27/17 - 0700
For: 08/28/17 - 0700
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/29/17 - 0700
For: 08/30/17 - 0700
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/31/17 - 0700
For: 09/01/17 - 0700
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/05/17 - 0700
For: 09/06/17 - 0700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LINA5TAB - LINAGLIPTIN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $0.00
Rx Number 01537430

History
08/16/17 1804 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LOSA50TA - LOSARTAN POTASSIUM 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 36 Total Costs $0.00 Total Charges $296.80
Rx Number 01538263

History
08/18/17 2226 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01537555
08/19/17 1003 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by DCYRIAC Eff: 08/19/17 0900
08/19/17 1003 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/16/17-1245 Stop Date 09/15/17 1244
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537221

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1349 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1245 Stop Date 09/15/17 1244
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537222

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1349 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MTF500TCR - METFORMIN HCL XR 500 MG TABCR

Dose 500 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $3.30
Rx Number 01539840

History
08/24/17 2129 - POM ORDER by RSHARMA
08/25/17 0724 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/17/17-2100 Stop Date 09/16/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 39 Total Costs $0.00 Total Charges $5.00
Rx Number 01537556

History
08/17/17 1125 - ENTER by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

08/30/17 0813 - FILL by BGIRLING

Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100

NFD90TCR1 - NIFEDIPINE 90 MG TABCR

Dose 90 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $54.00
Rx Number 01540215

History
08/25/17 1737 - POM ORDER by SMOHAMED
08/25/17 1745 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/16/17-1245 Stop Date 09/15/17 1244
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 6 Total Costs $ Total Charges $
Rx Number 01537224

History
08/16/17 1248 - POM ORDER by RSHARMA
08/16/17 1350 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 1245
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/16/17-2100 Stop Date 09/15/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 41 Total Costs $0.00 Total Charges $751.68
Rx Number 01537229

Warnings
Type: BURKE
Range: PROTONIX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/DAY - 40 MG/DAY. Ordered dose of 80 MG/DAY is
above the Daily Dose range but not greater than the Maximum Daily Dose
of 240 MG/DAY.

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1352 - VERIFIED by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

Items Dispensed: 4 Doses Dispensed: 4

For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100

PRD5T - PREDNISONE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 09/04/17 0930
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $0.00 Total Charges $0.50
Rx Number 01541254

History
08/30/17 0929 - POM ORDER by SMOHAMED
08/30/17 1150 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

PRD2.5T - PREDNISONE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/05/17-0900 Stop Date 09/06/17 0930
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01541255

History
08/30/17 0929 - POM ORDER by SMOHAMED
08/30/17 1150 - VERIFIED by AMOLINARI
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/05/17 - 0900

PRD1T - PREDNISONE 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/07/17-0900 Stop Date 09/08/17 0930
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541256

History
08/30/17 0929 - POM ORDER by SMOHAMED
08/30/17 1150 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 08/17/17-1200 Stop Date 09/16/17 1159
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 40 Total Costs $0.00 Total Charges $2.00
Rx Number 01537223

History
08/16/17 1248 - POM ORDER by RSHARMA
08/16/17 1350 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/17/17 - 1200
For: 08/18/17 - 1200
For: 08/19/17 - 1200
For: 08/20/17 - 1200
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 1200
For: 08/22/17 - 1200
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1200
For: 08/24/17 - 1200
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1200
For: 08/26/17 - 1200
For: 08/27/17 - 1200
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1200
For: 08/29/17 - 1200
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1200
For: 08/31/17 - 1200
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1200
For: 09/05/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/16/17-2100 Stop Date 09/15/17 2059
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 21 Total Costs $0.00 Total Charges $310.50
Rx Number 01537231

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1353 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/16/17 - 2100
For: 08/17/17 - 2100
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/03/17-1430 Stop Date 09/10/17 1429
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542321

History
09/03/17 1423 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540911
09/03/17 1431 - EDIT by MHAIMOWITZ
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/03/17-1430 STOP: 09/10/17 SOFT STOP:
TO:
START: 09/03/17-1430 STOP: 09/10/17-1429 SOFT STOP: 0
09/03/17 1431 - VERIFIED by MHAIMOWITZ

GUAI118S4 - GUAIFENESIN/D-METHORPHAN DM SUGAR-FREE SYRUP 118ML

Dose 5 ML (0.0423729 BOTTLES)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: Cough
Start Date 07/26/17-1100 Stop Date 08/25/17 1059 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 1 Total Costs $0.00 Total Charges $6.60
Rx Number 01531699

Discontinued Comments DC'd by Discharge

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1216 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/26/17 - 1100
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/07/17-1200 Stop Date 09/06/17 1159 DC: 08/07/17-1305
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01534744

Discontinued Comments DC'd by Discharge

History
08/07/17 0916 - POM ORDER by SMOHAMED
08/07/17 1005 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/07/17 - 1200
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 08/21/17-1600 Stop Date 08/22/17 0159 DC: 08/21/17-1653
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Last Bag 1
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01538671

History
08/21/17 1550 - ENTER by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 1600
08/21/17 1655 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1653
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/22/17 1422 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/21/17 1655
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 08/28/17-1600 Stop Date 08/29/17 0159 DC: 08/29/17-0159
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $15.75
Rx Number 01540782

Discontinued Comments Reached Stop Date

History
08/28/17 1551 - ENTER by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1600
08/29/17 0200 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 0159
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (ONE)
Start Date 08/29/17-1600 Stop Date 08/30/17 0159 DC: 08/30/17-0159
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $15.75
Rx Number 01541093

Discontinued Comments Reached Stop Date

History
08/29/17 1554 - ENTER by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1600
08/30/17 0200 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 0159
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 08/31/17-1400 Stop Date 08/31/17 2359 DC: 08/31/17-2359
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $15.75
Rx Number 01541589

Discontinued Comments Reached Stop Date

History
08/31/17 1357 - ENTER by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1400
08/31/17 2359 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 2359
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 500 ML (3.3333333 BAGS)

Dose Instructions 50cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/29/17-1600 Stop Date 08/29/17 1601 DC: 08/29/17-1600
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541094

History
08/29/17 1551 - POM ORDER by SMOHAMED
08/29/17 1554 - VERIFIED by SYSTEM
Verified in order to DC
08/29/17 1554 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 1600
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 07/26/17-1100 Stop Date 08/25/17 1059 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531687

Discontinued Comments DC'd by Discharge

History
07/26/17 1052 - POM ORDER by NCHANDEL
07/26/17 1214 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/04/17-1830 Stop Date 09/03/17 1829 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534480

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1833 - VERIFIED by EBALILO
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
For: 08/08/17 - 1200
For: 08/09/17 - 1200
For: 08/10/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency EVERY 6 HOURS (SCH)
Start Date 07/26/17-1200 Stop Date 08/25/17 1159 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $5.00
Rx Number 01531691

Discontinued Comments DC'd by Discharge

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1215 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 07/31/17 - 1200
For: 07/31/17 - 1800
For: 08/01/17 - 0000
For: 08/01/17 - 0600
For: 08/01/17 - 1200
For: 08/01/17 - 1800
For: 08/02/17 - 0000
For: 08/02/17 - 0600
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/02/17 - 1200
For: 08/02/17 - 1800
For: 08/03/17 - 0000
For: 08/03/17 - 0600
For: 08/03/17 - 1200
For: 08/03/17 - 1800
For: 08/04/17 - 0000
For: 08/04/17 - 0600
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NOW (SCH)
Start Date 07/27/17-2030 Stop Date 08/26/17 2029 DC: 07/28/17-1338
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $12.98
Rx Number 01532313

Warnings
Type: BURKE
Range: NORVASC
Condition: ALL COMMON INDICATIONS
Warnings AML5T: Unable to check dose ranges for MG/DAY (SIG - No Times).

History
07/27/17 2024 - POM ORDER by JRUSSO
07/27/17 2031 - VERIFIED by AADEGBAMIG
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 1339 - DISCONTINUE by NCHANDEL Eff: 07/28/17 1338
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
07/28/17 1339 - POM COPY AND EDIT by NCHANDEL
TO: Rx #U01418900
07/28/17 1346 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by NCHANDEL Eff: 07/28/17 1339
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NOW (SCH)
Start Date 07/28/17-1345 Stop Date 08/27/17 1344 DC: 07/28/17-1703
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532469

Warnings
Type: BURKE
Range: NORVASC
Condition: ALL COMMON INDICATIONS
Warnings AML10T: Unable to check dose ranges for MG/DAY (SIG - No Times).

Discontinued Comments DUPLICATE ORDER

History
07/28/17 1345 - ENTER by EBALILO
07/28/17 1703 - DISCONTINUE by AMACCA Eff: 07/28/17 1703
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DUPLICATE ORDER
07/28/17 1704 - POM COPY AND EDIT by NCHANDEL
TO: Rx #U01419074
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/29/17-0900 Stop Date 08/28/17 0859 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 3 Total Costs $0.00 Total Charges $1.26
Rx Number 01532603

Discontinued Comments DC'd by Discharge

History
07/28/17 1701 - POM ORDER by NCHANDEL
07/28/17 1703 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 07/29/17 - 0900
For: 07/30/17 - 0900
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NOW (ONE)
Start Date 07/28/17-1702 Stop Date 07/28/17 1703 DC: 07/28/17-1703
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01532604

Discontinued Comments Reached Stop Date

History
07/28/17 1704 - POM COPY AND EDIT by NCHANDEL
FROM: Rx #01532469
07/28/17 1706 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/28/17 - 1702
07/28/17 1706 - DISCONTINUE by PHABKGJOB Eff: 07/28/17 1703
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/05/17-0900 Stop Date 09/04/17 0859 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $1.89
Rx Number 01534488

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1836 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/08/17 - 0900
For: 08/09/17 - 0900
For: 08/10/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 08/24/17 1731 DC: 08/24/17-1731
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $5.04
Rx Number 01537225

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1350 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/24/17 1742 - EDIT by RSHARMA
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
FROM:
START: 08/17/17-0900 STOP: 09/16/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/17/17-0900 STOP: 08/24/17-1731 SOFT STOP:
DISPENSE: 8
08/24/17 1742 - DISCONTINUE by RSHARMA Eff: 08/24/17 1731
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/24/17 1742 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01425955
08/24/17 1831 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by RSHARMA Eff: 08/24/17 1742
Discontinue by RSHARMA Eff: 08/24/17 1742
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 09/16/17 0859 DC: 08/24/17-2100
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539794

History
08/24/17 1742 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01537225
Result of Frequency/Schedule Edit
Ordering Doctor: SHARMA,RAMAN MD PGY-3
Last Scheduled Administration Time: 08/24/17 - 0900
Last Actual Administration Time: 08/24/17 - 0929
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/24/17 - 1731
New Order Start: 08/24/17 - 2100
New Order Stop: 09/16/17 - 0859
08/24/17 1814 - VERIFIED by SYSTEM
Verified in order to DC
08/24/17 1814 - DISCONTINUE by RSHARMA Eff: 08/24/17 2100
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/24/17 1814 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01425962
08/24/17 1831 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by RSHARMA Eff: 08/24/17 1742
Ordering Doctor: SHARMA,RAMAN MD PGY-3
Last Scheduled Administration Time: 08/24/17 - 0900
Last Actual Administration Time: 08/24/17 - 0929
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/24/17 - 1731
New Order Start: 08/24/17 - 2100
New Order Stop: 09/16/17 - 0859
Edit by SYSTEM Eff: 08/24/17 1814
Freq/Sch Edit by SYSTEM Eff: 08/24/17 1814
Ordering Doctor: SHARMA,RAMAN MD PGY-3
Last Scheduled Administration Time: 08/24/17 - 0900
Last Actual Administration Time: 08/24/17 - 0929
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/24/17 - 1731
New Order Start: 08/24/17 - 2100
New Order Stop: 09/16/17 - 0859
Discontinue by RSHARMA Eff: 08/24/17 1814
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 08/25/17 2100 DC: 08/25/17-2100
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 01539802

History
08/24/17 1814 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01539794
08/24/17 1831 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/25/17 1737 - DISCONTINUE by SMOHAMED Eff: 08/25/17 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/25/17 1737 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/25/17-2100 STOP: 09/24/17 2059 SOFT STOP: 0
DISPENSE: 2
TO:
START: 08/25/17-2100 STOP: 08/25/17-2100 SOFT STOP:
DISPENSE: 0
08/28/17 1552 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 08/25/17 1737
Discontinue by SMOHAMED Eff: 08/25/17 1737
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 08/24/17 2101 DC: 08/24/17-2101
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $14.20
Rx Number 01539801

Discontinued Comments Reached Stop Date

History
08/24/17 1814 - POM ORDER by RSHARMA
08/24/17 1830 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 2100
08/24/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 07/26/17-2000 Stop Date 08/25/17 1959 DC: 07/31/17-0428
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531686

History
07/26/17 1052 - POM ORDER by NCHANDEL
07/26/17 1214 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 2000
For: 08/01/17 - 2000
07/31/17 0431 - DISCONTINUE by YIVANOV Eff: 07/31/17 0428
For: 07/31/17 - 1200
For: 08/01/17 - 1200
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
07/31/17 0431 - POM COPY AND EDIT by YIVANOV
TO: Rx #U01419276
07/31/17 0739 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YIVANOV Eff: 07/31/17 0431
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
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EAPEN,EZHAMALIL I W00001219163 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/31/17-2000 Stop Date 08/30/17 1959 DC: 07/31/17-2000
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532853

Discontinued Comments DC'd by Discharge

History
07/31/17 0431 - POM COPY AND EDIT by YIVANOV
FROM: Rx #01531686
07/31/17 0738 - VERIFIED by AMOLINARI
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 2000
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/04/17-2000 Stop Date 09/03/17 1959 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534479

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1833 - VERIFIED by EBALILO
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2000
For: 08/10/17 - 2000
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
For: 08/08/17 - 1200
For: 08/09/17 - 1200
For: 08/10/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CLC500CT - CALCIUM CARBONATE 500 MG CHEW TABLET

Dose 500 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/26/17-1300 Stop Date 08/25/17 1259 DC: 07/26/17-1300
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531664

Discontinued Comments dc per Dr. Chandel

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1141 - VERIFIED by SYSTEM
Verified in order to DC
07/26/17 1141 - DISCONTINUE by AADEGBAMIG Eff: 07/26/17 1300
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc per Dr. Chandel
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CLC500CT - CALCIUM CARBONATE 500 MG CHEW TABLET

Dose 500 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/26/17-1300 Stop Date 08/25/17 1259 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 16 Total Costs $0.00 Total Charges $1.04
Rx Number 01531770

Discontinued Comments DC'd by Discharge

History
07/26/17 1243 - POM ORDER by NCHANDEL
07/26/17 1329 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 07/26/17 - 1300
For: 07/26/17 - 1700
For: 07/27/17 - 0900
For: 07/27/17 - 1300
For: 07/27/17 - 1700
For: 07/28/17 - 0900
For: 07/28/17 - 1300
For: 07/28/17 - 1700
For: 07/29/17 - 0900
For: 07/29/17 - 1300
For: 07/29/17 - 1700
For: 07/30/17 - 0900
For: 07/30/17 - 1300
For: 07/30/17 - 1700
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/31/17 - 0900
For: 07/31/17 - 1300
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1300
For: 08/01/17 - 1700
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/02/17 - 0900
For: 08/02/17 - 1300
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1300
For: 08/03/17 - 1700
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 10 Doses Auto Credited: 10
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1300
For: 08/01/17 - 1700
For: 08/02/17 - 0900
For: 08/02/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

For: 08/02/17 - 1700

For: 08/03/17 - 0900
For: 08/03/17 - 1300
For: 08/03/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

CHLR25T - CHLORTHALIDONE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859 DC: 08/18/17-2224
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $4.78
Rx Number 01537776

History
08/17/17 1710 - POM ORDER by RSHARMA
08/17/17 1815 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/18/17 2225 - DISCONTINUE by RSHARMA Eff: 08/18/17 2224
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/18/17 2225 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01424483
08/21/17 1329 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RSHARMA Eff: 08/18/17 2225
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CHLR25T - CHLORTHALIDONE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 DC: 08/20/17-0843
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $4.78
Rx Number 01538262

History
08/18/17 2225 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01537776
08/19/17 1003 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by DCYRIAC Eff: 08/19/17 0900
08/19/17 1003 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/20/17 0845 - DISCONTINUE by RSHARMA Eff: 08/20/17 0843
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/20/17 0845 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01424584
08/21/17 1329 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RSHARMA Eff: 08/20/17 0845
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CHLR25T - CHLORTHALIDONE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/20/17-0900 Stop Date 09/19/17 0859 DC: 08/25/17-1737
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $47.75
Rx Number 01538356

History
08/20/17 0845 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01538262
08/20/17 0959 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MGIANDALON Eff: 08/20/17 0910
08/20/17 0959 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/25/17 1805 - DISCONTINUE by SMOHAMED Eff: 08/25/17 1737
Items Auto Credited: 8 Doses Auto Credited: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/25/17 1805 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01426382
08/28/17 1552 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SMOHAMED Eff: 08/25/17 1805
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CHLR25T - CHLORTHALIDONE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859 DC: 08/28/17-1541
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $14.34
Rx Number 01540219

History
08/25/17 1805 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538356
08/25/17 1812 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/28/17 1542 - DISCONTINUE by SMOHAMED Eff: 08/28/17 1541
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/28/17 1552 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SMOHAMED Eff: 08/28/17 1542
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CCLB10T - CYCLOBENZAPRINE HCL 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: Muscle spasm
Start Date 07/26/17-1100 Stop Date 08/25/17 1059 DC: 07/26/17-1729
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 01531698

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1215 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 07/26/17 - 1100
07/26/17 1738 - DISCONTINUE by NCHANDEL Eff: 07/26/17 1729
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
07/26/17 2041 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by NCHANDEL Eff: 07/26/17 1738

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 07/26/17-1100 Stop Date 08/25/17 1059 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531690

Discontinued Comments DC'd by Discharge

History
07/26/17 1052 - POM ORDER by NCHANDEL
07/26/17 1214 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 08/04/17-1830 Stop Date 09/03/17 1829 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534483

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1834 - VERIFIED by EBALILO
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
For: 08/08/17 - 1200
For: 08/09/17 - 1200
For: 08/10/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/26/17-1300 Stop Date 08/25/17 1259 DC: 07/31/17-0428
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01531683

History
07/26/17 1052 - POM ORDER by NCHANDEL
07/26/17 1214 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/31/17 - 0900
For: 07/31/17 - 1300
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1300
For: 08/01/17 - 1700
07/31/17 0431 - DISCONTINUE by YIVANOV Eff: 07/31/17 0428
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
07/31/17 0431 - POM COPY AND EDIT by YIVANOV
TO: Rx #U01419277
07/31/17 0739 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YIVANOV Eff: 07/31/17 0431
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/31/17-0430 Stop Date 08/30/17 0429 DC: 07/31/17-1346
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532854

Discontinued Comments DC'd by Discharge

History
07/31/17 0431 - POM COPY AND EDIT by YIVANOV
FROM: Rx #01531683
07/31/17 0739 - VERIFIED by AMOLINARI
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/05/17-0900 Stop Date 09/04/17 0859 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01534478

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1833 - VERIFIED by EBALILO
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/27/17-0900 Stop Date 07/29/17 0901 DC: 07/29/17-0901
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 3 Total Costs $0.00 Total Charges $1.29
Rx Number 01532025

Discontinued Comments Reached Stop Date

History
07/26/17 1740 - POM ORDER by NCHANDEL
07/26/17 1958 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 07/27/17 - 0900
For: 07/28/17 - 0900
For: 07/29/17 - 0900
07/29/17 0901 - DISCONTINUE by PHABKGJOB Eff: 07/29/17 0901
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/05/17-0900 Stop Date 09/04/17 0859 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 8 Total Costs $0.00 Total Charges $1.60
Rx Number 01534490

Discontinued Comments DC'd by Discharge

History
08/04/17 1823 - POM ORDER by SDAS
08/04/17 1836 - VERIFIED by EBALILO
Items Dispensed: 12 Doses Dispensed: 12
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
Items Auto Credited: 10 Doses Auto Credited: 10
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859 DC: 08/17/17-0900
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537429

History
08/16/17 1736 - POM ORDER by RSHARMA
08/16/17 1801 - DISCONTINUE by AADEGBAMIG Eff: 08/17/17 0900
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/16/17 1801 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 07/26/17-1400 Stop Date 08/25/17 1359 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 15 Total Costs $0.00 Total Charges $129.92
Rx Number 01531693

Discontinued Comments DC'd by Discharge

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1215 - VERIFIED by AMACCA
Items Dispensed: 15 Doses Dispensed: 15
For: 07/26/17 - 1400
For: 07/26/17 - 2200
For: 07/27/17 - 0600
For: 07/27/17 - 1400
For: 07/27/17 - 2200
For: 07/28/17 - 0600
For: 07/28/17 - 1400
For: 07/28/17 - 2200
For: 07/29/17 - 0600
For: 07/29/17 - 1400
For: 07/29/17 - 2200
For: 07/30/17 - 0600
For: 07/30/17 - 1400
For: 07/30/17 - 2200
For: 07/31/17 - 0600
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/31/17 - 1400
For: 07/31/17 - 2200
For: 08/01/17 - 0600
For: 08/01/17 - 1400
For: 08/01/17 - 2200
For: 08/02/17 - 0600
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/02/17 - 1400
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 12 Doses Auto Credited: 12
For: 07/31/17 - 1400
For: 07/31/17 - 2200
For: 08/01/17 - 0600
For: 08/01/17 - 1400
For: 08/01/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

For: 08/02/17 - 0600

For: 08/02/17 - 1400
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

HDRL10T - HYDRALAZINE HCL 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: SBP > 180
Start Date 07/26/17-1100 Stop Date 08/25/17 1059 DC: 07/26/17-1147
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531666

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1148 - VERIFIED by SYSTEM
Verified in order to DC
07/26/17 1148 - DISCONTINUE by NCHANDEL Eff: 07/26/17 1147
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
07/26/17 1211 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by SYSTEM Eff: 07/26/17 1148
Discontinue by NCHANDEL Eff: 07/26/17 1148
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

HDRL10T - HYDRALAZINE HCL 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 07/28/17-2230 Stop Date 07/28/17 2231 DC: 07/28/17-2231
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $0.48
Rx Number 01532671

Discontinued Comments Reached Stop Date

History
07/28/17 2229 - POM ORDER by HMOHAMED
07/29/17 1017 - REVIEW PROVIDER ACTIVITY by EBALILO
Administration of Unverified Order by RNEVIN Eff: 07/28/17 2254
07/29/17 1017 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 07/28/17 - 2230
07/29/17 1017 - DISCONTINUE by PHABKGJOB Eff: 07/28/17 2231
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

HDRL10T - HYDRALAZINE HCL 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 07/29/17-0630 Stop Date 07/29/17 0631 DC: 07/29/17-0631
Ordering Doctor BARRY,STEVEN
Total Dispensed 1 Total Costs $0.00 Total Charges $0.48
Rx Number 01532672

Discontinued Comments Reached Stop Date

History
07/29/17 0619 - POM ORDER by SBARRY
07/29/17 1017 - REVIEW PROVIDER ACTIVITY by EBALILO
Administration of Unverified Order by RNEVIN Eff: 07/29/17 0626
07/29/17 1017 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 07/29/17 - 0630
07/29/17 1017 - DISCONTINUE by PHABKGJOB Eff: 07/29/17 0631
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

HDRL10T - HYDRALAZINE HCL 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 07/29/17-2230 Stop Date 07/29/17 2231 DC: 07/29/17-2231
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $0.48
Rx Number 01532783

Discontinued Comments Reached Stop Date

History
07/29/17 2229 - POM ORDER by HAZIZI
07/30/17 1043 - REVIEW PROVIDER ACTIVITY by EBALILO
Administration of Unverified Order by RNEVIN Eff: 07/29/17 2256
07/30/17 1043 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 07/29/17 - 2230
07/30/17 1043 - DISCONTINUE by PHABKGJOB Eff: 07/29/17 2231
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/18/17-1045 Stop Date 08/18/17 1046 DC: 08/18/17-1046
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $0.30
Rx Number 01537883

Discontinued Comments Reached Stop Date

History
08/18/17 1044 - POM ORDER by RSHARMA
08/18/17 1046 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 1045
08/18/17 1047 - DISCONTINUE by PHABKGJOB Eff: 08/18/17 1046
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059 DC: 08/24/17-1109
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 4 Total Costs $0.00 Total Charges $1.20
Rx Number 01538997

History
08/22/17 1421 - POM ORDER by RSHARMA
08/22/17 1422 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/24/17 1111 - DISCONTINUE by SMOHAMED Eff: 08/24/17 1109
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/24/17 1111 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01425709
08/24/17 1114 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SMOHAMED Eff: 08/24/17 1111
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 50 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 08/25/17 1733 DC: 08/25/17-1733
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 22 Total Costs $0.00 Total Charges $1.20
Rx Number 01539538

History
08/24/17 1111 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538997
08/24/17 1114 - VERIFIED by MHAIMOWITZ
Items Dispensed: 14 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/25/17 1737 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/24/17-2100 STOP: 09/23/17 2059 SOFT STOP: 0
DISPENSE: 8
TO:
START: 08/24/17-2100 STOP: 08/25/17-1733 SOFT STOP:
DISPENSE: 4
08/25/17 1737 - DISCONTINUE by SMOHAMED Eff: 08/25/17 1733
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

Order filed UNV:

Allergies/Duplicates/Interactions differ from order entry
08/25/17 1737 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01426370
08/28/17 1552 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 08/25/17 1737
Discontinue by SMOHAMED Eff: 08/25/17 1737

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/29/17-0900 Stop Date 08/28/17 0859 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.20
Rx Number 01532605

Discontinued Comments DC'd by Discharge

History
07/28/17 1706 - POM ORDER by NCHANDEL
07/28/17 1706 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 07/29/17 - 0900
For: 07/30/17 - 0900
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 2 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 07/26/17-1100 Stop Date 08/02/17 1059 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531701

Discontinued Comments DC'd by Discharge

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1216 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

IPR02V2.5 - IPRATROPIUM BR 0.02% INH SOLN 2.5 ML NEB

Dose 2.5 ML (1 VIAL)

Admin Route NEBULIZER
Frequency EVERY 6 HOURS (SCH)
Start Date 07/26/17-1200 Stop Date 08/25/17 1159 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $88.00
Rx Number 01531694

Discontinued Comments DC'd by Discharge

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1215 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 07/31/17 - 1200
For: 07/31/17 - 1800
For: 08/01/17 - 0000
For: 08/01/17 - 0600
For: 08/01/17 - 1200
For: 08/01/17 - 1800
For: 08/02/17 - 0000
For: 08/02/17 - 0600
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/02/17 - 1200
For: 08/02/17 - 1800
For: 08/03/17 - 0000
For: 08/03/17 - 0600
For: 08/03/17 - 1200
For: 08/03/17 - 1800
For: 08/04/17 - 0000
For: 08/04/17 - 0600
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
For: 07/31/17 - 1400
For: 07/31/17 - 2200
For: 08/01/17 - 0600
For: 08/01/17 - 1400
For: 08/01/17 - 2200
For: 08/02/17 - 0600
For: 08/02/17 - 1400
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

IRB150T - IRBESARTAN 150 MG TAB

Dose 150 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/27/17-0900 Stop Date 08/26/17 0859 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 5 Total Costs $0.00 Total Charges $28.40
Rx Number 01532029

Discontinued Comments DC'd by Discharge

History
07/26/17 2037 - ENTER by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 07/27/17 - 0900
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CHRMC - CHROMAGEN CAP

Dose 1 EA (1 CAPSULE)
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/26/17-1300 Stop Date 08/25/17 1259 DC: 07/26/17-1333
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531783

History
07/26/17 1243 - POM ORDER by NCHANDEL
07/26/17 1333 - VERIFIED by SYSTEM
Verified in order to DC
07/26/17 1333 - DISCONTINUE by AADEGBAMIG Eff: 07/26/17 1333
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

CHRMC - CHROMAGEN CAP

Dose 1 EA (1 CAPSULE)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/26/17-1400 Stop Date 08/25/17 1359 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 6 Total Costs $0.00 Total Charges $14.00
Rx Number 01531782

Discontinued Comments DC'd by Discharge

History
07/26/17 1333 - ENTER by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 07/26/17 - 1400
For: 07/27/17 - 0900
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/26/17 1333 - NOW DOSE by AADEGBAMIG
Now Dose: 07/26/17 1400
07/26/17 1333 - KEEP NEXT DOSE by AADEGBAMIG
Keep Next Dose: 07/27/17 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LBT100T - LABETALOL HCL 100 MG TAB

Dose 200 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency NOW (ONE)
Start Date 07/28/17-1630 Stop Date 07/28/17 1631 DC: 07/28/17-1631
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 2 Total Costs $0.00 Total Charges $2.40
Rx Number 01532510

Discontinued Comments Reached Stop Date

History
07/28/17 1617 - POM ORDER by NCHANDEL
07/28/17 1621 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 1
For: 07/28/17 - 1630
07/28/17 1631 - DISCONTINUE by PHABKGJOB Eff: 07/28/17 1631
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LVT.075T1 - LEVOTHYROXINE SODIUM 75 MCG (SYNTHROID) TAB

Dose 75 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 07/27/17-0700 Stop Date 08/26/17 0659 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 5 Total Costs $0.00 Total Charges $15.00
Rx Number 01531695

Discontinued Comments DC'd by Discharge

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1215 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 07/27/17 - 0700
For: 07/28/17 - 0700
For: 07/29/17 - 0700
For: 07/30/17 - 0700
For: 07/31/17 - 0700
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/01/17 - 0700
For: 08/02/17 - 0700
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/03/17 - 0700
For: 08/04/17 - 0700
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/01/17 - 0700
For: 08/02/17 - 0700
For: 08/03/17 - 0700
For: 08/04/17 - 0700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LVT.075T1 - LEVOTHYROXINE SODIUM 75 MCG (SYNTHROID) TAB

Dose 75 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/05/17-0700 Stop Date 09/04/17 0659 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $9.00
Rx Number 01534486

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1835 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/05/17 - 0700
For: 08/06/17 - 0700
For: 08/07/17 - 0700
For: 08/08/17 - 0700
For: 08/09/17 - 0700
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/10/17 - 0700
For: 08/11/17 - 0700
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/08/17 - 0700
For: 08/09/17 - 0700
For: 08/10/17 - 0700
For: 08/11/17 - 0700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LINA5TAB - LINAGLIPTIN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/05/17-0900 Stop Date 09/04/17 0859 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $0.00
Rx Number 01534537

Discontinued Comments DC'd by Discharge

History
08/04/17 2102 - ENTER by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/08/17 - 0900
For: 08/09/17 - 0900
For: 08/10/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LSRT25T - LOSARTAN POTASSIUM 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859 DC: 08/18/17-0900
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537519

History
08/17/17 0908 - POM ORDER by RSHARMA
08/17/17 0913 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/17/17 1114 - DISCONTINUE by RSHARMA Eff: 08/18/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/17/17 1114 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01423804
08/17/17 1125 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RSHARMA Eff: 08/17/17 1114
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LSRT25T - LOSARTAN POTASSIUM 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency 0904 (ONE)
Start Date 08/17/17-0904 Stop Date 08/17/17 0905 DC: 08/17/17-0905
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $3.90
Rx Number 01537520

Discontinued Comments Reached Stop Date

History
08/17/17 0908 - POM ORDER by RSHARMA
08/17/17 0913 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 0904
08/17/17 0913 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 0905
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LOSA50TA - LOSARTAN POTASSIUM 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859 DC: 08/18/17-2225
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $9.28
Rx Number 01537555

History
08/17/17 1124 - ENTER by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/18/17 2226 - DISCONTINUE by RSHARMA Eff: 08/18/17 2225
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/18/17 2226 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01424484
08/21/17 1329 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RSHARMA Eff: 08/18/17 2226
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

LSRT25T - LOSARTAN POTASSIUM 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/17/17-1715 Stop Date 08/17/17 1716 DC: 08/17/17-1716
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $3.90
Rx Number 01537777

Discontinued Comments Reached Stop Date

History
08/17/17 1714 - POM ORDER by RSHARMA
08/17/17 1814 - REVIEW PROVIDER ACTIVITY by AMACCA
Administration of Unverified Order by DEMMANUEL Eff: 08/17/17 1736
08/17/17 1815 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 1715
08/17/17 1815 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 1716
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 07/26/17-1100 Stop Date 08/25/17 1059 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531688

Discontinued Comments DC'd by Discharge

History
07/26/17 1052 - POM ORDER by NCHANDEL
07/26/17 1214 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/04/17-1830 Stop Date 09/03/17 1829 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534481

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1833 - VERIFIED by EBALILO
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
For: 08/08/17 - 1200
For: 08/09/17 - 1200
For: 08/10/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/26/17-1100 Stop Date 08/25/17 1059 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531689

Discontinued Comments DC'd by Discharge

History
07/26/17 1052 - POM ORDER by NCHANDEL
07/26/17 1214 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/04/17-1830 Stop Date 09/03/17 1829 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534482

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1834 - VERIFIED by EBALILO
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
For: 08/08/17 - 1200
For: 08/09/17 - 1200
For: 08/10/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/26/17-1700 Stop Date 07/26/17 1700 DC: 07/26/17-1700
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531667

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1150 - EDIT by NCHANDEL
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
FROM:
START: 07/26/17-1700 STOP: 08/25/17 1659 SOFT STOP: 0
DISPENSE: 9
TO:
START: 07/26/17-1700 STOP: 07/26/17-1700 SOFT STOP:
DISPENSE: 0
07/26/17 1150 - VERIFIED by SYSTEM
Verified in order to DC
07/26/17 1150 - DISCONTINUE by NCHANDEL Eff: 07/26/17 1700
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
07/26/17 1211 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by NCHANDEL Eff: 07/26/17 1150
Edit by SYSTEM Eff: 07/26/17 1150
Discontinue by NCHANDEL Eff: 07/26/17 1150
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/26/17-1700 Stop Date 08/25/17 1659 DC: 07/28/17-1615
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 4 Total Costs $0.00 Total Charges $0.40
Rx Number 01531703

History
07/26/17 1150 - POM ORDER by NCHANDEL
07/26/17 1216 - VERIFIED by AMACCA
Items Dispensed: 9 Doses Dispensed: 9
For: 07/26/17 - 1700
For: 07/27/17 - 0900
For: 07/27/17 - 1700
For: 07/28/17 - 0900
For: 07/28/17 - 1700
For: 07/29/17 - 0900
For: 07/29/17 - 1700
For: 07/30/17 - 0900
For: 07/30/17 - 1700
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/17 - 0900
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1700
07/28/17 1616 - DISCONTINUE by NCHANDEL Eff: 07/28/17 1615
Items Auto Credited: 9 Doses Auto Credited: 9
For: 07/28/17 - 1700
For: 07/29/17 - 0900
For: 07/29/17 - 1700
For: 07/30/17 - 0900
For: 07/30/17 - 1700
For: 07/31/17 - 0900
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1700
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
07/28/17 1616 - POM COPY AND EDIT by NCHANDEL
TO: Rx #U01418986
07/28/17 1702 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NCHANDEL Eff: 07/28/17 1616
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 83
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/28/17-1700 Stop Date 08/27/17 1659 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 12 Total Costs $0.00 Total Charges $0.80
Rx Number 01532509

Discontinued Comments DC'd by Discharge

History
07/28/17 1616 - POM COPY AND EDIT by NCHANDEL
FROM: Rx #01531703
07/28/17 1621 - VERIFIED by AADEGBAMIG
Items Dispensed: 18 Doses Dispensed: 9
For: 07/28/17 - 1700
For: 07/29/17 - 0900
For: 07/29/17 - 1700
For: 07/30/17 - 0900
For: 07/30/17 - 1700
For: 07/31/17 - 0900
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1700
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1700
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 14 Doses Auto Credited: 7
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1700
For: 08/02/17 - 0900
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 84
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/05/17-0900 Stop Date 09/04/17 0859 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $0.50
Rx Number 01534487

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1836 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 8
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 85
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/16/17-2100 Stop Date 09/15/17 2059 DC: 08/17/17-0746
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01537228

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1351 - VERIFIED by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/17/17 0748 - DISCONTINUE by RSHARMA Eff: 08/17/17 0746
Items Auto Credited: 8 Doses Auto Credited: 8
For: 08/17/17 - 0900
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/17/17 0748 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01423748
08/17/17 0821 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RSHARMA Eff: 08/17/17 0748
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 86
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859 DC: 08/17/17-0900
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537497

History
08/17/17 0748 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01537228
08/17/17 0808 - DISCONTINUE by RSHARMA Eff: 08/17/17 0900
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/17/17 0808 - VERIFIED by SYSTEM
Verified in order to DC
08/17/17 0808 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01423751
08/17/17 0821 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 08/17/17 0808
Discontinue by RSHARMA Eff: 08/17/17 0808
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 87
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 50
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859 DC: 08/17/17-1113
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01537506

History
08/17/17 0808 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01537497
08/17/17 0821 - VERIFIED by AMOLINARI
Items Dispensed: 16 Doses Dispensed: 8
For: 08/17/17 - 0900
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/17/17 0904 - HOLD by RSHARMA Eff: 08/17/17 0903
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
Items Auto Credited: 14 Doses Auto Credited: 7
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/17/17 0913 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by RSHARMA Eff: 08/17/17 0904
08/17/17 1114 - DISCONTINUE by RSHARMA Eff: 08/17/17 1113
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/17/17 1114 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01423803
08/17/17 1125 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RSHARMA Eff: 08/17/17 1114
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 88
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

NFD60TCR - NIFEDIPINE 60 MG TABCR

Dose 120 MG (2 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY @ BREAKFAST (SCH)
Start Date 07/27/17-0800 Stop Date 07/27/17 0800 DC: 07/27/17-0800
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531668

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1150 - EDIT by NCHANDEL
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
FROM:
START: 07/27/17-0800 STOP: 08/26/17 0759 SOFT STOP: 0
DISPENSE: 8
TO:
START: 07/27/17-0800 STOP: 07/27/17-0800 SOFT STOP:
DISPENSE: 0
07/26/17 1150 - VERIFIED by SYSTEM
Verified in order to DC
07/26/17 1150 - DISCONTINUE by NCHANDEL Eff: 07/27/17 0800
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
07/26/17 1211 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by NCHANDEL Eff: 07/26/17 1150
Edit by SYSTEM Eff: 07/26/17 1150
Discontinue by NCHANDEL Eff: 07/26/17 1150
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 89
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

NFD60TCR - NIFEDIPINE 60 MG TABCR

Dose 120 MG (2 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/27/17-0900 Stop Date 07/27/17 0900 DC: 07/27/17-0900
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 8 Total Costs $ Total Charges $
Rx Number 01531702

History
07/26/17 1150 - POM ORDER by NCHANDEL
07/26/17 1216 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 4
For: 07/27/17 - 0900
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/26/17 1738 - DISCONTINUE by NCHANDEL Eff: 07/27/17 0900
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
07/26/17 1738 - EDIT by NCHANDEL
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
FROM:
START: 07/27/17-0900 STOP: 08/26/17 0859 SOFT STOP: 0
DISPENSE: 8
TO:
START: 07/27/17-0900 STOP: 07/27/17-0900 SOFT STOP:
DISPENSE: 0
07/26/17 2041 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by NCHANDEL Eff: 07/26/17 1738
Discontinue by NCHANDEL Eff: 07/26/17 1738
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 90
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (0 EACHS)
Dose Instructions Irbesartan 150 mg daily
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/27/17-0900 Stop Date 08/26/17 0859 DC: 07/27/17-0900
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531665

Discontinued Comments dc per Dr. Chandel

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1141 - DISCONTINUE by AADEGBAMIG Eff: 07/27/17 0900
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc per Dr. Chandel
07/26/17 1141 - VERIFIED by SYSTEM
Verified in order to DC

NF-MED - NON FORMULARY MEDICATION

Dose Instructions TRADJENTA. 5mg. daily. PO

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859 DC: 08/17/17-0900
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537431

History
08/16/17 1735 - POM ORDER by RSHARMA
08/16/17 1804 - DISCONTINUE by AADEGBAMIG Eff: 08/17/17 0900
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/16/17 1804 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 91
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/05/17-0900 Stop Date 09/04/17 0859 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $4.40
Rx Number 01534539

Discontinued Comments DC'd by Discharge

History
08/04/17 2206 - POM ORDER by SDAS
08/05/17 1005 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by ABLAKE Eff: 08/05/17 0850
08/05/17 1005 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 8
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 92
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 07/26/17-1100 Stop Date 08/25/17 1059 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 6 Total Costs $ Total Charges $
Rx Number 01531684

Discontinued Comments DC'd by Discharge

History
07/26/17 1052 - POM ORDER by NCHANDEL
07/26/17 1214 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 1100
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 93
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/04/17-1830 Stop Date 09/03/17 1829 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 8 Total Costs $ Total Charges $
Rx Number 01534484

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1834 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 8
For: 08/04/17 - 1830
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 07/26/17-1100 Stop Date 08/02/17 1059 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01531700

Discontinued Comments DC'd by Discharge

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1216 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 94
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/27/17-0900 Stop Date 08/28/17 0859 DC: 07/31/17-0428
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01531696

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1215 - VERIFIED by AMACCA
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0431 - DISCONTINUE by YIVANOV Eff: 07/31/17 0428
For: 07/31/17 - 1200
For: 08/01/17 - 1200
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
07/31/17 0432 - POM COPY AND EDIT by YIVANOV
TO: Rx #U01419278
07/31/17 0739 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YIVANOV Eff: 07/31/17 0431
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 95
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/31/17-0430 Stop Date 09/01/17 0429 DC: 07/31/17-1346
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532855

Discontinued Comments DC'd by Discharge

History
07/31/17 0432 - POM COPY AND EDIT by YIVANOV
FROM: Rx #01531696
07/31/17 0739 - VERIFIED by AMOLINARI
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 96
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

PRD20T - PREDNISONE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 08/24/17 0859 DC: 08/23/17-1658
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $3.48
Rx Number 01537230

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1353 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 0900
08/23/17 1658 - DISCONTINUE by RSHARMA Eff: 08/23/17 1658
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/23/17 1658 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01425597
08/23/17 1709 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RSHARMA Eff: 08/23/17 1658
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 97
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

PRD20T - PREDNISONE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 08/30/17 0859 DC: 08/28/17-1224
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $2.90
Rx Number 01539423

History
08/23/17 1658 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01537230
08/23/17 1710 - EDIT by AMACCA
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/24/17-0900 STOP: 08/30/17 SOFT STOP:
TO:
START: 08/24/17-0900 STOP: 08/30/17-0859 SOFT STOP:
08/23/17 1710 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 1225 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1224
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/29/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1225 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426786
08/28/17 1247 - REVIEW PROVIDER ACTIVITY by YLEE
Discontinue by EALEXEEV Eff: 08/28/17 1225
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 98
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

PRD20T - PREDNISONE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/03/17 0859 DC: 08/30/17-0857
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $0.58
Rx Number 01540643

History
08/28/17 1225 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539423
08/28/17 1247 - EDIT by YLEE
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0900 STOP: 09/03/17 SOFT STOP:
TO:
START: 08/29/17-0900 STOP: 09/03/17-0859 SOFT STOP:
08/28/17 1248 - VERIFIED by YLEE
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/01/17 - 0900
For: 09/02/17 - 0900
08/30/17 0858 - DISCONTINUE by SMOHAMED Eff: 08/30/17 0857
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/30/17 - 0900
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/30/17 0858 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01427321
08/30/17 1151 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/30/17 0858
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 99
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

PRD20T - PREDNISONE 20 MG TAB

Dose 15 MG (0.75 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/06/17 0859 DC: 08/30/17-1129
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541248

History
08/30/17 0858 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01540643
08/30/17 1129 - DISCONTINUE by AMOLINARI Eff: 08/30/17 1129
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/30/17 1129 - VERIFIED by SYSTEM
Verified in order to DC

PRD20T - PREDNISONE 20 MG TAB

Dose 15 MG (0.75 TABLETS)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/31/17-0900 Stop Date 08/31/17 0901 DC: 08/31/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541249

History
08/30/17 0929 - POM ORDER by SMOHAMED
08/30/17 1129 - DISCONTINUE by AMOLINARI Eff: 08/31/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/30/17 1129 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 100
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

PRD5T - PREDNISONE 5 MG TAB

Dose 15 MG (3 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-1131 Stop Date 08/31/17 0901 DC: 08/31/17-0901
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $3.00
Rx Number 01541250

Discontinued Comments Reached Stop Date

History
08/30/17 1131 - ENTER by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/30/17 - 1131
For: 08/31/17 - 0900
08/30/17 1131 - NOW DOSE by AMOLINARI
Now Dose: 08/30/17 1131
08/30/17 1131 - KEEP NEXT DOSE by AMOLINARI
Keep Next Dose: 08/31/17 0900
08/31/17 0901 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 0901
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

PRD5T - PREDNISONE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/02/17 0901 DC: 09/02/17-0901
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $2.00
Rx Number 01541257

Discontinued Comments Reached Stop Date

History
08/30/17 1151 - ENTER by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 09/01/17 - 0900
For: 09/02/17 - 0900
09/02/17 0901 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 0901
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 101
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 07/26/17-1200 Stop Date 08/25/17 1159 DC: 07/31/17-0428
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 10 Total Costs $0.00 Total Charges $0.80
Rx Number 01531685

History
07/26/17 1052 - POM ORDER by NCHANDEL
07/26/17 1214 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 07/26/17 - 1200
For: 07/27/17 - 1200
For: 07/28/17 - 1200
For: 07/29/17 - 1200
For: 07/30/17 - 1200
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/31/17 - 1200
For: 08/01/17 - 1200
07/31/17 0431 - DISCONTINUE by YIVANOV Eff: 07/31/17 0428
Items Auto Credited: 4 Doses Auto Credited: 2
For: 07/31/17 - 1200
For: 08/01/17 - 1200
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
07/31/17 0432 - POM COPY AND EDIT by YIVANOV
TO: Rx #U01419279
07/31/17 0739 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YIVANOV Eff: 07/31/17 0431
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 102
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/31/17-1200 Stop Date 08/30/17 1159 DC: 07/31/17-1346
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532856

Discontinued Comments DC'd by Discharge

History
07/31/17 0432 - POM COPY AND EDIT by YIVANOV
FROM: Rx #01531685
07/31/17 0739 - VERIFIED by AMOLINARI
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 103
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 08/05/17-1200 Stop Date 09/04/17 1159 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $0.20
Rx Number 01534485

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1834 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/05/17 - 1200
For: 08/06/17 - 1200
For: 08/07/17 - 1200
For: 08/08/17 - 1200
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 1200
For: 08/10/17 - 1200
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
Items Auto Credited: 6 Doses Auto Credited: 3
For: 08/08/17 - 1200
For: 08/09/17 - 1200
For: 08/10/17 - 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 104
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/27/17-0900 Stop Date 08/26/17 0859 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 5 Total Costs $0.00 Total Charges $69.00
Rx Number 01531697

Discontinued Comments DC'd by Discharge

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1215 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 07/27/17 - 0900
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 105
Run Time 1513 PHA Profile

EAPEN,EZHAMALIL I W00001219163 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/04/17-2100 Stop Date 09/03/17 2059 DC: 08/07/17-1305
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $51.75
Rx Number 01534489

Discontinued Comments DC'd by Discharge

History
08/04/17 1822 - POM ORDER by SDAS
08/04/17 1836 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/07/17 2154 - DISCONTINUE by DISCHARGE Eff: 08/07/17 1305
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/07/17 - 2100
For: 08/08/17 - 2100
For: 08/09/17 - 2100
For: 08/10/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 106
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EAPEN,EZHAMALIL I W00001219163 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/16/17-1245 Stop Date 08/23/17 1244 DC: 08/21/17-1233
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537217

History
08/16/17 1249 - POM ORDER by RSHARMA
08/16/17 1345 - VERIFIED by EBALILO
08/18/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0827 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 1234 - DISCONTINUE by SMOHAMED Eff: 08/21/17 1233
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/21/17 1234 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01424786
08/21/17 1329 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/21/17 1234
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EAPEN,EZHAMALIL I W00001219163 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/21/17-1245 Stop Date 08/28/17 1244 DC: 08/25/17-0833
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538570

History
08/21/17 1234 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01537217
08/21/17 1329 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/21/17-1245 STOP: 08/28/17 SOFT STOP:
TO:
START: 08/21/17-1245 STOP: 08/28/17-1244 SOFT STOP:
08/21/17 1329 - VERIFIED by AADEGBAMIG
08/23/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - DISCONTINUE by EALEXEEV Eff: 08/25/17 0833
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/25/17 0834 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426036
08/25/17 1242 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by EALEXEEV Eff: 08/25/17 0834
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EAPEN,EZHAMALIL I W00001219163 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/25/17-0845 Stop Date 09/01/17 0844 DC: 08/29/17-0943
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539997

History
08/25/17 0834 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01538570
08/25/17 1241 - EDIT by EBALILO
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-0845 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-0845 STOP: 09/01/17-0844 SOFT STOP: 0
08/25/17 1241 - VERIFIED by EBALILO
08/28/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/29/17 0943 - DISCONTINUE by EALEXEEV Eff: 08/29/17 0943
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/29/17 0943 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427015
08/29/17 0948 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/29/17 0943
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EAPEN,EZHAMALIL I W00001219163 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/29/17-0945 Stop Date 09/05/17 0944 DC: 09/03/17-1423
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540911

History
08/29/17 0943 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01539997
08/29/17 0949 - EDIT by AMACCA
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0945 STOP: 09/05/17 SOFT STOP:
TO:
START: 08/29/17-0945 STOP: 09/05/17-0944 SOFT STOP:
08/29/17 0949 - VERIFIED by AMACCA
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/03/17 1423 - DISCONTINUE by JRUSSO Eff: 09/03/17 1423
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/03/17 1423 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01428357
09/03/17 1431 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by JRUSSO Eff: 09/03/17 1423
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 110
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EAPEN,EZHAMALIL I W00001219163 (Continued)

VITA-243 - VITAMIN B COMP W-C 1 EA TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/27/17-0900 Stop Date 08/26/17 0859 DC: 07/31/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 5 Total Costs $0.00 Total Charges $1.20
Rx Number 01531692

Discontinued Comments DC'd by Discharge

History
07/26/17 1101 - POM ORDER by NCHANDEL
07/26/17 1215 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 07/27/17 - 0900
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0807 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
07/31/17 1347 - DISCONTINUE by DISCHARGE Eff: 07/31/17 1346
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 111
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EAPEN,EZHAMALIL I W00001219163 (Continued)

LVF250T - LEVOFLOXACIN 250 MG TAB - 250 MG

LVF500T - LEVOFLOXACIN 500 MG TAB - 500 MG

Dose 750 MG (2 TABLETS)

Admin Route ORAL
Frequency DAILY @ DINNER (SCH)
Start Date 08/22/17-1700 Stop Date 08/28/17 1701 DC: 08/22/17-1713
Ordering Doctor SHARMA,RAMAN MD PGY-3
Clinical Indication COMPLICATED UTI
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01539000

History
08/22/17 1444 - ENTER by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 08/22/17 - 1700
For: 08/23/17 - 1700
For: 08/24/17 - 1700
08/22/17 1713 - DISCONTINUE by RSHARMA Eff: 08/22/17 1713
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/23/17 - 1700
For: 08/24/17 - 1700
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/22/17 1714 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RSHARMA Eff: 08/22/17 1713

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 500 ML (3.3333333 BAGS)

Dose Instructions 50cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/21/17-1530 Stop Date 08/21/17 1531 CAN: 08/21/17-1548
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424885

History
08/21/17 1537 - POM ORDER by SMOHAMED
08/21/17 1548 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
change to LVP
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 112
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EAPEN,EZHAMALIL I W00001219163 (Continued)

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 500 ML (3.3333333 BAGS)

Dose Instructions 50cc/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/28/17-1545 Stop Date 08/28/17 1546 CAN: 08/28/17-1550
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01426896

History
08/28/17 1542 - POM ORDER by SMOHAMED
08/28/17 1550 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO LVP

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 500 ML (3.3333333 BAGS)

Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/31/17-1400 Stop Date 08/31/17 1401 CAN: 08/31/17-1357
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427657

History
08/31/17 1352 - POM ORDER by SMOHAMED
08/31/17 1357 - CANCEL by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO LVP WITH RATE OF 50ML/HR X 1 BAG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 113
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EAPEN,EZHAMALIL I W00001219163 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NOW (SCH)
Start Date 07/28/17-1345 Stop Date 08/27/17 1344 CAN: 07/28/17-1343
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01418900

Warnings
Type: BURKE
Range: NORVASC
Condition: ALL COMMON INDICATIONS
Warnings AML5T: Unable to check dose ranges for MG/DAY (SIG - No Times).

History
07/28/17 1339 - POM COPY AND EDIT by NCHANDEL
FROM: Rx #01532313
07/28/17 1343 - CANCEL by EBALILO
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 10MG TAB

CHLR25T - CHLORTHALIDONE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 CAN: 08/18/17-1048
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424215

History
08/18/17 1046 - POM ORDER by RSHARMA
08/18/17 1048 - CANCEL by EBALILO
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CANCEL ORDER PER DR. SHARMA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 114
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EAPEN,EZHAMALIL I W00001219163 (Continued)

CHLR25T - CHLORTHALIDONE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency 1043 (ONE)
Start Date 08/18/17-1043 Stop Date 08/18/17 1044 CAN: 08/18/17-1048
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424216

History
08/18/17 1046 - POM ORDER by RSHARMA
08/18/17 1048 - CANCEL by EBALILO
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CANCEL ORDER PER DR. SHARMA

LVF500T - LEVOFLOXACIN 500 MG TAB

Dose 750 MG (1.5 TABLETS)

Admin Route ORAL
Frequency DAILY @ DINNER (SCH)
Start Date 08/22/17-1700 Stop Date 08/28/17 1701 CAN: 08/22/17-1443
Ordering Doctor SHARMA,RAMAN MD PGY-3
Clinical Indication COMPLICATED UTI
Total Dispensed Total Costs $ Total Charges $
Rx Number U01425194

History
08/22/17 1438 - POM ORDER by RSHARMA
08/22/17 1443 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
change to split med
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 115
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EAPEN,EZHAMALIL I W00001219163 (Continued)

LSRT25T - LOSARTAN POTASSIUM 25 MG TAB

Dose 50 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859 CAN: 08/17/17-1124
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01423804

History
08/17/17 1114 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01537519
08/17/17 1124 - CANCEL by AMOLINARI
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 50MG TAB

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 25 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/17/17-2100 Stop Date 09/16/17 2059 CAN: 08/17/17-1125
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01423803

History
08/17/17 1114 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01537506
08/17/17 1125 - CANCEL by AMOLINARI
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO 25MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 116
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EAPEN,EZHAMALIL I W00001219163 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 150 EA (0 EACHS)

Dose Instructions Irbesartan 150 mg daily
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/27/17-0900 Stop Date 08/26/17 0859 CAN: 07/26/17-2035
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01418433

History
07/26/17 1740 - POM ORDER by NCHANDEL
07/26/17 2035 - CANCEL by EBALILO
EDIT DOCTOR: CHANDEL,NEEL MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO NF ENTRY

PRD20T - PREDNISONE 20 MG TAB

Dose 10 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/02/17 0930 CAN: 08/30/17-1150
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427328

History
08/30/17 0929 - POM ORDER by SMOHAMED
08/30/17 1150 - CANCEL by AMOLINARI
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
changed to use 5mg tab
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 117
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EAPEN,EZHAMALIL I W00001219163 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 5 EA (0 EACHS)
Admin Route PO
Frequency DAILY (SCH)
Start Date 08/05/17-0900 Stop Date 09/04/17 0859 CAN: 08/04/17-2101
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01420886

History
08/04/17 2044 - POM ORDER by SDAS
08/04/17 2101 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO NF BARCODE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
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Patient EIDELMAN,SHARON Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219760 Location B1WE Unit Number M000209478
Age/Sex 73/F Room 145 Registered Date 09/01/17
Status ADM IN Bed 01 Discharged Date

Height 4 ft 11.02 in 149.9 cm Body Surface Area 1.51 m2

Weight 124 lb 8 oz 56.472 kg
Hem-Onc No

Drug Allergies Corticosteroids (Glucocorticoids)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: PULMONARY EMBOLISM
Secondary Diagnosis:

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Dose Instructions FOR MILD PAIN OR FEVER
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/01/17-1915 Stop Date 10/01/17 1914
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542129

History
09/01/17 1907 - POM ORDER by DSPUNBERG
09/01/17 1942 - VERIFIED by MHAIMOWITZ

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $1.36
Rx Number 01542130

History
09/01/17 1903 - POM ORDER by DSPUNBERG
09/01/17 1942 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
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EIDELMAN,SHARON W00001219760 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 09/03/17 2101
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $129.40
Rx Number 01542137

History
09/01/17 1903 - POM ORDER by DSPUNBERG
09/01/17 2001 - VERIFIED by MHAIMOWITZ
Items Dispensed: 10 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/04/17-0900 Stop Date 10/04/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01542169

History
09/01/17 2336 - POM ORDER by DSPUNBERG
09/02/17 1053 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
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EIDELMAN,SHARON W00001219760 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1930 Stop Date 10/01/17 1929
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542132

History
09/01/17 1930 - POM ORDER by DSPUNBERG
09/01/17 1943 - VERIFIED by MHAIMOWITZ

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $1.05
Rx Number 01542136

History
09/01/17 1904 - POM ORDER by DSPUNBERG
09/01/17 2000 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 8
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
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EIDELMAN,SHARON W00001219760 (Continued)

LVT.1T2 - LEVOTHYROXINE SODIUM 100 MCG (SYNTHROID) TAB

Dose 100 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 09/02/17-0700 Stop Date 10/02/17 0659
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $6.06
Rx Number 01542133

History
09/01/17 1903 - POM ORDER by DSPUNBERG
09/01/17 1944 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
For: 09/05/17 - 0700
For: 09/06/17 - 0700

PRV20T - PRAVASTATIN SOD 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $3.40
Rx Number 01542134

History
09/01/17 1903 - POM ORDER by DSPUNBERG
09/01/17 1959 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

EIDELMAN,SHARON W00001219760 (Continued)

PREG25CA - PREGABALIN 25 MG (NON-FORM.) CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 09/09/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $34.46
Rx Number 01542135

History
09/01/17 1903 - POM ORDER by DSPUNBERG
09/01/17 1959 - VERIFIED by MHAIMOWITZ

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1930 Stop Date 10/01/17 1929
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01542131

History
09/01/17 1930 - POM ORDER by DSPUNBERG
09/01/17 1942 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 09/01/17 - 1930
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient ELLIOTT JR,HENRY P Responsible Doctor VALLES,JENNIE MD

Account Number W00001219278 Location B1NN Unit Number M000209339
Age/Sex 82/M Room 123 Registered Date 08/28/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.99 in 172.7 cm Body Surface Area 1.92 m2

Weight 172 lb 3.2 oz 78.109 kg
Hem-Onc No

Drug Allergies No Known Drug Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/28/17-1825 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

CHL12B473 - CHLORHEXIDINE GLUCONATE 0.12% ORAL SOLN 473 ML BTL

Dose 15 ML (0.0317125 BOTTLES)

Admin Route MTH/THROAT
Frequency EVERY 6 HOURS (SCH)
Start Date 08/28/17-1800 Stop Date 09/27/17 1759
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $39.57
Rx Number 01540799

History
08/28/17 1607 - POM ORDER by SMOHAMED
08/28/17 1623 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

INSU100V26 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSICIAN
Admin Route SUBCUTAN.
Frequency EVERY 4 HOURS (SCH)
Start Date 08/28/17-1700 Stop Date 09/27/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01540804

History
08/28/17 1608 - POM ORDER by SMOHAMED
08/28/17 1630 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
TO:
DOSE INSTRUCTIONS:
100 TO 150 = 0 UNITS SUBCUT.
151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSICIAN
08/28/17 1630 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

CFTR2V - CEFTRIAXONE SOD 2 GM VIAL - 2 GM

in NS.9100 - SODIUM CHLORIDE 0.9% IV SOLN 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency DAILY@1800 (SCH)
Start Date 09/01/17-1800 Stop Date 09/08/17 1759
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 3
Total Dispensed 3 Total Costs $0.00 Total Charges $74.60
Rx Number 01541830

History
08/31/17 1828 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
RATE: 100 MLS/HR
DURATION: 1 HR
TO:
RATE: 200 MLS/HR
DURATION: 30 MIN
08/31/17 1828 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01541829
08/31/17 1828 - ENTER by AADEGBAMIG
09/01/17 1001 - FILL by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1800
09/02/17 1130 - FILL by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 1800
09/03/17 1215 - FILL by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/03/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Dose Instructions FOR MILD PAIN OR FEVER
Admin Route PEG TUBE
Frequency EVERY 6 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/28/17-1645 Stop Date 09/27/17 1559
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540809

History
08/28/17 1636 - ENTER by AADEGBAMIG
08/28/17 1636 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
START: 08/28/17-1600 STOP: 09/27/17 1559 SOFT STOP: 0
TO:
ROUTE: PEG TUBE
START: 08/28/17-1645 STOP: 09/27/17-1559 SOFT STOP: 0
08/28/17 1636 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01540793
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route G TUBE
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01540787

History
08/28/17 1607 - POM ORDER by SMOHAMED
08/28/17 1617 - VERIFIED by AADEGBAMIG
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $4.50
Rx Number 01540810

History
08/28/17 1636 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/28/17 1636 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
08/28/17 1636 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01540795
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/28/17-2000 Stop Date 09/27/17 1959
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01540794

History
08/28/17 1616 - POM ORDER by SMOHAMED
08/28/17 1617 - VERIFIED by AADEGBAMIG
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2000
For: 09/02/17 - 2000
For: 09/03/17 - 2000
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2000
For: 09/05/17 - 2000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

CLN.1T - CLONIDINE HCL 0.1 MG TAB

Dose 0.2 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency EVERY 8 HOURS (SCH)
Start Date 08/28/17-2200 Stop Date 09/27/17 2159
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 52 Total Costs $0.00 Total Charges $213.30
Rx Number 01540789

History
08/28/17 1607 - POM ORDER by SMOHAMED
08/28/17 1617 - VERIFIED by AADEGBAMIG
Items Dispensed: 22 Doses Dispensed: 11
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

D50I50 - DEXTROSE 50% 50 ML SYR

Dose 25 ML (0.5 SYRINGES)

Admin Route INTRAVEN.
Frequency DAILY (PRN) PRN REASON: hypoglycemia
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01540872

History
08/28/17 1812 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01540869
08/28/17 1826 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

ENXP30I.3 - ENOXAPARIN 30 MG/0.3 ML SYR

Dose 30 MG (0.3 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 17 Total Costs $0.00 Total Charges $767.16
Rx Number 01540797

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.77
MG/KG/DAY is below the Low Daily Dose.

History
08/28/17 1619 - ENTER by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route PEG TUBE
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 17 Total Costs $0.00 Total Charges $4.20
Rx Number 01540790

History
08/28/17 1608 - POM ORDER by SMOHAMED
08/28/17 1617 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency EVERY 6 HOURS (PRN) PRN REASON: SOB - For Shortness of Breath
Start Date 08/28/17-1600 Stop Date 09/27/17 1559
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540791

History
08/28/17 1608 - POM ORDER by SMOHAMED
08/28/17 1617 - VERIFIED by AADEGBAMIG
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION, give if no BM in 48 hours
Admin Route PEG TUBE
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1645 Stop Date 09/27/17 1559
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01540811

History
08/28/17 1636 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01540792
08/28/17 1636 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 1
For: 08/28/17 - 1645
08/28/17 1636 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
START: 08/28/17-1600 STOP: 09/27/17 1559 SOFT STOP: 0
TO:
ROUTE: PEG TUBE
START: 08/28/17-1645 STOP: 09/27/17-1559 SOFT STOP: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

CFTR1V - CEFTRIAXONE SOD 1 GM VIAL - 1 GM

in SODI50IV2 - SODIUM CHLORIDE 0.9% BAG 50 ML - 50 ML

Site
Total Volume 50 MLS Rate 100 MLS/HR Duration 30 MIN
Frequency DAILY (SCH)
Start Date 08/31/17-1800 Stop Date 09/04/17 0929 DC: 08/31/17-1800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541822

Discontinued Comments START DOSE 1600 ON 9/1/17

History
08/31/17 1733 - POM ORDER by SMOHAMED
08/31/17 1733 - NOW DOSE by SMOHAMED
Now Dose: 08/31/17 1800
08/31/17 1733 - KEEP NEXT DOSE by System
Keep Next Dose: 09/01/17 0900
08/31/17 1744 - REVIEW PROVIDER ACTIVITY by AMACCA
Now Dose by SMOHAMED Eff: 08/31/17 1733
Now Dose 08/31/17 - 1800
Keep Next Dose 09/01/17 - 0900
08/31/17 1744 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/31/17 - 1800
For: 09/01/17 - 0900
08/31/17 1749 - DISCONTINUE by AMACCA Eff: 08/31/17 1800
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/31/17 - 1800
For: 09/01/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
START DOSE 1600 ON 9/1/17
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

CFTR1V - CEFTRIAXONE SOD 1 GM VIAL - 1 GM

in SODI50IV2 - SODIUM CHLORIDE 0.9% BAG 50 ML - 50 ML

Site
Total Volume 50 MLS Rate 100 MLS/HR Duration 30 MIN
Frequency 1731 (ONE)
Start Date 08/31/17-1731 Stop Date 08/31/17 1800 DC: 08/31/17-1800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 1
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01541821

Discontinued Comments Reached Stop Date

History
08/31/17 1733 - POM ORDER by SMOHAMED
08/31/17 1735 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1731
08/31/17 1800 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 1800
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

CFTR1V - CEFTRIAXONE SOD 1 GM VIAL - 1 GM

in SODI50IV2 - SODIUM CHLORIDE 0.9% BAG 50 ML - 50 ML

Site
Total Volume 50 MLS Rate 100 MLS/HR Duration 30 MIN
Frequency DAILY@1800 (SCH)
Start Date 09/01/17-1800 Stop Date 09/08/17 1759 DC: 09/01/17-1800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541824

History
08/31/17 1757 - ENTER by AMACCA
08/31/17 1818 - DISCONTINUE by SMOHAMED Eff: 09/01/17 1800
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/31/17 1818 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01427872
08/31/17 1823 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/31/17 1818
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

CFTR1V - CEFTRIAXONE SOD 1 GM VIAL - 2 GM

in SODI50IV2 - SODIUM CHLORIDE 0.9% BAG 50 ML - 50 ML

Site
Total Volume 50 MLS Rate 100 MLS/HR Duration 30 MIN
Frequency DAILY@1800 (SCH)
Start Date 09/01/17-1800 Stop Date 09/08/17 1759 DC: 09/01/17-1800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541827

History
08/31/17 1818 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01541824
08/31/17 1822 - DISCONTINUE by AADEGBAMIG Eff: 09/01/17 1800
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/31/17 1822 - VERIFIED by SYSTEM
Verified in order to DC

CFTR2V - CEFTRIAXONE SOD 2 GM VIAL - 2 GM

in NS.9100 - SODIUM CHLORIDE 0.9% IV SOLN 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency ONETIME (ONE)
Start Date 08/31/17-1830 Stop Date 08/31/17 1859 DC: 08/31/17-1859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $37.30
Rx Number 01541828

Discontinued Comments Reached Stop Date

History
08/31/17 1819 - POM ORDER by SMOHAMED
08/31/17 1823 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1830
08/31/17 1859 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 1859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

CFTR2V - CEFTRIAXONE SOD 2 GM VIAL - 2 GM

in NS.9100 - SODIUM CHLORIDE 0.9% IV SOLN 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 100 MLS/HR Duration 1 HR
Frequency DAILY@1800 (SCH)
Start Date 09/01/17-1800 Stop Date 09/08/17 1759 DC: 09/01/17-1800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541829

History
08/31/17 1825 - ENTER by AADEGBAMIG
08/31/17 1828 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01541830
08/31/17 1828 - DISCONTINUE by AADEGBAMIG Eff: 09/01/17 1800
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

CFTR1V - CEFTRIAXONE SOD 1 GM VIAL - 1 GM

in SODI50IV2 - SODIUM CHLORIDE 0.9% BAG 50 ML - 50 ML

Site
Total Volume 50 MLS Rate 100 MLS/HR Duration 30 MIN
Frequency .Q30M (SCH)
Start Date 09/01/17-1800 Stop Date 09/08/17 1759 DC: 09/01/17-1800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Last Bag 0
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541823

History
08/31/17 1752 - ENTER by AMACCA
08/31/17 1754 - DISCONTINUE by AMACCA Eff: 09/01/17 1800
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
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ELLIOTT JR,HENRY P W00001219278 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Dose Instructions FOR MILD PAIN OR FEVER
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/28/17-1600 Stop Date 09/27/17 1559 DC: 08/28/17-1636
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540793

History
08/28/17 1608 - POM ORDER by SMOHAMED
08/28/17 1617 - VERIFIED by AADEGBAMIG
08/28/17 1636 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01540809
08/28/17 1636 - DISCONTINUE by AADEGBAMIG Eff: 08/28/17 1636
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859 DC: 08/29/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540796

History
08/28/17 1607 - POM ORDER by SMOHAMED
08/28/17 1618 - VERIFIED by SYSTEM
Verified in order to DC
08/28/17 1618 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859 DC: 08/29/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540795

History
08/28/17 1618 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/28/17 1636 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01540810
08/28/17 1636 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1600 Stop Date 09/27/17 1559 DC: 08/28/17-1749
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540788

History
08/28/17 1607 - POM ORDER by SMOHAMED
08/28/17 1617 - VERIFIED by AADEGBAMIG
08/28/17 1751 - DISCONTINUE by SMOHAMED Eff: 08/28/17 1749
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/28/17 1752 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/28/17 1751
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

CEFP100T - CEFPODOXIME PROXETIL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route G TUBE
Frequency EVERY 12 HOURS (SCH)
Start Date 08/30/17-2100 Stop Date 09/13/17 2115 DC: 08/31/17-1733
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Total Dispensed 2 Total Costs $0.00 Total Charges $26.96
Rx Number 01541271

History
08/30/17 0950 - POM ORDER by SMOHAMED
08/30/17 1203 - VERIFIED by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
08/31/17 1736 - DISCONTINUE by SMOHAMED Eff: 08/31/17 1733
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/31/17 1744 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SMOHAMED Eff: 08/31/17 1736
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

CEFP100T - CEFPODOXIME PROXETIL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route G TUBE
Frequency 0939 (ONE)
Start Date 08/30/17-0939 Stop Date 08/30/17 0940 DC: 08/30/17-0940
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Clinical Indication BACTEREMIA
Total Dispensed 1 Total Costs $0.00 Total Charges $13.48
Rx Number 01541236

Discontinued Comments Reached Stop Date

History
08/30/17 0950 - POM ORDER by SMOHAMED
08/30/17 0952 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0939
08/30/17 0952 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 0940
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

D50I50 - DEXTROSE 50% 50 ML SYR

Dose 25 ML (0.5 SYRINGES)

Admin Route INTRAVEN.
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859 DC: 08/29/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540869

History
08/28/17 1756 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/28/17 1812 - DISCONTINUE by SMOHAMED Eff: 08/29/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/28/17 1812 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01426977
08/28/17 1826 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SMOHAMED Eff: 08/28/17 1812
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

ENXP80I.8 - ENOXAPARIN INJ 80 MG/0.8 ML SYR

Dose 30 MG (0.3 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059 DC: 08/28/17-2100
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540798

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Warnings ENXP80I.8: Unable to check dose ranges for MG/KG/DAY (No Weight).

Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Warnings ENXP80I.8: Unable to check dose ranges for MG/KG/DOSE (No Weight).

Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Warnings ENXP80I.8: Unable to check dose ranges for MG/KG/DAY (No Weight).

History
08/28/17 1608 - POM ORDER by SMOHAMED
08/28/17 1619 - VERIFIED by SYSTEM
Verified in order to DC
08/28/17 1619 - DISCONTINUE by AADEGBAMIG Eff: 08/28/17 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

ELLIOTT JR,HENRY P W00001219278 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION, give if no BM in 48 hours
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1600 Stop Date 09/27/17 1559 DC: 08/28/17-1636
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01540792

History
08/28/17 1608 - POM ORDER by SMOHAMED
08/28/17 1617 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 1
For: 08/28/17 - 1600
08/28/17 1636 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01540811
08/28/17 1636 - DISCONTINUE by AADEGBAMIG Eff: 08/28/17 1636
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Dextrose 50% in water - 12.5gm IVB PRn for hypoglycemia
Admin Route IV
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859 DC: 08/29/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540870

History
08/28/17 1608 - POM ORDER by SMOHAMED
08/28/17 1756 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/28/17 1756 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient ENGLISH,JOHN Responsible Doctor ELASHVILI, MERY

Account Number W00001219194 Location B2EA Unit Number M000209090
Age/Sex 83/M Room 213 Registered Date 08/17/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.99 in 172.7 cm Body Surface Area 1.79 m2

Weight 147 lb oz 66.678 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

HPF10V10 - HEPARIN SOD (PORCINE) LK FLSH 10 UNIT/ML VIAL

Dose 10 UNIT (1 ML)

Admin Route IV FLUSH
Frequency DAILY (PRN) PRN REASON: for picc line flash
Start Date 08/24/17-1515 Stop Date 09/23/17 1514
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $5.40
Rx Number 01539637

History
08/24/17 1503 - POM ORDER by MELASHVI
08/24/17 1506 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 1515
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/29/17-2100 Stop Date 09/05/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540984

History
08/29/17 1319 - POM COPY AND EDIT by YCHO
FROM: Rx #01539855
08/29/17 1342 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-2100 STOP: 09/05/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/29/17-2100 STOP: 09/05/17-2059 SOFT STOP: 0
DISPENSE: 0
08/29/17 1342 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/17/17-1800 Stop Date 09/16/17 1759
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01537784

History
08/17/17 1751 - POM ORDER by MELASHVI
08/17/17 1839 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

ACPCT - ACIDOPHILUS/PECTIN TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 57 Total Costs $0.00 Total Charges $4.00
Rx Number 01537797

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1840 - VERIFIED by AMACCA
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

For: 08/28/17 - 1300

For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

ALLP100T - ALLOPURINOL 100 MG TAB

Dose 200 MG (2 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 38 Total Costs $0.00 Total Charges $23.80
Rx Number 01537792

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1840 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 12 Total Costs $0.00 Total Charges $5.67
Rx Number 01539630

History
08/24/17 1432 - POM ORDER by TKOUTZEVA
08/24/17 1433 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/17/17-1800 Stop Date 09/16/17 1759
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537785

History
08/17/17 1751 - POM ORDER by MELASHVI
08/17/17 1839 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 1,000 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 19 Total Costs $0.00 Total Charges $1.36
Rx Number 01537793

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1840 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

DICL250C - DICLOXACILLIN SODIUM 250 MG CAP

Dose 500 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY 6 HOURS (SCH)
Start Date 09/03/17-0000 Stop Date 09/08/17 2059
Ordering Doctor BARRY,STEVEN
Clinical Indication OSTEOMYELITIS
Total Dispensed 28 Total Costs $0.00 Total Charges $9.45
Rx Number 01542293

History
09/02/17 1916 - POM COPY AND EDIT by SBARRY
FROM: Rx #01541875
Result of Frequency/Schedule Edit
Ordering Doctor: BARRY,STEVEN
Last Scheduled Administration Time: 09/02/17 - 0900
Last Actual Administration Time: 09/02/17 - 0949
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: EVERY 6 HOURS (SCH)
Old Order Stop: 09/02/17 - 1915
New Order Start: 09/03/17 - 0000
New Order Stop: 09/08/17 - 2059
09/03/17 1051 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SBARRY Eff: 09/02/17 1916
Ordering Doctor: BARRY,STEVEN
Last Scheduled Administration Time: 09/02/17 - 0900
Last Actual Administration Time: 09/02/17 - 0949
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: EVERY 6 HOURS (SCH)
Old Order Stop: 09/02/17 - 1915
New Order Start: 09/03/17 - 0000
New Order Stop: 09/08/17 - 2059
Administration of Unverified Order by GABRAHAM Eff: 09/03/17 0018
Administration of Unverified Order by GABRAHAM Eff: 09/03/17 0610
09/03/17 1051 - VERIFIED by MHAIMOWITZ
Items Dispensed: 28 Doses Dispensed: 14
For: 09/03/17 - 0000
For: 09/03/17 - 0600
For: 09/03/17 - 1200
For: 09/03/17 - 1800
For: 09/04/17 - 0000
For: 09/04/17 - 0600
For: 09/04/17 - 1200
For: 09/04/17 - 1800
For: 09/05/17 - 0000
For: 09/05/17 - 0600
For: 09/05/17 - 1200
For: 09/05/17 - 1800
For: 09/06/17 - 0000
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

DPAS20025 - DIPYRIDAMOLE/ASPIRIN 200-25 MG (AGGRENOX)

Dose 1 EA (1 CAPSULE CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 38 Total Costs $0.00 Total Charges $677.49
Rx Number 01537802

Warnings
Type: BURKE
Range: DIPYRIDAMOLE/ASPIRIN (1 EA)
Condition: ALL COMMON INDICATIONS
Warnings DPAS20025: Unable to check dose ranges for TAB/DOSE (Dose Units).

Type: BURKE
Range: DIPYRIDAMOLE/ASPIRIN (1 EA)
Condition: ALL COMMON INDICATIONS
Warnings DPAS20025: Unable to check dose ranges for TAB/DAY (Dose Units).

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1841 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

Items Dispensed: 4 Doses Dispensed: 4

For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/21/17-0900 Stop Date 09/17/17 1659
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $10.25
Rx Number 01538483

History
08/21/17 0844 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01537783
Result of Frequency/Schedule Edit
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: 08/20/17 - 1700
Last Actual Administration Time: 08/20/17 - 1639
Old Freq/Sch: EVERY EVENING (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/21/17 - 0843
New Order Start: 08/21/17 - 0900
New Order Stop: 09/17/17 - 1659
08/21/17 0855 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by TKOUTZEVA Eff: 08/21/17 0844
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: 08/20/17 - 1700
Last Actual Administration Time: 08/20/17 - 1639
Old Freq/Sch: EVERY EVENING (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/21/17 - 0843
New Order Start: 08/21/17 - 0900
New Order Stop: 09/17/17 - 1659
08/21/17 0855 - VERIFIED by AMOLINARI
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 19 Total Costs $0.00 Total Charges $5.10
Rx Number 01537794

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1840 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 17 Total Costs $0.00 Total Charges $1.80
Rx Number 01540639

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 200 MG/DAY
is below the Low Daily Dose.

History
08/28/17 1228 - POM ORDER by TKOUTZEVA
08/28/17 1239 - VERIFIED by YLEE
Items Dispensed: 7 Doses Dispensed: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

GUAI600T36 - GUAIFENESIN 600 MG TABSR

Dose 600 MG (1 TAB SUSTAINED RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (PRN) PRN REASON: cough and congestion
Start Date 08/17/17-1800 Stop Date 09/16/17 1759
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01537795

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1840 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 1800
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

LACT10SY31 - LACTULOSE 20 GM/30 ML UDC

Dose 20 GM (30 ML)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/21/17-1700 Stop Date 09/20/17 1659
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 16 Total Costs $0.00 Total Charges $39.00
Rx Number 01538544

History
08/21/17 0843 - POM ORDER by TKOUTZEVA
08/21/17 1249 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 1700
For: 08/22/17 - 1700
For: 08/23/17 - 1700
For: 08/24/17 - 1700
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/17/17-1800 Stop Date 09/16/17 1759
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537787

History
08/17/17 1751 - POM ORDER by MELASHVI
08/17/17 1839 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/17/17-1800 Stop Date 09/16/17 1759
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537786

History
08/17/17 1751 - POM ORDER by MELASHVI
08/17/17 1839 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $4.25
Rx Number 01537798

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1841 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/18/17-0800 Stop Date 09/17/17 0759
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 19 Total Costs $0.00 Total Charges $14.96
Rx Number 01537799

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1841 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0800
For: 08/19/17 - 0800
For: 08/20/17 - 0800
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0800
For: 08/22/17 - 0800
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0800
For: 08/24/17 - 0800
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Admin Route ORAL
Frequency DAILY@1230 (SCH)
Start Date 08/31/17-1230 Stop Date 09/07/17 1229
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01541504

History
08/31/17 0814 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540544
08/31/17 0832 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-1230 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/31/17-1230 STOP: 09/07/17-1229 SOFT STOP: 0
08/31/17 0832 - VERIFIED by AMOLINARI
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1230
For: 09/05/17 - 1230

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/01/17-1200 Stop Date 09/07/17 1159
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541889

History
09/01/17 1200 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540543
09/01/17 1205 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1200 STOP: 09/07/17 SOFT STOP:
TO:
START: 09/01/17-1200 STOP: 09/07/17-1159 SOFT STOP: 0
09/01/17 1205 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency DAILY@0700 (SCH)
Start Date 09/02/17-0700 Stop Date 09/04/17 0659
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541890

History
09/01/17 1200 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01541264
09/01/17 1205 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/02/17-0700 STOP: 09/04/17 SOFT STOP:
TO:
START: 09/02/17-0700 STOP: 09/04/17-0659 SOFT STOP: 0
09/01/17 1205 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/17/17-2100 Stop Date 09/18/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $3.75
Rx Number 01537788

History
08/17/17 1751 - POM ORDER by MELASHVI
08/17/17 1839 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

NFR150C - POLYSACCHARIDE IRON COMPLEX 150 MG CAP

Dose 150 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A WEEK (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $14.25
Rx Number 01537796

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1840 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 26 Total Costs $0.00 Total Charges $1.80
Rx Number 01539508

History
08/24/17 0814 - POM ORDER by TKOUTZEVA
08/24/17 0833 - VERIFIED by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/24/17 - 2100
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

SMV20T - SIMVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/17/17-2100 Stop Date 09/16/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 40 Total Costs $0.00 Total Charges $10.20
Rx Number 01537801

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1841 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 4
For: 08/17/17 - 2100
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

HPF10V10 - HEPARIN SOD (PORCINE) LK FLSH 10 UNIT/ML VIAL

Dose 10 UNIT (1 ML)

Admin Route IV FLUSH
Frequency 1501 (ONE)
Start Date 08/24/17-1501 Stop Date 08/24/17 1502 DC: 08/24/17-1502
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $5.40
Rx Number 01539638

Discontinued Comments Reached Stop Date

History
08/24/17 1503 - POM ORDER by MELASHVI
08/24/17 1506 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 1501
08/24/17 1506 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 1502
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/21/17-1300 Stop Date 08/21/17 1301 DC: 08/21/17-1301
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01538584

Warnings
Type: MAINTENANCE
Range: SODIUM POLYSTYRENE SULFONATE (15 GM/60 ML)
Condition: ALL COMMON INDICATIONS
Warnings SODI15OR2: Unable to check dose ranges for G/DAY (Dose Units).

Discontinued Comments Reached Stop Date

History
08/21/17 1253 - POM ORDER by TKOUTZEVA
08/21/17 1352 - VERIFIED by YLEE
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 1300
08/21/17 1352 - DISCONTINUE by PHABKGJOB Eff: 08/21/17 1301
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 7.5 GM (30 ML)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 08/31/17 2101 DC: 08/31/17-2101
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01541294

Discontinued Comments Reached Stop Date

History
08/30/17 1249 - POM ORDER by MELASHVI
08/30/17 1255 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 2100
08/31/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/21/17-2100 Stop Date 08/28/17 2059 DC: 08/25/17-0820
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01538701

History
08/21/17 1634 - POM ORDER by TKOUTZEVA
08/21/17 1641 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 2100
08/25/17 0820 - DISCONTINUE by TKOUTZEVA Eff: 08/25/17 0820
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/25/17 0820 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426020
08/25/17 0825 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/25/17 0820
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/25/17-2100 Stop Date 09/01/17 2059 DC: 08/29/17-1318
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539855

History
08/25/17 0820 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538701
08/25/17 0825 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-2100 STOP: 09/01/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/25/17-2100 STOP: 09/01/17-2059 SOFT STOP: 0
DISPENSE: 0
08/25/17 0825 - VERIFIED by AMOLINARI
08/29/17 1319 - DISCONTINUE by YCHO Eff: 08/29/17 1318
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/29/17 1319 - POM COPY AND EDIT by YCHO
TO: Rx #U01427083
08/29/17 1343 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/29/17 1319
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

NAFC2VIA10 - NAFCILLIN SODIUM 2 GM VIAL - 2 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency EVERY 4 HOURS (SCH)
Start Date 08/17/17-2100 Stop Date 08/24/17 2059 DC: 08/21/17-1022
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Clinical Indication OTHER
Last Bag 22
Total Dispensed 22 Total Costs $0.00 Total Charges $2330.68
Rx Number 01537803

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1847 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 6
For: 08/17/17 - 2100
For: 08/18/17 - 0100
For: 08/18/17 - 0500
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
08/18/17 0932 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 2100
For: 08/19/17 - 0100
For: 08/19/17 - 0500
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
08/19/17 1000 - FILL by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 08/19/17 - 2100
For: 08/20/17 - 0100
For: 08/20/17 - 0500
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/20/17 1012 - FILL by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 08/20/17 - 2100
For: 08/21/17 - 0100
For: 08/21/17 - 0500
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
08/21/17 1005 - FILL by EBALILO
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 2100
For: 08/22/17 - 0100
For: 08/22/17 - 0500
For: 08/22/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

For: 08/22/17 - 1300

For: 08/22/17 - 1700
08/21/17 1022 - DISCONTINUE by TKOUTZEVA Eff: 08/21/17 1022
Items Auto Credited: 8 Doses Auto Credited: 8
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/21/17 - 2100
For: 08/22/17 - 0100
For: 08/22/17 - 0500
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/21/17 1022 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01424716
08/21/17 1250 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/21/17 1022
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

NAFC2VIA10 - NAFCILLIN SODIUM 2 GM VIAL - 2 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency EVERY 4 HOURS (SCH)
Start Date 08/21/17-1300 Stop Date 08/28/17 1259 DC: 08/22/17-1316
Ordering Doctor Koutzeva,Totka MD PGY-4
Clinical Indication OTHER
Last Bag 7
Total Dispensed 7 Total Costs $0.00 Total Charges $741.58
Rx Number 01538545

History
08/21/17 1022 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01537803
08/21/17 1250 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/21/17-1300 STOP: 08/28/17 SOFT STOP:
TO:
START: 08/21/17-1300 STOP: 08/28/17-1259 SOFT STOP: 0
08/21/17 1250 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 8
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/21/17 - 2100
For: 08/22/17 - 0100
For: 08/22/17 - 0500
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/22/17 1006 - FILL by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 6
For: 08/22/17 - 2100
For: 08/23/17 - 0100
For: 08/23/17 - 0500
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
08/22/17 1318 - DISCONTINUE by MELASHVI Eff: 08/22/17 1316
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/22/17 - 1700
For: 08/22/17 - 2100
For: 08/23/17 - 0100
For: 08/23/17 - 0500
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
EDIT DOCTOR: ELASHVILI, MERY
08/22/17 1318 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01425184
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

08/22/17 1322 - REVIEW PROVIDER ACTIVITY by AMACCA

Discontinue by MELASHVI Eff: 08/22/17 1318

NAFC2VIA10 - NAFCILLIN SODIUM 2 GM VIAL - 2 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency EVERY 4 HOURS (SCH)
Start Date 08/22/17-1700 Stop Date 08/28/17 2300 DC: 08/23/17-1323
Ordering Doctor ELASHVILI, MERY
Clinical Indication OTHER
Last Bag 6
Total Dispensed 6 Total Costs $0.00 Total Charges $635.64
Rx Number 01538987

History
08/22/17 1318 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01538545
08/22/17 1322 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/22/17 - 1700
For: 08/22/17 - 2100
For: 08/23/17 - 0100
For: 08/23/17 - 0500
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
08/23/17 1007 - FILL by EBALILO
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 2100
For: 08/24/17 - 0100
For: 08/24/17 - 0500
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 1324 - DISCONTINUE by TKOUTZEVA Eff: 08/23/17 1323
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/23/17 - 1700
For: 08/23/17 - 2100
For: 08/24/17 - 0100
For: 08/24/17 - 0500
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/23/17 1324 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01425442
08/23/17 1429 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by TKOUTZEVA Eff: 08/23/17 1324
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

NAFC2VIA10 - NAFCILLIN SODIUM 2 GM VIAL - 2 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency EVERY 4 HOURS (SCH)
Start Date 08/23/17-1700 Stop Date 08/25/17 0005 DC: 08/24/17-1132
Ordering Doctor Koutzeva,Totka MD PGY-4
Clinical Indication OTHER
Last Bag 5
Total Dispensed 5 Total Costs $0.00 Total Charges $529.70
Rx Number 01539291

History
08/23/17 1324 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538987
08/23/17 1429 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/23/17 - 1700
For: 08/23/17 - 2100
For: 08/24/17 - 0100
For: 08/24/17 - 0500
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/24/17 1005 - FILL by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 2100
08/24/17 1134 - DISCONTINUE by TKOUTZEVA Eff: 08/24/17 1132
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/24/17 - 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/24/17 1134 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01425712
08/24/17 1139 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by TKOUTZEVA Eff: 08/24/17 1134
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

NAFC2VIA10 - NAFCILLIN SODIUM 2 GM VIAL - 2 GM

in D5100 - DEXTROSE 5% INJ 100 ML BAG - 100 ML

Site
Total Volume 100 MLS Rate 200 MLS/HR Duration 30 MIN
Frequency EVERY 4 HOURS (SCH)
Start Date 08/24/17-1300 Stop Date 08/29/17 0005 DC: 08/29/17-0005
Ordering Doctor Koutzeva,Totka MD PGY-4
Clinical Indication OTHER
Last Bag 27
Total Dispensed 27 Total Costs $0.00 Total Charges $2860.38
Rx Number 01539540

Discontinued Comments Reached Stop Date

History
08/24/17 1134 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01539291
08/24/17 1139 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 8
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/24/17 - 2100
For: 08/25/17 - 0100
For: 08/25/17 - 0500
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
08/25/17 1011 - FILL by EBALILO
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 2100
For: 08/26/17 - 0100
For: 08/26/17 - 0500
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
08/26/17 1016 - FILL by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 08/26/17 - 2100
For: 08/27/17 - 0100
For: 08/27/17 - 0500
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/27/17 1019 - FILL by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 08/27/17 - 2100
For: 08/28/17 - 0100
For: 08/28/17 - 0500
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
08/28/17 1004 - FILL by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

For: 08/28/17 - 2100

08/29/17 0005 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 0005
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

DICL250C - DICLOXACILLIN SODIUM 250 MG CAP

Dose 500 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 09/02/17 1915 DC: 09/02/17-1915
Ordering Doctor ELASHVILI, MERY
Clinical Indication OSTEOMYELITIS
Total Dispensed 18 Total Costs $0.00 Total Charges $6.30
Rx Number 01541875

History
09/01/17 1058 - POM ORDER by MELASHVI
09/01/17 1115 - VERIFIED by AMOLINARI
Items Dispensed: 18 Doses Dispensed: 9
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
09/02/17 1916 - DISCONTINUE by SBARRY Eff: 09/02/17 1915
EDIT DOCTOR: BARRY,STEVEN
09/02/17 1916 - EDIT by SBARRY
EDIT DOCTOR: BARRY,STEVEN
FROM:
START: 09/01/17-2100 STOP: 09/08/17 2059 SOFT STOP: 0
DISPENSE: 18
TO:
START: 09/01/17-2100 STOP: 09/02/17-1915 SOFT STOP:
DISPENSE: 4
09/02/17 1916 - POM COPY AND EDIT by SBARRY
TO: Rx #U01428315
09/03/17 1051 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SBARRY Eff: 09/02/17 1916
Discontinue by SBARRY Eff: 09/02/17 1916
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/18/17-1700 Stop Date 08/21/17 0843 DC: 08/21/17-0843
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01537783

History
08/17/17 1751 - POM ORDER by MELASHVI
08/17/17 1839 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 1700
For: 08/22/17 - 1700
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1700
For: 08/24/17 - 1700
08/21/17 0844 - EDIT by TKOUTZEVA
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
START: 08/18/17-1700 STOP: 09/17/17 1659 SOFT STOP: 0
TO:
START: 08/18/17-1700 STOP: 08/21/17-0843 SOFT STOP:
08/21/17 0844 - DISCONTINUE by TKOUTZEVA Eff: 08/21/17 0843
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/21/17 0844 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01424697
08/21/17 0855 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by TKOUTZEVA Eff: 08/21/17 0844
Discontinue by TKOUTZEVA Eff: 08/21/17 0844
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/17/17-1815 Stop Date 08/17/17 1900 DC: 08/17/17-1900
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537789

History
08/17/17 1803 - POM ORDER by MELASHVI
08/17/17 1839 - VERIFIED by AMACCA
08/17/17 1906 - EDIT by RMINASSIAN
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
FROM:
START: 08/17/17-1815 STOP: 08/24/17 1814 SOFT STOP: 0
TO:
START: 08/17/17-1815 STOP: 08/17/17-1900 SOFT STOP:
08/17/17 1906 - DISCONTINUE by RMINASSIAN Eff: 08/17/17 1900
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/17/17 1906 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01424050
08/17/17 1918 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by RMINASSIAN Eff: 08/17/17 1906
Discontinue by RMINASSIAN Eff: 08/17/17 1906
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/17/17-1800 Stop Date 08/24/17 1759 DC: 08/17/17-1851
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537790

Discontinued Comments DUPLICATRE RX

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1840 - VERIFIED by AMACCA
08/17/17 1851 - DISCONTINUE by AMACCA Eff: 08/17/17 1851
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DUPLICATRE RX

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/17/17-1800 Stop Date 08/24/17 1759 DC: 08/21/17-1022
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01537791

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1840 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 1022 - DISCONTINUE by TKOUTZEVA Eff: 08/21/17 1022
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/21/17 1022 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01424717
08/21/17 1248 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/21/17 1022
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/17/17-2100 Stop Date 08/24/17 1814 DC: 08/21/17-1022
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01537806

History
08/17/17 1906 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01537789
Result of Frequency/Schedule Edit
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 6 HOURS (PRN)
New Freq/Sch: EVERY 4 HOURS (PRN)
Old Order Stop: 08/17/17 - 1900
New Order Start: 08/17/17 - 2100
New Order Stop: 08/24/17 - 1814
08/17/17 1918 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by RMINASSIAN Eff: 08/17/17 1906
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 6 HOURS (PRN)
New Freq/Sch: EVERY 4 HOURS (PRN)
Old Order Stop: 08/17/17 - 1900
New Order Start: 08/17/17 - 2100
New Order Stop: 08/24/17 - 1814
08/17/17 1918 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 1022 - DISCONTINUE by TKOUTZEVA Eff: 08/21/17 1022
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/21/17 - 2100
For: 08/22/17 - 0100
For: 08/22/17 - 0500
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/21/17 1022 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01424718
08/21/17 1248 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/21/17 1022
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/21/17-1030 Stop Date 08/22/17 0900 DC: 08/22/17-0900
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538542

Discontinued Comments Reached Stop Date

History
08/21/17 1022 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01537791
08/21/17 1247 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/21/17-1030 STOP: 08/28/17 SOFT STOP:
TO:
START: 08/21/17-1030 STOP: 08/28/17-1029 SOFT STOP: 0
08/21/17 1247 - VERIFIED by MHAIMOWITZ
08/21/17 1421 - EDIT by TKOUTZEVA
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
START: 08/21/17-1030 STOP: 08/28/17 1029 SOFT STOP: 0
TO:
START: 08/21/17-1030 STOP: 08/22/17-0900 SOFT STOP:
08/21/17 1421 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01424825
08/22/17 0900 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/22/17 1322 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by TKOUTZEVA Eff: 08/21/17 1421
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/21/17-1030 Stop Date 08/27/17 1029 DC: 08/25/17-0820
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01538543

History
08/21/17 1022 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01537806
08/21/17 1248 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/21/17-1030 STOP: 08/27/17 SOFT STOP:
TO:
START: 08/21/17-1030 STOP: 08/27/17-1029 SOFT STOP: 0
08/21/17 1248 - VERIFIED by MHAIMOWITZ
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0820 - DISCONTINUE by TKOUTZEVA Eff: 08/25/17 0820
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/25/17 0820 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426018
08/25/17 0825 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/25/17 0820
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency DAILY@0700 (SCH)
Start Date 08/22/17-0700 Stop Date 08/28/17 1029 DC: 08/25/17-0820
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01538621

History
08/21/17 1421 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538542
Result of Frequency/Schedule Edit
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/21/17 - 1301
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: DAILY@0700 (SCH)
Old Order Stop: 08/22/17 - 0900
New Order Start: 08/22/17 - 0700
New Order Stop: 08/28/17 - 1029
08/21/17 1443 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by TKOUTZEVA Eff: 08/21/17 1421
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/21/17 - 1301
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: DAILY@0700 (SCH)
Old Order Stop: 08/22/17 - 0900
New Order Start: 08/22/17 - 0700
New Order Stop: 08/28/17 - 1029
08/21/17 1443 - VERIFIED by MHAIMOWITZ
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/26/17 - 0700
For: 08/27/17 - 0700
For: 08/28/17 - 0700
08/25/17 0820 - DISCONTINUE by TKOUTZEVA Eff: 08/25/17 0820
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/25/17 0820 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426019
08/25/17 0825 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/25/17 0820
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Admin Route ORAL
Frequency DAILY@1230 (SCH)
Start Date 08/22/17-1230 Stop Date 08/29/17 1229 DC: 08/28/17-0907
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01538620

History
08/21/17 1423 - POM ORDER by TKOUTZEVA
08/21/17 1443 - VERIFIED by MHAIMOWITZ
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1230
For: 08/26/17 - 1230
For: 08/27/17 - 1230
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1230
08/28/17 0907 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0907
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0907 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426673
08/28/17 1014 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0907
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/25/17-0830 Stop Date 08/31/17 0829 DC: 08/28/17-0907
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01539853

History
08/25/17 0820 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538543
08/25/17 0824 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-0830 STOP: 08/31/17 SOFT STOP:
TO:
START: 08/25/17-0830 STOP: 08/31/17-0829 SOFT STOP: 0
08/25/17 0825 - VERIFIED by AMOLINARI
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0907 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0907
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0907 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426674
08/28/17 1014 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0907
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency DAILY@0700 (SCH)
Start Date 08/26/17-0700 Stop Date 08/31/17 0659 DC: 08/28/17-0907
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01539854

History
08/25/17 0820 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538621
08/25/17 0825 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/26/17-0700 STOP: 08/31/17 SOFT STOP:
TO:
START: 08/26/17-0700 STOP: 08/31/17-0659 SOFT STOP: 0
08/25/17 0825 - VERIFIED by AMOLINARI
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/29/17 - 0700
For: 08/30/17 - 0700
08/28/17 0907 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0907
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0907 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426675
08/28/17 1014 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0907
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Admin Route ORAL
Frequency DAILY@1230 (SCH)
Start Date 08/28/17-1230 Stop Date 09/04/17 1229 DC: 08/31/17-0814
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540544

History
08/28/17 0907 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538620
08/28/17 1014 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1230 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-1230 STOP: 09/04/17-1229 SOFT STOP: 0
08/28/17 1014 - VERIFIED by MHAIMOWITZ
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1230
For: 09/02/17 - 1230
For: 09/03/17 - 1230
08/31/17 0814 - DISCONTINUE by TKOUTZEVA Eff: 08/31/17 0814
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/31/17 0814 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427579
08/31/17 0832 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/31/17 0814
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 1 TAB (1 TABLET)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/28/17-0915 Stop Date 09/03/17 0914 DC: 09/01/17-1159
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540543

History
08/28/17 0907 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01539853
08/28/17 1014 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0915 STOP: 09/03/17 SOFT STOP:
TO:
START: 08/28/17-0915 STOP: 09/03/17-0914 SOFT STOP: 0
08/28/17 1014 - VERIFIED by MHAIMOWITZ
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 1200 - DISCONTINUE by EALEXEEV Eff: 09/01/17 1159
EDIT DOCTOR: Alexeev,Edward MD PGY-4
09/01/17 1200 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427940
09/01/17 1205 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 09/01/17 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency DAILY@0700 (SCH)
Start Date 08/29/17-0700 Stop Date 09/02/17 0659 DC: 08/30/17-0851
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540542

History
08/28/17 0907 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01539854
08/28/17 1013 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0700 STOP: 09/02/17 SOFT STOP:
TO:
START: 08/29/17-0700 STOP: 09/02/17-0659 SOFT STOP: 0
08/28/17 1013 - VERIFIED by MHAIMOWITZ
08/30/17 0852 - DISCONTINUE by TKOUTZEVA Eff: 08/30/17 0851
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/30/17 0852 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427320
08/30/17 1155 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/30/17 0852
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

OXAC5325 - OXYCODONE/ACETAMINOPHEN 5/325 MG TAB

Dose 2 TAB (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency DAILY@0700 (SCH)
Start Date 08/31/17-0700 Stop Date 09/03/17 0659 DC: 09/01/17-1159
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541264

History
08/30/17 0852 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540542
08/30/17 1155 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-0700 STOP: 09/03/17 SOFT STOP:
TO:
START: 08/31/17-0700 STOP: 09/03/17-0659 SOFT STOP: 0
08/30/17 1155 - VERIFIED by AMOLINARI
09/01/17 1200 - DISCONTINUE by EALEXEEV Eff: 09/01/17 1159
EDIT DOCTOR: Alexeev,Edward MD PGY-4
09/01/17 1200 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427941
09/01/17 1205 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 09/01/17 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

ENGLISH,JOHN W00001219194 (Continued)

RAMI10CA75 - RAMIPRIL 10 MG CAPSULE

Dose 10 MG (1 CAPSULE)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859 DC: 08/24/17-1426
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $8.61
Rx Number 01537800

History
08/17/17 1811 - POM ORDER by RMINASSIAN
08/17/17 1841 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/24/17 1430 - DISCONTINUE by TKOUTZEVA Eff: 08/24/17 1426
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/24/17 1433 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/24/17 1430
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient EPPS,KATRINA Y Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001219082 Location B2EA Unit Number M000208997
Age/Sex 46/F Room 220 Registered Date 08/10/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 2.01 in 157.5 cm Body Surface Area 1.72 m2

Weight 155 lb 6.4 oz 70.488 kg
Hem-Onc No

Drug Allergies No Known Allergies (NKA)

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/15/17-0747 RENAL DOSING COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

INSH7030V - INS HUMAN ISOPH/INS REG 70/30 100 UNIT/ML VIAL

Dose 15 UNIT (0.15 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/10/17-2100 Stop Date 09/09/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $1338.30
Rx Number 01535898

History
08/10/17 2049 - ENTER by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/10/17 - 2100
08/20/17 0956 - DEBIT by AADEGBAMIG
ITEMS: 1
08/29/17 2235 - HOLD/RESUME by SBARRY
EDIT DOCTOR: BARRY,STEVEN
FROM: 08/29/17-2234
TO: 08/30/17-2100
08/30/17 1523 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by SBARRY Eff: 08/29/17 2235
08/31/17 0746 - DEBIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

INSH7030V - INS HUMAN ISOPH/INS REG 70/30 100 UNIT/ML VIAL

Dose 22 UNIT (0.22 ML)

Admin Route SUBCUTAN.
Frequency BEFORE BREAKFAST (SCH)
Start Date 08/16/17-0800 Stop Date 09/15/17 0759
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01536881

History
08/15/17 0959 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535909
08/15/17 1003 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 0800
08/15/17 1005 - CREDIT by EBALILO
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 26 Total Costs $0.00 Total Charges $15.12
Rx Number 01535886

History
08/10/17 1905 - POM ORDER by SDAS
08/10/17 2013 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 26 Total Costs $0.00 Total Charges $0.72
Rx Number 01535888

History
08/10/17 1905 - POM ORDER by SDAS
08/10/17 2019 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

For: 09/01/17 - 0900

For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/10/17-2100 Stop Date 09/09/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 27 Total Costs $0.00 Total Charges $18.00
Rx Number 01535897

History
08/10/17 2046 - ENTER by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/10/17 - 2100
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

For: 09/01/17 - 2100

For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 26 Total Costs $0.00 Total Charges $387.12
Rx Number 01535889

History
08/10/17 1905 - POM ORDER by SDAS
08/10/17 2019 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

For: 09/01/17 - 0900

For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $10.25
Rx Number 01535890

History
08/10/17 1905 - POM ORDER by SDAS
08/10/17 2020 - VERIFIED by MHAIMOWITZ
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 0900
For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

For: 08/24/17 - 0900

For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

LACT10SY31 - LACTULOSE 20 GM/30 ML UDC

Dose 20 GM (30 ML)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: constipation
Start Date 08/10/17-1915 Stop Date 09/09/17 1914
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535891

History
08/10/17 1905 - POM ORDER by SDAS
08/10/17 2021 - VERIFIED by MHAIMOWITZ
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 26 Total Costs $0.00 Total Charges $7.20
Rx Number 01535896

History
08/10/17 2039 - ENTER by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

For: 09/01/17 - 0900

For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

MGX400T - MAGNESIUM OXIDE 400 MG TAB

Dose 400 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 52 Total Costs $0.00 Total Charges $6.11
Rx Number 01535894

History
08/10/17 1905 - POM ORDER by SDAS
08/10/17 2035 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0825 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency 2X DAILY BRKFST/DIN (SCH)
Start Date 08/11/17-0800 Stop Date 09/10/17 0759
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 52 Total Costs $0.00 Total Charges $80.50
Rx Number 01535895

History
08/10/17 1824 - POM ORDER by JRUSSO
08/10/17 2035 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0800
For: 08/11/17 - 1700
For: 08/12/17 - 0800
For: 08/12/17 - 1700
For: 08/13/17 - 0800
For: 08/13/17 - 1700
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0800
For: 08/14/17 - 1700
For: 08/15/17 - 0800
For: 08/15/17 - 1700
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0800
For: 08/16/17 - 1700
For: 08/17/17 - 0800
For: 08/17/17 - 1700
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0800
For: 08/18/17 - 1700
For: 08/19/17 - 0800
For: 08/19/17 - 1700
For: 08/20/17 - 0800
For: 08/20/17 - 1700
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0800
For: 08/21/17 - 1700
For: 08/22/17 - 0800
For: 08/22/17 - 1700
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0800
For: 08/23/17 - 1700
For: 08/24/17 - 0800
For: 08/24/17 - 1700
08/23/17 0825 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 08/25/17 - 0800
For: 08/25/17 - 1700
For: 08/26/17 - 0800
For: 08/26/17 - 1700
For: 08/27/17 - 0800
For: 08/27/17 - 1700
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0800
For: 08/28/17 - 1700
For: 08/29/17 - 0800
For: 08/29/17 - 1700
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0800
For: 08/30/17 - 1700
For: 08/31/17 - 0800
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0800
For: 09/01/17 - 1700
For: 09/02/17 - 0800
For: 09/02/17 - 1700
For: 09/03/17 - 0800
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0800
For: 09/04/17 - 1700
For: 09/05/17 - 0800
For: 09/05/17 - 1700

INSH7030V - INS HUMAN ISOPH/INS REG 70/30 100 UNIT/ML VIAL

Dose 20 UNIT (0.2 ML)

Admin Route SUBCUTAN.
Frequency BEFORE BREAKFAST (SCH)
Start Date 08/11/17-0800 Stop Date 09/10/17 0759 DC: 08/15/17-0957
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535909

History
08/10/17 2140 - ENTER by MHAIMOWITZ
08/15/17 0959 - DISCONTINUE by CDOHLE Eff: 08/15/17 0957
EDIT DOCTOR: DOHLE,CAROLIN MD
08/15/17 0959 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01423172
08/15/17 1003 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by CDOHLE Eff: 08/15/17 0959
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/10/17-2200 Stop Date 09/09/17 2159 DC: 08/15/17-0957
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01535887

History
08/10/17 1824 - POM ORDER by JRUSSO
08/10/17 2019 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/10/17 - 2200
08/15/17 0959 - DISCONTINUE by CDOHLE Eff: 08/15/17 0957
EDIT DOCTOR: DOHLE,CAROLIN MD
08/15/17 1109 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by CDOHLE Eff: 08/15/17 0959

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/23/17-1700 Stop Date 08/23/17 1701 DC: 08/23/17-1701
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539355

Discontinued Comments Reached Stop Date

History
08/23/17 1601 - POM ORDER by CDOHLE
08/23/17 1603 - VERIFIED by AADEGBAMIG
08/23/17 1701 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 1701
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency 2100 (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059 DC: 08/31/17-1417
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538922

History
08/22/17 1104 - POM ORDER by RMINASSIAN
08/22/17 1108 - VERIFIED by EBALILO
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/31/17 1419 - DISCONTINUE by RMINASSIAN Eff: 08/31/17 1417
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
09/01/17 1227 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/31/17 1419
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 10 MG (2 TABLET, ENTERIC COATEDS)

Admin Route ORAL
Frequency 1700 (SCH)
Start Date 08/22/17-1700 Stop Date 09/21/17 1659 DC: 08/31/17-1417
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538921

History
08/22/17 1104 - POM ORDER by RMINASSIAN
08/22/17 1107 - VERIFIED by EBALILO
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
08/31/17 1419 - DISCONTINUE by RMINASSIAN Eff: 08/31/17 1417
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
09/01/17 1227 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/31/17 1419
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/11/17-1400 Stop Date 09/10/17 1359 DC: 08/11/17-1723
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01536012

History
08/11/17 1003 - POM ORDER by RMINASSIAN
08/11/17 1205 - VERIFIED by MHAIMOWITZ
Items Dispensed: 15 Doses Dispensed: 15
For: 08/11/17 - 1400
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/11/17 1723 - DISCONTINUE by RMINASSIAN Eff: 08/11/17 1723
Items Auto Credited: 14 Doses Auto Credited: 14
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/15/17 0746 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/11/17 1723
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 08/11/17 0900 DC: 08/11/17-0900
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535862

History
08/10/17 1824 - POM ORDER by JRUSSO
08/10/17 1905 - EDIT by SDAS
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
START: 08/11/17-0900 STOP: 09/10/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/11/17-0900 STOP: 08/11/17-0900 SOFT STOP:
DISPENSE: 0
08/10/17 1905 - VERIFIED by SYSTEM
Verified in order to DC
08/10/17 1905 - DISCONTINUE by SDAS Eff: 08/11/17 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/10/17 2020 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SDAS Eff: 08/10/17 1905
Edit by SYSTEM Eff: 08/10/17 1905
Discontinue by SDAS Eff: 08/10/17 1905
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859 DC: 08/11/17-0900
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535863

History
08/10/17 1824 - POM ORDER by JRUSSO
08/10/17 1905 - VERIFIED by SYSTEM
Verified in order to DC
08/10/17 1905 - DISCONTINUE by SDAS Eff: 08/11/17 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/10/17 1905 - POM COPY AND EDIT by SDAS
TO: Rx #U01422217
08/10/17 2039 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SYSTEM Eff: 08/10/17 1905
Discontinue by SDAS Eff: 08/10/17 1905
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 08/11/17 0900 DC: 08/11/17-0900
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535864

History
08/10/17 1824 - POM ORDER by JRUSSO
08/10/17 1905 - EDIT by SDAS
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
START: 08/11/17-0900 STOP: 09/10/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/11/17-0900 STOP: 08/11/17-0900 SOFT STOP:
DISPENSE: 0
08/10/17 1905 - VERIFIED by SYSTEM
Verified in order to DC
08/10/17 1905 - DISCONTINUE by SDAS Eff: 08/11/17 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/10/17 2039 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SDAS Eff: 08/10/17 1905
Edit by SYSTEM Eff: 08/10/17 1905
Discontinue by SDAS Eff: 08/10/17 1905
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/15/17-0900 Stop Date 08/17/17 1701 DC: 08/17/17-1701
Ordering Doctor DOHLE,CAROLIN MD
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 6 Total Costs $0.00 Total Charges $48.18
Rx Number 01536824

Discontinued Comments Reached Stop Date

History
08/15/17 0733 - POM ORDER by CDOHLE
08/15/17 0746 - VERIFIED by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/15/17 - 0900
For: 08/15/17 - 1700
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/17/17 1702 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 1701
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency 2100 (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 DC: 08/31/17-1417
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $1.20
Rx Number 01538595

History
08/21/17 1046 - POM ORDER by RMINASSIAN
08/21/17 1354 - VERIFIED by YLEE
Items Dispensed: 8 Doses Dispensed: 4
For: 08/21/17 - 2100
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/31/17 1419 - DISCONTINUE by RMINASSIAN Eff: 08/31/17 1417
Items Auto Credited: 8 Doses Auto Credited: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
09/01/17 1227 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/31/17 1419
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

HUM100VI10 - HUM INSULIN NPH/REG INSULIN HM (NOVOLIN 70/30) 100 UNIT/1 ML VIAL

Dose 20 UNIT (0.2 ML)

Admin Route SUBCUTAN.
Frequency BEFORE BREAKFAST (SCH)
Start Date 08/11/17-0800 Stop Date 09/10/17 0759 CAN: 08/10/17-2139
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01422211

History
08/10/17 1824 - POM ORDER by JRUSSO
08/10/17 2139 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
change to humulin 70/30

HUM100VI10 - HUM INSULIN NPH/REG INSULIN HM (NOVOLIN 70/30) 100 UNIT/1 ML VIAL

Dose 15 UNIT (0.15 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/10/17-2100 Stop Date 09/09/17 2059 CAN: 08/10/17-2048
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01422212

History
08/10/17 1824 - POM ORDER by JRUSSO
08/10/17 2048 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO HUMULIN 70/30
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

EPPS,KATRINA Y W00001219082 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/10/17-2100 Stop Date 09/09/17 2059 CAN: 08/10/17-2040
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01422221

History
08/10/17 1905 - POM ORDER by SDAS
08/10/17 2040 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE STRENGTH 80MG

LSNP5T - LISINOPRIL 5 MG TAB

Dose 20 MG (4 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859 CAN: 08/10/17-2036
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01422217

History
08/10/17 1905 - POM COPY AND EDIT by SDAS
FROM: Rx #01535863
08/10/17 2036 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
NEW STRENGTH
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient EVANS,LUCINDA Responsible Doctor NOVITCH, RICHARD MD.

Account Number W00001219590 Location B1WE Unit Number M000209377
Age/Sex 72/F Room 144 Registered Date 08/29/17
Status ADM IN Bed 02 Discharged Date

Height 4 ft 11.02 in 149.9 cm Body Surface Area 1.85 m2

Weight 202 lb 11.2 oz 91.943 kg
Hem-Onc No

Drug Allergies cefuroxime (From Ceftin)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

BENZ1LOZ9 - CETYLPYRIDINIUM/BENZOCAINE 1 EA LOZG

Dose 1 EA (1 LOZENGE)
Dose Instructions PRN COUGH
Admin Route MTH/THROAT
Frequency 4 TIMES A DAY (PRN) PRN REASON: COUGH - FOR COUGH
Start Date 08/29/17-1600 Stop Date 09/28/17 1559
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 18 Total Costs $0.00 Total Charges $7.02
Rx Number 01541106

History
08/29/17 1606 - POM ORDER by RNOVITCH
08/29/17 1607 - VERIFIED by AADEGBAMIG
Items Dispensed: 18 Doses Dispensed: 1
For: 08/29/17 - 1600

TIOT18CA6 - TIOTROPIUM BROMIDE 18 MCG BOX

Dose 18 MCG (1 BOX)

Admin Route INHALATION
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $243.09
Rx Number 01541104

History
08/29/17 1606 - POM ORDER by RNOVITCH
08/29/17 1607 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

EVANS,LUCINDA W00001219590 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: FEVER - Fever
Start Date 08/31/17-0700 Stop Date 09/30/17 0659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541494

History
08/31/17 0655 - POM ORDER by SDAS
08/31/17 0732 - VERIFIED by AMOLINARI
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

EVANS,LUCINDA W00001219590 (Continued)

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Dose Instructions PRN WHEEZING
Admin Route NEBULIZER
Frequency EVERY 4 HRS W/AWAKE (PRN) PRN REASON: WHEEZE - for Wheezing
Start Date 09/01/17-1300 Stop Date 09/28/17 1559
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01541872

History
09/01/17 0903 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01541102
Result of Frequency/Schedule Edit
Ordering Doctor: NOVITCH, RICHARD MD.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 09/01/17 - 0830
Old Freq/Sch: 4 TIMES A DAY (PRN)
New Freq/Sch: EVERY 4 HRS W/AWAKE (PRN)
Old Order Stop: 09/01/17 - 0901
New Order Start: 09/01/17 - 1300
New Order Stop: 09/28/17 - 1559
09/01/17 1020 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by RNOVITCH Eff: 09/01/17 0903
Ordering Doctor: NOVITCH, RICHARD MD.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 09/01/17 - 0830
Old Freq/Sch: 4 TIMES A DAY (PRN)
New Freq/Sch: EVERY 4 HRS W/AWAKE (PRN)
Old Order Stop: 09/01/17 - 0901
New Order Start: 09/01/17 - 1300
New Order Stop: 09/28/17 - 1559
09/01/17 1020 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

EVANS,LUCINDA W00001219590 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1600 Stop Date 09/28/17 1559
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01541101

History
08/29/17 1606 - POM ORDER by RNOVITCH
08/29/17 1607 - VERIFIED by AADEGBAMIG
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY OTHER DAY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 3 Total Costs $0.00 Total Charges $0.28
Rx Number 01541103

History
08/29/17 1606 - POM ORDER by RNOVITCH
08/29/17 1607 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

EVANS,LUCINDA W00001219590 (Continued)

VLC500T - VALACYCLOVIR HCL 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/05/17 0901
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 10 Total Costs $0.00 Total Charges $174.18
Rx Number 01541803

History
08/31/17 1643 - POM ORDER by RNOVITCH
08/31/17 1700 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

EVANS,LUCINDA W00001219590 (Continued)

VALS40TA2 - VALSARTAN 40 MG TAB

Dose 40 MG (1 TABLET)
Dose Instructions HOLD IF BP SYS < 90
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 7 Total Costs $0.00 Total Charges $34.00
Rx Number 01541107

History
08/29/17 1610 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

PRD20T - PREDNISONE 20 MG TAB - 20 MG

PRD5T - PREDNISONE 5 MG TAB - 5 MG

Dose 25 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 09/09/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 8 Total Costs $0.00 Total Charges $2.16
Rx Number 01541873

History
09/01/17 1021 - ENTER by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

EVANS,LUCINDA W00001219590 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency 0654 (ONE)
Start Date 08/31/17-0654 Stop Date 08/31/17 0655 DC: 08/31/17-0655
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541495

Discontinued Comments Reached Stop Date

History
08/31/17 0655 - POM ORDER by SDAS
08/31/17 0732 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by MPAULOSE Eff: 08/31/17 0657
08/31/17 0732 - VERIFIED by AMOLINARI
08/31/17 0732 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 0655
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

EVANS,LUCINDA W00001219590 (Continued)

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Dose Instructions PRN WHEEZING
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (PRN) PRN REASON: WHEEZE - for Wheezing
Start Date 08/29/17-1600 Stop Date 09/01/17 0901 DC: 09/01/17-0901
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01541102

History
08/29/17 1606 - POM ORDER by RNOVITCH
08/29/17 1607 - VERIFIED by AADEGBAMIG
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0902 - EDIT by RNOVITCH
EDIT DOCTOR: NOVITCH, RICHARD MD.
FROM:
START: 08/29/17-1600 STOP: 09/28/17 1559 SOFT STOP: 0
TO:
START: 08/29/17-1600 STOP: 09/01/17-0901 SOFT STOP:
09/01/17 0902 - DISCONTINUE by RNOVITCH Eff: 09/01/17 0901
EDIT DOCTOR: NOVITCH, RICHARD MD.
09/01/17 0903 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01427889
09/01/17 1021 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by RNOVITCH Eff: 09/01/17 0902
Discontinue by RNOVITCH Eff: 09/01/17 0902
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

EVANS,LUCINDA W00001219590 (Continued)

PRD20T - PREDNISONE 20 MG TAB

Dose 30 MG (1.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/02/17 0859 DC: 09/01/17-0901
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 6 Total Costs $0.00 Total Charges $3.45
Rx Number 01541105

History
08/29/17 1606 - POM ORDER by RNOVITCH
08/29/17 1607 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 09/01/17 - 0900
09/01/17 0903 - DISCONTINUE by RNOVITCH Eff: 09/01/17 0901
EDIT DOCTOR: NOVITCH, RICHARD MD.
09/01/17 0903 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01427890
09/01/17 1021 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RNOVITCH Eff: 09/01/17 0903

NF-MED - NON FORMULARY MEDICATION

Dose 40 EA (0 EACHS)
Dose Instructions hold BP sys <90
Admin Route NF
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859 DC: 08/30/17-0900
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541108

History
08/29/17 1607 - POM ORDER by RNOVITCH
08/29/17 1610 - DISCONTINUE by AADEGBAMIG Eff: 08/30/17 0900
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1610 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

EVANS,LUCINDA W00001219590 (Continued)

PRD20T - PREDNISONE 20 MG TAB

Dose 25 MG (1.25 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 09/09/17 0859 CAN: 09/01/17-1021
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427890

History
09/01/17 0903 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01541105
09/01/17 1021 - CANCEL by AMOLINARI
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO SPLIT MED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient FAY,ANNE T Responsible Doctor ELASHVILI, MERY

Account Number W00001219749 Location B2EA Unit Number M000209465
Age/Sex 78/F Room 219 Registered Date 09/01/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 1.79 m2

Weight 150 lb 3.2 oz 68.13 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/01/17-1830 Stop Date 10/01/17 1829
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542142

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 2046 - VERIFIED by MHAIMOWITZ

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01542144

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 2047 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

FAY,ANNE T W00001219749 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $1.50
Rx Number 01542141

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 2046 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by ACABELLO Eff: 09/01/17 2042
09/01/17 2046 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1830 Stop Date 10/01/17 1829
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542145

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 2047 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

FAY,ANNE T W00001219749 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 09/01/17-1830 Stop Date 10/01/17 1829
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542110

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 1824 - NOW DOSE by RMINASSIAN
Now Dose: 09/01/17 1830
09/01/17 1824 - KEEP NEXT DOSE by System
Keep Next Dose: 09/02/17 0900
09/01/17 1827 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Now Dose by RMINASSIAN Eff: 09/01/17 1824
Now Dose 09/01/17 - 1830
Keep Next Dose 09/02/17 - 0900
09/01/17 1827 - VERIFIED by MHAIMOWITZ

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 4 Total Costs $0.00 Total Charges $0.20
Rx Number 01542146

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 2048 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

FAY,ANNE T W00001219749 (Continued)

LOSA50TA - LOSARTAN POTASSIUM 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 8 Total Costs $0.00 Total Charges $37.10
Rx Number 01542147

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 2048 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 09/01/17-1830 Stop Date 10/01/17 1829
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542148

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 2048 - VERIFIED by MHAIMOWITZ

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1830 Stop Date 10/01/17 1829
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542149

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 2048 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

FAY,ANNE T W00001219749 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 10 Total Costs $ Total Charges $
Rx Number 01542143

History
09/01/17 1824 - POM ORDER by RMINASSIAN
09/01/17 2047 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by ACABELLO Eff: 09/01/17 2042
09/01/17 2047 - VERIFIED by MHAIMOWITZ
Items Dispensed: 10 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 40 MEQ (2 TABLET, CONTROLLED-RELEASES)

Admin Route ORAL
Frequency EVERY 4 HOURS (SCH)
Start Date 09/02/17-2100 Stop Date 09/03/17 0101 DC: 09/02/17-2100
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542272

Discontinued Comments change to liquid

History
09/02/17 1743 - POM ORDER by HAZIZI
09/02/17 1800 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 09/02/17 - 2100
For: 09/03/17 - 0100
09/02/17 1847 - DISCONTINUE by MHAIMOWITZ Eff: 09/02/17 2100
Items Auto Credited: 4 Doses Auto Credited: 2
For: 09/02/17 - 2100
For: 09/03/17 - 0100
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
change to liquid
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

FAY,ANNE T W00001219749 (Continued)

KCL10U30 - POTASSIUM CHLORIDE 10% LIQD 20 MEQ/15 ML UDC

Dose 40 MEQ (30 ML)

Admin Route ORAL
Frequency EVERY 4 HOURS (SCH)
Start Date 09/02/17-2100 Stop Date 09/03/17 0101 DC: 09/03/17-0101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 4 Total Costs $0.00 Total Charges $45.10
Rx Number 01542277

Discontinued Comments Reached Stop Date

History
09/02/17 1848 - ENTER by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 09/02/17 - 2100
For: 09/03/17 - 0100
09/03/17 0101 - DISCONTINUE by PHABKGJOB Eff: 09/03/17 0101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient FEDER,MORRIS J Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219328 Location B2WEII Unit Number M000209177
Age/Sex 75/M Room 256 Registered Date 08/20/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.99 in 172.7 cm Body Surface Area 2.06 m2

Weight 204 lb oz 92.533 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/20/17-1805 DRUG REGIMEN REVIEW COMPLETE
08/29/17-1113 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

DIPH12.5L - DIPHENHYDRAMINE HCL ELIXIR 12.5 MG/5 ML

Dose 25 MG (10 ML)

Dose Instructions PRN FOR ITCH OR RASH
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: ITCH - Itching
Start Date 08/24/17-1815 Stop Date 09/23/17 1814
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539804

History
08/24/17 1815 - POM COPY AND EDIT by SDAS
FROM: Rx #01538420
08/24/17 1834 - EDIT by EBALILO
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/24/17-1815 STOP: 09/23/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/24/17-1815 STOP: 09/23/17-1814 SOFT STOP: 0
DISPENSE: 0
08/24/17 1834 - VERIFIED by EBALILO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

ZNDP28C - DIPHENHYDRAMINE/ZINC ACET 1% 28.3 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions Apply to the itching area
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (PRN) PRN REASON: ITCH - Itching
Start Date 08/30/17-0845 Stop Date 09/29/17 0844
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541238

History
08/30/17 0835 - POM COPY AND EDIT by YOLEE
FROM: Rx #01540552
08/30/17 1018 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0845
08/30/17 1019 - CREDIT by AMOLINARI
ITEMS: 1

MO133EN - MINERAL OIL ENEMA 133 ML BTL

Dose 133 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency EVERY OTHER DAY (SCH)
Start Date 09/01/17-1630 Stop Date 10/01/17 1629
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541545

History
08/31/17 1036 - POM ORDER by YOLEE
08/31/17 1036 - NOW DOSE by YOLEE
Now Dose: 09/01/17 1630
08/31/17 1036 - KEEP NEXT DOSE by System
Keep Next Dose: 09/03/17 0900
08/31/17 1048 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Now Dose by YOLEE Eff: 08/31/17 1036
Now Dose 09/01/17 - 1630
Keep Next Dose 09/03/17 - 0900
08/31/17 1048 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

TOLN15CR4 - TOLNAFTATE 30 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $3.75
Rx Number 01541239

History
08/30/17 0838 - POM ORDER by YOLEE
08/30/17 1018 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-1730 Stop Date 09/06/17 1729
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01541417

History
08/30/17 1717 - POM ORDER by YOLEE
08/30/17 1717 - NOW DOSE by YOLEE
Now Dose: 08/30/17 1730
08/30/17 1717 - KEEP NEXT DOSE by System
Keep Next Dose: 08/31/17 0900
08/30/17 1727 - REVIEW PROVIDER ACTIVITY by AMACCA
Now Dose by YOLEE Eff: 08/30/17 1717
Now Dose 08/30/17 - 1730
Keep Next Dose 08/31/17 - 0900
08/30/17 1727 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 1730
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: pain
Start Date 08/20/17-1545 Stop Date 09/19/17 1544
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01538423

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1616 - VERIFIED by AADEGBAMIG
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0800 Stop Date 09/29/17 0759
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01540933

History
08/29/17 1107 - POM ORDER by YOLEE
08/29/17 1107 - NOW DOSE by YOLEE
Now Dose: 08/30/17 0800
08/29/17 1107 - KEEP NEXT DOSE by System
Keep Next Dose: 08/30/17 0900
08/29/17 1113 - REVIEW PROVIDER ACTIVITY by AMACCA
Now Dose by YOLEE Eff: 08/29/17 1107
Now Dose 08/30/17 - 0800
Keep Next Dose 08/30/17 - 0900
08/29/17 1113 - VERIFIED by AMACCA
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 100 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 16 Total Costs $0.00 Total Charges $8.84
Rx Number 01538416

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1615 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 16 Total Costs $0.00 Total Charges $198.80
Rx Number 01538417

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1615 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/20/17-1700 Stop Date 09/19/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 33 Total Costs $0.00 Total Charges $453.04
Rx Number 01538418

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1615 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/20/17 - 1700
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

09/01/17 0824 - FILL by BGIRLING

Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 16 Total Costs $0.00 Total Charges $1.40
Rx Number 01538419

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1616 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 16 Total Costs $0.00 Total Charges $10.50
Rx Number 01538426

History
08/20/17 1617 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/23/17-1300 Stop Date 09/22/17 1259
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 41 Total Costs $0.00 Total Charges $25.50
Rx Number 01539247

History
08/23/17 1112 - POM ORDER by SDAS
08/23/17 1217 - VERIFIED by AMOLINARI
Items Dispensed: 14 Doses Dispensed: 14
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

For: 09/03/17 - 1300

For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: constipation
Start Date 09/01/17-1600 Stop Date 10/01/17 1559
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542020

History
09/01/17 1554 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01540932
09/01/17 1600 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-1036 Stop Date 09/30/17 1035
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $64.52
Rx Number 01541539

History
08/31/17 1036 - ENTER by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 1036
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1036 - NOW DOSE by AMOLINARI
Now Dose: 08/31/17 1036
08/31/17 1036 - KEEP NEXT DOSE by AMOLINARI
Keep Next Dose: 09/01/17 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/22/17-1700 Stop Date 09/21/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $8.75
Rx Number 01538995

History
08/22/17 1352 - ENTER by AMACCA
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

For: 09/04/17 - 1300

For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $1.75
Rx Number 01541535

History
08/31/17 1018 - POM ORDER by YOLEE
08/31/17 1033 - VERIFIED by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

FLX20C - FLUOXETINE HCL 20 MG CAP

Dose 20 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 14 Total Costs $0.00 Total Charges $6.00
Rx Number 01538957

History
08/22/17 1207 - POM ORDER by SDAS
08/22/17 1216 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

PSYL1PAC15 - PSYLLIUM SEED 1 EA PKT

Dose 1 EA (1 PACKET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/28/17-1200 Stop Date 09/27/17 1159
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 9 Total Costs $0.00 Total Charges $4.76
Rx Number 01540551

History
08/28/17 0949 - POM ORDER by YOLEE
08/28/17 0949 - NOW DOSE by YOLEE
Now Dose: 08/28/17 1200
08/28/17 0949 - KEEP NEXT DOSE by System
Keep Next Dose: 08/29/17 0900
08/28/17 1024 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Now Dose by YOLEE Eff: 08/28/17 0949
Now Dose 08/28/17 - 1200
Keep Next Dose 08/29/17 - 0900
08/28/17 1024 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 1200
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 16 Total Costs $0.00 Total Charges $1.40
Rx Number 01538414

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1615 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 16 Total Costs $0.00 Total Charges $241.50
Rx Number 01538422

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1616 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

DIPH12.5L - DIPHENHYDRAMINE HCL ELIXIR 12.5 MG/5 ML

Dose 25 MG (10 ML)

Dose Instructions PRN FOR ITCH OR RASH
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: ITCH - Itching
Start Date 08/20/17-1545 Stop Date 09/19/17 1544 DC: 08/24/17-1815
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 118 Total Costs $0.00 Total Charges $3.54
Rx Number 01538420

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1616 - VERIFIED by AADEGBAMIG
Items Dispensed: 118 Doses Dispensed: 1
For: 08/20/17 - 1545
08/24/17 1815 - DISCONTINUE by SDAS Eff: 08/24/17 1815
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/24/17 1815 - POM COPY AND EDIT by SDAS
TO: Rx #U01425965
08/24/17 1835 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SDAS Eff: 08/24/17 1815

ZNDP28C - DIPHENHYDRAMINE/ZINC ACET 1% 28.3 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions apply to right wrist and arm
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/22/17-1700 Stop Date 08/25/17 1659 DC: 08/23/17-1325
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $8.28
Rx Number 01539003

History
08/22/17 1509 - POM ORDER by JHILL
08/22/17 1511 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 1700
08/23/17 1326 - DISCONTINUE by SDAS Eff: 08/23/17 1325
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/23/17 1326 - POM COPY AND EDIT by SDAS
TO: Rx #U01425449
08/23/17 1335 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SDAS Eff: 08/23/17 1326
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

ZNDP28C - DIPHENHYDRAMINE/ZINC ACET 1% 28.3 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions apply to right wrist and arm
Admin Route TOPICALLY
Frequency 1455 (ONE)
Start Date 08/22/17-1455 Stop Date 08/22/17 1456 DC: 08/22/17-1456
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01539004

Discontinued Comments Reached Stop Date

History
08/22/17 1509 - POM ORDER by JHILL
08/22/17 1511 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 1455
08/22/17 1511 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 1456
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/22/17 1526 - CREDIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

ZNDP28C - DIPHENHYDRAMINE/ZINC ACET 1% 28.3 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions apply to right wrist and arm
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/23/17-1700 Stop Date 08/26/17 1659 DC: 08/24/17-1830
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539261

History
08/23/17 1326 - POM COPY AND EDIT by SDAS
FROM: Rx #01539003
08/23/17 1335 - EDIT by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/23/17-1700 STOP: 08/26/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/23/17-1700 STOP: 08/26/17-1659 SOFT STOP: 0
DISPENSE: 0
08/23/17 1335 - VERIFIED by MHAIMOWITZ
08/24/17 1830 - DISCONTINUE by SDAS Eff: 08/24/17 1830
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/24/17 1830 - POM COPY AND EDIT by SDAS
TO: Rx #U01425971
08/24/17 1835 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SDAS Eff: 08/24/17 1830
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

ZNDP28C - DIPHENHYDRAMINE/ZINC ACET 1% 28.3 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions apply to right wrist and arm
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/25/17-0900 Stop Date 08/27/17 0859 DC: 08/27/17-0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539805

Discontinued Comments Reached Stop Date

History
08/24/17 1830 - POM COPY AND EDIT by SDAS
FROM: Rx #01539261
08/24/17 1835 - EDIT by EBALILO
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-0900 STOP: 08/27/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/25/17-0900 STOP: 08/27/17-0859 SOFT STOP: 0
DISPENSE: 0
08/24/17 1835 - VERIFIED by EBALILO
08/27/17 0900 - DISCONTINUE by PHABKGJOB Eff: 08/27/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

ZNDP28C - DIPHENHYDRAMINE/ZINC ACET 1% 28.3 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions Apply to R wrist and arm
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (PRN) PRN REASON: ITCH - Itching
Start Date 08/28/17-1000 Stop Date 09/27/17 0959 DC: 08/30/17-0833
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $8.28
Rx Number 01540552

History
08/28/17 0955 - POM ORDER by YOLEE
08/28/17 1024 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1000
08/30/17 0835 - DISCONTINUE by YOLEE Eff: 08/30/17 0833
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/30/17 0835 - POM COPY AND EDIT by YOLEE
TO: Rx #U01427317
08/30/17 1019 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YOLEE Eff: 08/30/17 0835
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

FLUO20SO8 - FLUOXETINE HCL 20 MG/5 ML 120 ML ML

Dose 5 ML (5 MLS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859 DC: 08/22/17-1206
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 120 Total Costs $0.00 Total Charges $370.80
Rx Number 01538435

Warnings
Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DAY (Dose Units).

Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DOSE (Dose Units).

Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DAY (Dose Units).

History
08/20/17 1749 - ENTER by AADEGBAMIG
Items Dispensed: 120 Doses Dispensed: 1
For: 08/21/17 - 0900
08/22/17 1207 - DISCONTINUE by SDAS Eff: 08/22/17 1206
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/22/17 1218 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SDAS Eff: 08/22/17 1207
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

MO133EN - MINERAL OIL ENEMA 133 ML BTL

Dose 133 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 08/24/17-2100 Stop Date 08/24/17 2101 DC: 08/24/17-2100
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539533

History
08/24/17 1029 - POM ORDER by SDAS
08/24/17 1039 - VERIFIED by MHAIMOWITZ
08/24/17 1344 - DISCONTINUE by JHILL Eff: 08/24/17 2100
EDIT DOCTOR: HILL,JUSTIN M.D.
08/24/17 1347 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by JHILL Eff: 08/24/17 1344

MO133EN - MINERAL OIL ENEMA 133 ML BTL

Dose 133 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (SCH)
Start Date 08/30/17-1430 Stop Date 08/30/17 1431 DC: 08/30/17-1430
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541237

History
08/30/17 0835 - POM ORDER by YOLEE
08/30/17 1018 - VERIFIED by AMOLINARI
08/30/17 1347 - DISCONTINUE by YOLEE Eff: 08/30/17 1430
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/30/17 1347 - POM COPY AND EDIT by YOLEE
TO: Rx #U01427410
08/30/17 1417 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YOLEE Eff: 08/30/17 1347
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

MO133EN - MINERAL OIL ENEMA 133 ML BTL

Dose 133 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (SCH)
Start Date 08/30/17-2000 Stop Date 08/30/17 2001 DC: 08/30/17-2001
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541333

Discontinued Comments Reached Stop Date

History
08/30/17 1347 - POM COPY AND EDIT by YOLEE
FROM: Rx #01541237
Last Scheduled Administration Time: 08/30/17 - 1430
Last Actual Administration Time: 08/30/17 - 1327 (Not Given)
Old Total Doses: 1
New Total Doses: 1 (Defaulted Remaining Doses)
08/30/17 1416 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Total Doses Edit by YOLEE Eff: 08/30/17 1347
Last Scheduled Administration Time: 08/30/17 - 1430
Last Actual Administration Time: 08/30/17 - 1327 (Not Given)
Old Total Doses: 1
New Total Doses: 1 (Defaulted Remaining Doses)
08/30/17 1416 - VERIFIED by MHAIMOWITZ
08/30/17 2002 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2001
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

FEDER,MORRIS J W00001219328 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 08/24/17-1345 Stop Date 08/24/17 1346 DC: 08/24/17-1346
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539606

Discontinued Comments Reached Stop Date

History
08/24/17 1343 - POM ORDER by JHILL
08/24/17 1347 - VERIFIED by EBALILO
08/24/17 1347 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Dose Instructions FOR CONSTIPATION
Admin Route RECTALLY
Frequency EVERY OTHER DAY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859 DC: 08/31/17-0900
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540934

History
08/29/17 1107 - POM ORDER by YOLEE
08/29/17 1113 - VERIFIED by AMACCA
08/30/17 1347 - DISCONTINUE by YOLEE Eff: 08/31/17 0900
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/30/17 1347 - POM COPY AND EDIT by YOLEE
TO: Rx #U01427411
08/30/17 1417 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YOLEE Eff: 08/30/17 1347
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
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FEDER,MORRIS J W00001219328 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Dose Instructions FOR CONSTIPATION
Admin Route RECTALLY
Frequency EVERY OTHER DAY (SCH)
Start Date 08/31/17-2000 Stop Date 08/31/17 2000 DC: 08/31/17-2000
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541334

History
08/30/17 1347 - POM COPY AND EDIT by YOLEE
FROM: Rx #01540934
08/30/17 1347 - NOW DOSE by YOLEE
Now Dose: 08/31/17 2000
08/30/17 1347 - KEEP NEXT DOSE by System
Keep Next Dose: 09/02/17 0900
08/30/17 1417 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Now Dose by YOLEE Eff: 08/30/17 1347
Now Dose 08/31/17 - 2000
Keep Next Dose 09/02/17 - 0900
08/30/17 1417 - VERIFIED by MHAIMOWITZ
08/31/17 1036 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 08/31/17-2000 STOP: 09/30/17 1959 SOFT STOP: 0
TO:
START: 08/31/17-2000 STOP: 08/31/17-2000 SOFT STOP:
08/31/17 1036 - DISCONTINUE by YOLEE Eff: 08/31/17 2000
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/31/17 1048 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YOLEE Eff: 08/31/17 1036
Discontinue by YOLEE Eff: 08/31/17 1036
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
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FEDER,MORRIS J W00001219328 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859 DC: 08/21/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538427

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1618 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/20/17 1618 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
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FEDER,MORRIS J W00001219328 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/20/17-1545 Stop Date 08/29/17 1105 DC: 08/29/17-1105
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538413

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1615 - VERIFIED by AADEGBAMIG
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/29/17 1107 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 08/20/17-1545 STOP: 09/19/17 1544 SOFT STOP: 0
TO:
START: 08/20/17-1545 STOP: 08/29/17-1105 SOFT STOP:
08/29/17 1107 - DISCONTINUE by YOLEE Eff: 08/29/17 1105
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/29/17 1107 - POM COPY AND EDIT by YOLEE
TO: Rx #U01427035
08/29/17 1111 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by YOLEE Eff: 08/29/17 1107
Discontinue by YOLEE Eff: 08/29/17 1107
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
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FEDER,MORRIS J W00001219328 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency DAILY (SCH)
Start Date 08/29/17-1600 Stop Date 09/19/17 1544 DC: 09/01/17-1553
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540932

History
08/29/17 1107 - POM COPY AND EDIT by YOLEE
FROM: Rx #01538413
Result of Frequency/Schedule Edit
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/20/17 - 2023
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/29/17 - 1105
New Order Start: 08/29/17 - 1600
New Order Stop: 09/19/17 - 1544
08/29/17 1107 - NOW DOSE by YOLEE
Now Dose: 08/29/17 1600
08/29/17 1107 - KEEP NEXT DOSE by System
Keep Next Dose: 08/30/17 0900
08/29/17 1111 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by YOLEE Eff: 08/29/17 1107
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/20/17 - 2023
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/29/17 - 1105
New Order Start: 08/29/17 - 1600
New Order Stop: 09/19/17 - 1544
Now Dose by YOLEE Eff: 08/29/17 1107
Now Dose 08/29/17 - 1600
Keep Next Dose 08/30/17 - 0900
08/29/17 1111 - VERIFIED by AMACCA
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
09/01/17 1554 - DISCONTINUE by RMINASSIAN Eff: 09/01/17 1553
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
09/01/17 1554 - POM COPY AND EDIT by RMINASSIAN
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
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FEDER,MORRIS J W00001219328 (Continued)

TO: Rx #U01428057
09/01/17 1601 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RMINASSIAN Eff: 09/01/17 1554

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/20/17-1700 Stop Date 09/19/17 1659 DC: 08/20/17-1751
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538415

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1615 - VERIFIED by AADEGBAMIG
08/20/17 1751 - DISCONTINUE by AADEGBAMIG Eff: 08/20/17 1751
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/20/17-1800 Stop Date 09/19/17 1759 DC: 08/22/17-1345
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01538437

History
08/20/17 1754 - ENTER by AADEGBAMIG
08/20/17 1754 - NOW DOSE by AADEGBAMIG
Now Dose: 08/20/17 1800
08/20/17 1754 - KEEP NEXT DOSE by AADEGBAMIG
Keep Next Dose: 08/21/17 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/22/17 1346 - DISCONTINUE by SDAS Eff: 08/22/17 1345
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/22/17 1349 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SDAS Eff: 08/22/17 1346
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
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FEDER,MORRIS J W00001219328 (Continued)

DOCU100T10 - DOCUSATE SODIUM TABLET 100 MG

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/22/17-1700 Stop Date 09/21/17 1659 DC: 08/22/17-1700
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538994

Discontinued Comments SPOKE TO MD- CHANGE TO CAPSULE

History
08/22/17 1346 - POM ORDER by SDAS
08/22/17 1352 - DISCONTINUE by AMACCA Eff: 08/22/17 1700
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
SPOKE TO MD- CHANGE TO CAPSULE
08/22/17 1352 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
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FEDER,MORRIS J W00001219328 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859 DC: 08/21/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538425

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.43
MG/KG/DAY is below the Low Daily Dose.

History
08/20/17 1556 - POM ORDER by SMOHAMED
08/20/17 1616 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/20/17 1804 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
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FEDER,MORRIS J W00001219328 (Continued)

FLUO20SO3 - FLUOXETINE HCL 20 MG/5 ML UNIT DOSE CUP

Dose 20 MG (5 ML)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/21/17-0900 Stop Date 09/20/17 0859 DC: 08/21/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538424

History
08/20/17 1556 - POM ORDER by SMOHAMED
08/20/17 1616 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/20/17 1747 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
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FEDER,MORRIS J W00001219328 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-2100 Stop Date 08/29/17 2059 DC: 08/29/17-2059
Ordering Doctor HILL,JUSTIN M.D.
Clinical Indication COMPLICATED UTI
Total Dispensed 14 Total Costs $0.00 Total Charges $120.45
Rx Number 01539001

Discontinued Comments Reached Stop Date

History
08/22/17 1456 - POM ORDER by JHILL
08/22/17 1457 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
08/29/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
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FEDER,MORRIS J W00001219328 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 1453 (ONE)
Start Date 08/22/17-1453 Stop Date 08/22/17 1454 DC: 08/22/17-1454
Ordering Doctor HILL,JUSTIN M.D.
Clinical Indication COMPLICATED UTI
Total Dispensed 1 Total Costs $0.00 Total Charges $8.03
Rx Number 01539002

Discontinued Comments Reached Stop Date

History
08/22/17 1456 - POM ORDER by JHILL
08/22/17 1457 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 1453
08/22/17 1457 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 1454
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/21/17-0800 Stop Date 09/20/17 0759 DC: 08/21/17-0800
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538421

History
08/20/17 1555 - POM ORDER by SMOHAMED
08/20/17 1616 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0800
For: 08/22/17 - 0800
08/20/17 1751 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 0800
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/21/17 - 0800
For: 08/22/17 - 0800
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
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FEDER,MORRIS J W00001219328 (Continued)

PANT40SU2 - PANTOPRAZOLE SODIUM 40 MG PKT

Dose 40 MG (1 PACKET)
Admin Route ORAL
Frequency DAILY@0800 (SCH)
Start Date 08/21/17-0800 Stop Date 09/20/17 0759 DC: 08/31/17-1016
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $360.58
Rx Number 01538436

History
08/20/17 1752 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0800
For: 08/22/17 - 0800
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0800
For: 08/24/17 - 0800
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
08/31/17 1018 - DISCONTINUE by YOLEE Eff: 08/31/17 1016
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/31/17 1033 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YOLEE Eff: 08/31/17 1018
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
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FEDER,MORRIS J W00001219328 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/28/17-1600 Stop Date 08/28/17 1601 DC: 08/28/17-1601
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540553

Discontinued Comments Reached Stop Date

History
08/28/17 0949 - POM ORDER by YOLEE
08/28/17 1025 - VERIFIED by MHAIMOWITZ
08/28/17 1601 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 1601
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-1030 Stop Date 10/01/17 1029 CAN: 08/31/17-1035
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427605

History
08/31/17 1016 - POM ORDER by YOLEE
08/31/17 1016 - NOW DOSE by YOLEE
Now Dose: 09/01/17 1030
08/31/17 1016 - KEEP NEXT DOSE by System
Keep Next Dose: 09/02/17 0900
08/31/17 1035 - CANCEL by AMOLINARI
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO ONE DOSE TODAY THEN DAILY
08/31/17 1036 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Now Dose by YOLEE Eff: 08/31/17 1016
Now Dose 09/01/17 - 1030
Keep Next Dose 09/02/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
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Patient FERNANDES,VICTOR M Responsible Doctor VALLES,JENNIE MD

Account Number W00001219493 Location B1NN Unit Number M000209311
Age/Sex 73/M Room 129 Registered Date 08/29/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 1.70 m2

Weight 132 lb 14.4 oz 60.282 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 10 UNIT (0.1 ML)

Admin Route SUBCUTAN.
Frequency EVERY BEDTIME (SCH)
Start Date 09/03/17-2100 Stop Date 10/03/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01542315

History
09/03/17 1122 - POM ORDER by JRUSSO
09/03/17 1315 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/03/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
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FERNANDES,VICTOR M W00001219493 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/29/17-2200 Stop Date 09/28/17 2159
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01541211

History
08/29/17 1811 - POM ORDER by SMOHAMED
08/29/17 1840 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 2200

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions buttocks
Admin Route TOPICALLY
Frequency 3 TIMES A DAY (PRN) PRN REASON: skin irritation
Start Date 09/02/17-1145 Stop Date 09/09/17 1144
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01542174

History
09/02/17 1142 - POM ORDER by HAZIZI
09/02/17 1145 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 1145
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
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FERNANDES,VICTOR M W00001219493 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route XX
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/29/17-1515 Stop Date 09/28/17 1459
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541026

History
08/29/17 1506 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01541025
08/29/17 1506 - ENTER by AADEGBAMIG
08/29/17 1506 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
START: 08/29/17-1500 STOP: 09/28/17 1459 SOFT STOP: 0
TO:
ROUTE: XX
START: 08/29/17-1515 STOP: 09/28/17-1459 SOFT STOP: 0
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

ALLP100T - ALLOPURINOL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route XX
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $3.50
Rx Number 01540998

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1439 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: XX
08/29/17 1442 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Dose Instructions through G-tube
For delivery through a G-tube, crushed tablets may be
suspended in 60 mL of water or D5W followed by immediate
delivery
Admin Route XX
Frequency EVERY 12 HOURS (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 15 Total Costs $0.00 Total Charges $161.80
Rx Number 01541002

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1441 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
through G-tube
TO:
DOSE INSTRUCTIONS:
through G-tube
For delivery through a G-tube, crushed tablets may be
suspended in 60 mL of water or D5W followed by immediate
delivery
08/29/17 1442 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route G TUBE
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $0.50
Rx Number 01541016

History
08/29/17 1453 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route XX
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 14 Total Costs $0.00 Total Charges $341.50
Rx Number 01540999

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1439 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: XX
08/29/17 1442 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1500 Stop Date 09/28/17 1459
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541029

History
08/29/17 1456 - POM ORDER by SMOHAMED
08/29/17 1507 - VERIFIED by AADEGBAMIG
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

DLT60T - DILTIAZEM HCL 60 MG TAB

Dose 60 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route G TUBE
Frequency EVERY 8 HOURS (SCH)
Start Date 08/29/17-2200 Stop Date 09/28/17 2159
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 23 Total Costs $0.00 Total Charges $10.20
Rx Number 01541001

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1442 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 8
For: 08/29/17 - 2200
For: 08/30/17 - 0600
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route G TUBE
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $1.75
Rx Number 01541005

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1439 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: G TUBE
08/29/17 1442 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route G TUBE
Frequency 3 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 22 Total Costs $0.00 Total Charges $3.00
Rx Number 01541003

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1439 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: G TUBE
08/29/17 1442 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route G TUBE
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/29/17-1500 Stop Date 09/28/17 1459
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541031

History
08/29/17 1456 - POM ORDER by SMOHAMED
08/29/17 1507 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: G TUBE
08/29/17 1507 - VERIFIED by AADEGBAMIG
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route G TUBE
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1500 Stop Date 09/28/17 1459
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541030

History
08/29/17 1456 - POM ORDER by SMOHAMED
08/29/17 1507 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: G TUBE
08/29/17 1507 - VERIFIED by AADEGBAMIG
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route G TUBE
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 30 Total Costs $0.00 Total Charges $35.00
Rx Number 01541015

History
08/29/17 1452 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01541013
08/29/17 1452 - ENTER by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/29/17 1452 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: G TUBE
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route G TUBE
Frequency EVERY 12 HOURS (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 15 Total Costs $0.00 Total Charges $2.50
Rx Number 01541004

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1440 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: G TUBE
08/29/17 1442 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

QNPR10T - QUINAPRIL HCL 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route G TUBE
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $55.40
Rx Number 01541009

History
08/29/17 1450 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01541006
08/29/17 1450 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/29/17 1450 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: G TUBE
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

RASA0.5T2 - RASAGILINE MESYLATE 0.5 MG TABLET

Dose 0.5 MG (1 TABLET)

Admin Route G TUBE
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $178.00
Rx Number 01541000

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1440 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: G TUBE
08/29/17 1442 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route G TUBE
Frequency NIGHTLY (PRN) PRN REASON: cosntipation
Start Date 08/29/17-1500 Stop Date 09/28/17 1459
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01541034

History
08/29/17 1456 - POM ORDER by SMOHAMED
08/29/17 1507 - EDIT by AADEGBAMIG
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: G TUBE
08/29/17 1507 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 1
For: 08/29/17 - 1500
08/30/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/29/17-1500 Stop Date 09/28/17 1459 DC: 08/29/17-1506
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541025

History
08/29/17 1456 - POM ORDER by SMOHAMED
08/29/17 1506 - VERIFIED by AADEGBAMIG
08/29/17 1506 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01541026
08/29/17 1506 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 1506
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859 DC: 08/30/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541017

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1453 - DISCONTINUE by AADEGBAMIG Eff: 08/30/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1453 - VERIFIED by SYSTEM
Verified in order to DC

MTF850T - METFORMIN HCL 850 MG TAB

Dose 1,000 MG (1.1764706 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659 DC: 08/29/17-1700
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541014

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1452 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 1700
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1452 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659 DC: 08/29/17-1700
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541013

History
08/29/17 1452 - ENTER by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/29/17 1452 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01541015
08/29/17 1452 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 1700
Items Auto Credited: 10 Doses Auto Credited: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Quinapril 10 mg tablet

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859 DC: 08/30/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541011

History
08/29/17 1438 - POM ORDER by SMOHAMED
08/29/17 1451 - DISCONTINUE by AADEGBAMIG Eff: 08/30/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1451 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

FERNANDES,VICTOR M W00001219493 (Continued)

QNPR10T - QUINAPRIL HCL 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859 DC: 08/30/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541006

History
08/29/17 1448 - ENTER by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/29/17 1450 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01541009
08/29/17 1450 - DISCONTINUE by AADEGBAMIG Eff: 08/30/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient FIGUEROA,ISABELLA A Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001219081 Location B2EA Unit Number M000209094
Age/Sex 23/F Room 214 Registered Date 08/16/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 2.01 in 157.5 cm Body Surface Area 1.60 m2

Weight 131 lb 3.2 oz 59.511 kg
Hem-Onc No

Drug Allergies [shellfish], shellfish derived

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

ALBU8HFA - ALBUTEROL SULFATE HFA 8 GM INH

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency EVERY 6 HOURS (PRN) PRN REASON: SOB - For Shortness of Breath
Start Date 08/24/17-1030 Stop Date 09/23/17 1029
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $57.24
Rx Number 01539530

History
08/24/17 1019 - POM ORDER by TKOUTZEVA
08/24/17 1022 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 1030
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/16/17-1645 Stop Date 09/15/17 1644
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $4.50
Rx Number 01537325

History
08/16/17 1638 - POM ORDER by TKOUTZEVA
08/16/17 1640 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $0.54
Rx Number 01537370

History
08/16/17 1659 - POM ORDER by RMINASSIAN
08/16/17 1706 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1645 Stop Date 09/15/17 1644
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537326

History
08/16/17 1638 - POM ORDER by TKOUTZEVA
08/16/17 1640 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

CLCX200C - CELECOXIB 200 MG CAP

Dose 200 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: for pain score 4-6
Start Date 08/16/17-1700 Stop Date 09/15/17 1659
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $165.30
Rx Number 01537371

History
08/16/17 1659 - POM ORDER by RMINASSIAN
08/16/17 1706 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/16/17 - 1700
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/16/17-1700 Stop Date 09/15/17 1659
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01537324

History
08/16/17 1638 - POM ORDER by TKOUTZEVA
08/16/17 1640 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 1700
For: 08/22/17 - 1700
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1700
For: 08/24/17 - 1700
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

FLX10C - FLUOXETINE HCL 10 MG CAP

Dose 10 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 15 Total Costs $0.00 Total Charges $4.55
Rx Number 01538667

History
08/21/17 1530 - POM ORDER by TKOUTZEVA
08/21/17 1544 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 09/22/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 14 Total Costs $0.00 Total Charges $2.20
Rx Number 01539255

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/23/17 1252 - POM ORDER by TKOUTZEVA
08/23/17 1259 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/23/17 - 2100
For: 08/24/17 - 2100
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 08/16/17-2100 Stop Date 09/15/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 41 Total Costs $0.00 Total Charges $334.08
Rx Number 01537432

History
08/16/17 1729 - POM ORDER by TKOUTZEVA
08/16/17 1805 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

For: 08/31/17 - 0900

For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/16/17-1645 Stop Date 09/15/17 1644
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537327

History
08/16/17 1638 - POM ORDER by TKOUTZEVA
08/16/17 1640 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

NCT7TD - NICOTINE 7 MG/24 HR TDSY

Dose 1 EA (1 TRANSDERMAL SYSTEM)

Admin Route TRANSDERM.
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $94.50
Rx Number 01537374

History
08/16/17 1659 - POM ORDER by RMINASSIAN
08/16/17 1707 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Dose Instructions PRN NAUSEA
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/16/17-1700 Stop Date 09/15/17 1659
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01537372

History
08/16/17 1659 - POM ORDER by RMINASSIAN
08/16/17 1707 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 1700
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/16/17-2100 Stop Date 09/17/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01537329

History
08/16/17 1638 - POM ORDER by TKOUTZEVA
08/16/17 1641 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859 DC: 08/30/17-1324
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01537438

History
08/16/17 1812 - POM ORDER by TKOUTZEVA
08/16/17 1827 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 08/17/17 - 0900
08/27/17 1037 - DEBIT by AADEGBAMIG
ITEMS: 1
08/30/17 1326 - DISCONTINUE by TKOUTZEVA Eff: 08/30/17 1324
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/30/17 1521 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/30/17 1326

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions apply to neck
Admin Route TOPICALLY
Frequency ONETIME (ONE)
Start Date 08/16/17-2145 Stop Date 08/16/17 2146 DC: 08/16/17-2146
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01537493

Discontinued Comments Reached Stop Date

History
08/16/17 2146 - POM ORDER by HMOHAMED
08/17/17 0738 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by GABRAHAM Eff: 08/16/17 2223
08/17/17 0738 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 08/16/17 - 2145
08/17/17 0739 - DISCONTINUE by PHABKGJOB Eff: 08/16/17 2146
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/17/17 0739 - CREDIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions to left shoulder
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 DC: 08/30/17-1324
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01538820

History
08/21/17 1801 - POM ORDER by CDOHLE
08/21/17 2052 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 08/21/17 - 2100
08/30/17 1326 - DISCONTINUE by TKOUTZEVA Eff: 08/30/17 1324
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/30/17 1521 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/30/17 1326

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1645 Stop Date 09/15/17 1644 DC: 08/30/17-1627
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537328

History
08/16/17 1638 - POM ORDER by TKOUTZEVA
08/16/17 1641 - VERIFIED by EBALILO
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 1628 - DISCONTINUE by TKOUTZEVA Eff: 08/30/17 1627
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1226 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/30/17 1628
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

MTHL5T - METHYLPHENIDATE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/02/17 0859 DC: 08/29/17-1732
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 2 Total Costs $0.00 Total Charges $1.00
Rx Number 01539987

History
08/25/17 1124 - POM ORDER by TKOUTZEVA
08/25/17 1238 - VERIFIED by EBALILO
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/29/17 1733 - DISCONTINUE by CDOHLE Eff: 08/29/17 1732
EDIT DOCTOR: DOHLE,CAROLIN MD
08/30/17 1521 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/29/17 1733
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

FIGUEROA,ISABELLA A W00001219081 (Continued)

VNL375CCR - VENLAFAXINE HCL 37.5 MG CAPCR

Dose 37.5 MG (1 CAPSULE CONTROLLED-RELEASE)

Dose Instructions ONCE A DAY DOSING
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859 DC: 08/21/17-1528
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $143.50
Rx Number 01537373

History
08/16/17 1659 - POM ORDER by RMINASSIAN
08/16/17 1707 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/21/17 1529 - DISCONTINUE by TKOUTZEVA Eff: 08/21/17 1528
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/21/17 1545 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by TKOUTZEVA Eff: 08/21/17 1529
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient FLEISCHNER,MORTON J Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219626 Location B2WEII Unit Number M000205065
Age/Sex 75/M Room 255 Registered Date 08/31/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 5.98 in 167.6 cm Body Surface Area 1.87 m2

Weight 170 lb 14.4 oz 77.519 kg
Hem-Onc No

Drug Allergies Penicillins, amiodarone

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/31/17-1613 CHANGE ROUTE COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: TOXIC METABOLIC ENCEPHALOPATHY CABGX3 TRACH PEG
Secondary Diagnosis:

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency EVERY 6 HOURS (SCH)
Start Date 08/31/17-1800 Stop Date 09/30/17 1759
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01541724

History
08/31/17 1553 - POM ORDER by JRUSSO
08/31/17 1603 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions To sacrum
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/31/17-2100 Stop Date 09/07/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01541793

History
08/31/17 1640 - POM ORDER by JRUSSO
08/31/17 1646 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 2100

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/31/17-1545 Stop Date 09/30/17 1544
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541690

History
08/31/17 1542 - POM ORDER by JRUSSO
08/31/17 1549 - VERIFIED by AMACCA
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $1.26
Rx Number 01541795

History
08/31/17 1645 - POM ORDER by JRUSSO
08/31/17 1647 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $0.09
Rx Number 01541826

History
08/31/17 1812 - POM ORDER by JRUSSO
08/31/17 1813 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 08/31/17-2100 Stop Date 09/30/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $2.25
Rx Number 01541718

History
08/31/17 1552 - POM ORDER by JRUSSO
08/31/17 1602 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1545 Stop Date 09/30/17 1544
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541693

History
08/31/17 1542 - POM ORDER by JRUSSO
08/31/17 1550 - VERIFIED by AMACCA
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

DVL250TEC - DIVALPROEX SODIUM DR 250 MG TABEC

Dose 250 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $17.10
Rx Number 01541791

History
08/31/17 1640 - POM ORDER by JRUSSO
08/31/17 1646 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

DVL500TEC - DIVALPROEX SODIUM DR 500 MG TABEC

Dose 500 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/30/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $31.44
Rx Number 01541792

History
08/31/17 1640 - POM ORDER by JRUSSO
08/31/17 1646 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $1.75
Rx Number 01541835

History
08/31/17 2008 - POM ORDER by JRUSSO
08/31/17 2010 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency EVERY 6 HOURS (PRN) PRN REASON: WHEEZE - for Wheezing
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541797

History
08/31/17 1645 - POM ORDER by JRUSSO
08/31/17 1647 - VERIFIED by AADEGBAMIG
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

LVF250T - LEVOFLOXACIN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 09/10/17 0859
Ordering Doctor AZIZI,HANA MD
Clinical Indication COMPLICATED UTI
Total Dispensed 3 Total Costs $0.00 Total Charges $65.53
Rx Number 01542176

History
09/02/17 1145 - POM ORDER by HAZIZI
09/02/17 1224 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $0.10
Rx Number 01541788

History
08/31/17 1638 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01541720
08/31/17 1645 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

LPRM2T - LOPERAMIDE HCL 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: DIARRHEA - FOR DIARRHEA
Start Date 08/31/17-1645 Stop Date 09/30/17 1644
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01541796

History
08/31/17 1645 - POM ORDER by JRUSSO
08/31/17 1647 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/31/17 - 1645
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/31/17-1545 Stop Date 09/30/17 1544
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541692

History
08/31/17 1542 - POM ORDER by JRUSSO
08/31/17 1549 - VERIFIED by AMACCA
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@2100 (SCH)
Start Date 09/02/17-2100 Stop Date 09/30/17 2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 4 Total Costs $0.00 Total Charges $0.20
Rx Number 01542275

History
09/02/17 1808 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01542005
Result of Frequency/Schedule Edit
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/02/17 - 1800
Last Actual Administration Time: 09/01/17 - 1811
Old Freq/Sch: DAILY@1800 (SCH)
New Freq/Sch: DAILY@2100 (SCH)
Old Order Stop: 09/02/17 - 1807
New Order Start: 09/02/17 - 2100
New Order Stop: 09/30/17 - 2059
09/02/17 1809 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by HAZIZI Eff: 09/02/17 1808
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/02/17 - 1800
Last Actual Administration Time: 09/01/17 - 1811
Old Freq/Sch: DAILY@1800 (SCH)
New Freq/Sch: DAILY@2100 (SCH)
Old Order Stop: 09/02/17 - 1807
New Order Start: 09/02/17 - 2100
New Order Stop: 09/30/17 - 2059
09/02/17 1809 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 75 MG (1.5 TABLETS)

Dose Instructions HOLD FOR SBP < 100 AND/OR PULSE < 50
Admin Route ORAL
Frequency EVERY 6 HOURS (SCH)
Start Date 08/31/17-1800 Stop Date 09/30/17 1759
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 46 Total Costs $0.00 Total Charges $2.00
Rx Number 01541800

History
08/31/17 1657 - ENTER by AADEGBAMIG
Items Dispensed: 30 Doses Dispensed: 15
For: 08/31/17 - 1800
For: 09/01/17 - 0000
For: 09/01/17 - 0600
For: 09/01/17 - 1200
For: 09/01/17 - 1800
For: 09/02/17 - 0000
For: 09/02/17 - 0600
For: 09/02/17 - 1200
For: 09/02/17 - 1800
For: 09/03/17 - 0000
For: 09/03/17 - 0600
For: 09/03/17 - 1200
For: 09/03/17 - 1800
For: 09/04/17 - 0000
For: 09/04/17 - 0600
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 16 Doses Dispensed: 8
For: 09/04/17 - 1200
For: 09/04/17 - 1800
For: 09/05/17 - 0000
For: 09/05/17 - 0600
For: 09/05/17 - 1200
For: 09/05/17 - 1800
For: 09/06/17 - 0000
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

SRTR50T - SERTRALINE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $1.20
Rx Number 01541789

History
08/31/17 1640 - POM ORDER by JRUSSO
08/31/17 1646 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 09/03/17 2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542242

History
09/02/17 1605 - POM ORDER by HAZIZI
09/02/17 1617 - EDIT by MHAIMOWITZ
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/02/17-2100 STOP: 09/04/17 2059 SOFT STOP:
TO:
START: 09/02/17-2100 STOP: 09/03/17-2101 SOFT STOP: 0
09/02/17 1617 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

DLT180CCR - DILTIAZEM HCL 180 MG (CARDIZEM CD) CR CAP 24HR

Dose 180 MG (1 CAPSULE CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/01/17 0900 DC: 09/01/17-0900
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01541719

History
08/31/17 1553 - POM ORDER by JRUSSO
08/31/17 1602 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1637 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 09/01/17-0900 STOP: 10/01/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 09/01/17-0900 STOP: 09/01/17-0900 SOFT STOP:
DISPENSE: 0
08/31/17 1637 - DISCONTINUE by JRUSSO Eff: 09/01/17 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/31/17 1644 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by JRUSSO Eff: 08/31/17 1637
Discontinue by JRUSSO Eff: 08/31/17 1637
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 08/31/17 1700 DC: 08/31/17-1700
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541689

History
08/31/17 1542 - POM ORDER by JRUSSO
08/31/17 1549 - VERIFIED by AMACCA
08/31/17 1553 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 08/31/17-1700 STOP: 09/30/17 1659 SOFT STOP: 0
TO:
START: 08/31/17-1700 STOP: 08/31/17-1700 SOFT STOP:
08/31/17 1553 - DISCONTINUE by JRUSSO Eff: 08/31/17 1700
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/31/17 1603 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by JRUSSO Eff: 08/31/17 1553
Discontinue by JRUSSO Eff: 08/31/17 1553

LVF250T - LEVOFLOXACIN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/31/17-1800 Stop Date 09/03/17 1639 DC: 09/01/17-2312
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 2 Total Costs $0.00 Total Charges $131.06
Rx Number 01541798

History
08/31/17 1645 - POM ORDER by JRUSSO
08/31/17 1647 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/31/17 - 1800
For: 09/01/17 - 1800
For: 09/02/17 - 1800
09/01/17 2314 - DISCONTINUE by RMINASSIAN Eff: 09/01/17 2312
Items Auto Credited: 1 Doses Auto Credited: 1
For: 09/02/17 - 1800
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
09/02/17 1224 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RMINASSIAN Eff: 09/01/17 2314
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

LVF250T - LEVOFLOXACIN 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency 1144 (ONE)
Start Date 09/02/17-1144 Stop Date 09/02/17 1145 DC: 09/02/17-1145
Ordering Doctor AZIZI,HANA MD
Clinical Indication COMPLICATED UTI
Total Dispensed 1 Total Costs $0.00 Total Charges $65.53
Rx Number 01542175

Discontinued Comments Reached Stop Date

History
09/02/17 1145 - POM ORDER by HAZIZI
09/02/17 1224 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 1144
09/02/17 1224 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 1145
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859 DC: 09/01/17-0900
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541720

History
08/31/17 1553 - POM ORDER by JRUSSO
08/31/17 1603 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1637 - DISCONTINUE by JRUSSO Eff: 09/01/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/31/17 1638 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01427837
08/31/17 1644 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JRUSSO Eff: 08/31/17 1637

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1545 Stop Date 09/30/17 1544 DC: 08/31/17-1552
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541691

History
08/31/17 1542 - POM ORDER by JRUSSO
08/31/17 1549 - VERIFIED by AMACCA
08/31/17 1553 - DISCONTINUE by JRUSSO Eff: 08/31/17 1552
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/31/17 1603 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 08/31/17 1553
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/01/17 1539 DC: 09/01/17-1539
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $0.20
Rx Number 01541790

History
08/31/17 1640 - POM ORDER by JRUSSO
08/31/17 1646 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
09/01/17 1540 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/31/17-2100 STOP: 09/30/17 2059 SOFT STOP: 0
DISPENSE: 2
TO:
START: 08/31/17-2100 STOP: 09/01/17-1539 SOFT STOP:
DISPENSE: 1
09/01/17 1540 - DISCONTINUE by YCHO Eff: 09/01/17 1539
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
09/01/17 1540 - POM COPY AND EDIT by YCHO
TO: Rx #U01428050
09/01/17 1544 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by YCHO Eff: 09/01/17 1540
Discontinue by YCHO Eff: 09/01/17 1540
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 09/01/17-1800 Stop Date 09/02/17 1807 DC: 09/02/17-1807
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $0.20
Rx Number 01542005

History
09/01/17 1540 - POM COPY AND EDIT by YCHO
FROM: Rx #01541790
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/31/17 - 2100
Last Actual Administration Time: 08/31/17 - 2041
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: DAILY@1800 (SCH)
Old Order Stop: 09/01/17 - 1539
New Order Start: 09/01/17 - 1800
New Order Stop: 09/30/17 - 2059
09/01/17 1542 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by YCHO Eff: 09/01/17 1540
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/31/17 - 2100
Last Actual Administration Time: 08/31/17 - 2041
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: DAILY@1800 (SCH)
Old Order Stop: 09/01/17 - 1539
New Order Start: 09/01/17 - 1800
New Order Stop: 09/30/17 - 2059
09/01/17 1542 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 09/01/17 - 1800
For: 09/02/17 - 1800
For: 09/03/17 - 1800
For: 09/04/17 - 1800
For: 09/05/17 - 1800
09/02/17 1808 - DISCONTINUE by HAZIZI Eff: 09/02/17 1807
EDIT DOCTOR: AZIZI,HANA MD
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

Order filed UNV:

Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
09/02/17 1808 - EDIT by HAZIZI
EDIT DOCTOR: AZIZI,HANA MD
FROM:
START: 09/01/17-1800 STOP: 09/30/17 2059 SOFT STOP:
DISPENSE: 5
TO:
START: 09/01/17-1800 STOP: 09/02/17-1807 SOFT STOP:
DISPENSE: 2
09/02/17 1808 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01428311
09/02/17 1808 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by HAZIZI Eff: 09/02/17 1808
Discontinue by HAZIZI Eff: 09/02/17 1808

MTF500TCR - METFORMIN HCL XR 500 MG TABCR

Dose 500 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/01/17 0900 DC: 09/01/17-0900
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01541721

History
08/31/17 1553 - POM ORDER by JRUSSO
08/31/17 1603 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1637 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 09/01/17-0900 STOP: 10/01/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 09/01/17-0900 STOP: 09/01/17-0900 SOFT STOP:
DISPENSE: 0
08/31/17 1637 - DISCONTINUE by JRUSSO Eff: 09/01/17 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/31/17 1644 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by JRUSSO Eff: 08/31/17 1637
Discontinue by JRUSSO Eff: 08/31/17 1637
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 75 MG (3 TABLETS)
Dose Instructions HOLD FOR SBP < 100 AND/OR PULSE < 50
Admin Route ORAL
Frequency EVERY 6 HOURS (SCH)
Start Date 08/31/17-1800 Stop Date 09/30/17 1759 DC: 08/31/17-1800
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541801

History
08/31/17 1645 - POM ORDER by JRUSSO
08/31/17 1657 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1657 - DISCONTINUE by AADEGBAMIG Eff: 08/31/17 1800
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 09/02/17-0900 Stop Date 09/05/17 0859 DC: 09/02/17-1144
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542173

History
09/01/17 2314 - POM ORDER by RMINASSIAN
09/02/17 1145 - DISCONTINUE by HAZIZI Eff: 09/02/17 1144
EDIT DOCTOR: AZIZI,HANA MD
09/02/17 1145 - VERIFIED by SYSTEM
Verified in order to DC
09/02/17 1224 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SYSTEM Eff: 09/02/17 1145
Discontinue by HAZIZI Eff: 09/02/17 1145
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 60 EA (0 EACHS)
Dose Instructions Ticagrelor
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/01/17 0900 DC: 09/01/17-0900
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541770

History
08/31/17 1552 - POM ORDER by JRUSSO
08/31/17 1559 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
LABEL COMMENTS:
TO:
LABEL COMMENTS:
SPOKE TO MD ORDERED FOR 9/1/17
08/31/17 1637 - DISCONTINUE by JRUSSO Eff: 09/01/17 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/31/17 1637 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 09/01/17-0900 STOP: 10/01/17 0859 SOFT STOP: 0
TO:
START: 09/01/17-0900 STOP: 09/01/17-0900 SOFT STOP:
08/31/17 1637 - VERIFIED by SYSTEM
Verified in order to DC
08/31/17 1644 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by JRUSSO Eff: 08/31/17 1637
Edit by SYSTEM Eff: 08/31/17 1637
Discontinue by JRUSSO Eff: 08/31/17 1637
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 150 EA (0 EACHS)

Dose Instructions RANITIDINE
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659 DC: 08/31/17-1700
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541725

History
08/31/17 1553 - POM ORDER by JRUSSO
08/31/17 1603 - DISCONTINUE by AMACCA Eff: 08/31/17 1700
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/31/17 1603 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

PRX20T - PAROXETINE HCL 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/01/17 0900 DC: 09/01/17-0900
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01541722

History
08/31/17 1553 - POM ORDER by JRUSSO
08/31/17 1603 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1637 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 09/01/17-0900 STOP: 10/01/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 09/01/17-0900 STOP: 09/01/17-0900 SOFT STOP:
DISPENSE: 0
08/31/17 1638 - DISCONTINUE by JRUSSO Eff: 09/01/17 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/31/17 1644 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by JRUSSO Eff: 08/31/17 1637
Discontinue by JRUSSO Eff: 08/31/17 1638
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

RNT150T - RANITIDINE HCL 150 MG TAB

Dose 150 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 08/31/17 1700 DC: 08/31/17-1700
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 7 Total Costs $ Total Charges $
Rx Number 01541726

History
08/31/17 1604 - ENTER by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
08/31/17 1638 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 08/31/17-1700 STOP: 09/30/17 1659 SOFT STOP: 0
DISPENSE: 7
TO:
START: 08/31/17-1700 STOP: 08/31/17-1700 SOFT STOP:
DISPENSE: 0
08/31/17 1638 - DISCONTINUE by JRUSSO Eff: 08/31/17 1700
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/31/17 1644 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by JRUSSO Eff: 08/31/17 1638
Discontinue by JRUSSO Eff: 08/31/17 1638
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

SDCH1T - SODIUM CHLORIDE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency EVERY 4 DAYS (SCH)
Start Date 09/06/17-0900 Stop Date 09/10/17 0901 DC: 09/06/17-0900
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542271

History
09/02/17 1747 - POM ORDER by HAZIZI
09/02/17 1759 - DISCONTINUE by HAZIZI Eff: 09/06/17 0900
EDIT DOCTOR: AZIZI,HANA MD
09/02/17 1759 - VERIFIED by SYSTEM
Verified in order to DC
09/02/17 1759 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01428309
09/02/17 1808 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SYSTEM Eff: 09/02/17 1759
Discontinue by HAZIZI Eff: 09/02/17 1759
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

SDCH1T - SODIUM CHLORIDE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency EVERY 4 HOURS (SCH)
Start Date 09/02/17-2100 Stop Date 09/03/17 0101 DC: 09/02/17-2100
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542274

History
09/02/17 1759 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01542271
Result of Frequency/Schedule Edit
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/06/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: EVERY 4 DAYS (SCH)
New Freq/Sch: EVERY 4 HOURS (SCH)
Old Order Stop: 09/06/17 - 0900
New Order Start: 09/02/17 - 2100
New Order Stop: 09/03/17 - 0101
Old Total Doses: 2
New Total Doses: 2 (Remaining)
09/02/17 1808 - DISCONTINUE by HAZIZI Eff: 09/02/17 2100
EDIT DOCTOR: AZIZI,HANA MD
09/02/17 1808 - VERIFIED by SYSTEM
Verified in order to DC
09/02/17 1808 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01428312
09/02/17 1811 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by HAZIZI Eff: 09/02/17 1759
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/06/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: EVERY 4 DAYS (SCH)
New Freq/Sch: EVERY 4 HOURS (SCH)
Old Order Stop: 09/06/17 - 0900
New Order Start: 09/02/17 - 2100
New Order Stop: 09/03/17 - 0101
Total Doses Edit by HAZIZI Eff: 09/02/17 1759
Old Total Doses: 2
New Total Doses: 2 (Remaining)
Edit by SYSTEM Eff: 09/02/17 1808
Freq/Sch Edit by SYSTEM Eff: 09/02/17 1808
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/06/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: EVERY 4 DAYS (SCH)
New Freq/Sch: EVERY 4 HOURS (SCH)
Old Order Stop: 09/06/17 - 0900
New Order Start: 09/02/17 - 2100
New Order Stop: 09/03/17 - 0101
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

Discontinue by HAZIZI Eff: 09/02/17 1808

SDCH1T - SODIUM CHLORIDE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency 1758 (ONE)
Start Date 09/02/17-1758 Stop Date 09/02/17 1759 DC: 09/02/17-1759
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $0.30
Rx Number 01542273

Discontinued Comments Reached Stop Date

History
09/02/17 1759 - POM ORDER by HAZIZI
09/02/17 1808 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 1758
09/02/17 1808 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 1759
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

SDCH1T - SODIUM CHLORIDE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency EVERY 4 HOURS (SCH)
Start Date 09/02/17-2100 Stop Date 09/02/17 2101 DC: 09/02/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $0.30
Rx Number 01542276

Discontinued Comments Reached Stop Date

History
09/02/17 1808 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01542274
Last Scheduled Administration Time:
Last Actual Administration Time:
Old Total Doses: 2
New Total Doses: 1 (Defaulted Remaining Doses - Old Total Doses edited from 2 to 1)
09/02/17 1810 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Total Doses Edit by HAZIZI Eff: 09/02/17 1808
Last Scheduled Administration Time:
Last Actual Administration Time:
Old Total Doses: 2
New Total Doses: 1 (Defaulted Remaining Doses - Old Total Doses edited from 2 to 1)
09/02/17 1810 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 2100
09/02/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

FLEISCHNER,MORTON J W00001219626 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/31/17-2100 Stop Date 08/31/17 2101 DC: 08/31/17-2101
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541723

Warnings
Type: BURKE
Range: WARFARIN SOD
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.5 MG/DAY - 15 MG/DAY. Ordered dose of 0 MG/DAY is
below the Low Daily Dose.

Discontinued Comments Reached Stop Date

History
08/31/17 1553 - POM ORDER by JRUSSO
08/31/17 1603 - VERIFIED by AMACCA
08/31/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/01/17-2100 Stop Date 09/01/17 2101 DC: 09/01/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542138

Discontinued Comments Reached Stop Date

History
09/01/17 1840 - POM ORDER by HAZIZI
09/01/17 2016 - VERIFIED by MHAIMOWITZ
09/01/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient FRIES,FORTUNA Responsible Doctor VALLES,JENNIE MD

Account Number W00001219471 Location B1NN Unit Number M000209360
Age/Sex 78/F Room 136 Registered Date 08/29/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 4.02 in 162.6 cm Body Surface Area 1.71 m2

Weight 145 lb 4.8 oz 65.907 kg
Hem-Onc No

Drug Allergies Penicillins, metoprolol

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/31/17-1335 RENAL DOSING COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA, AFIB,PPM INSERTION
Secondary Diagnosis:

BUDE10.22 - BUDESONIDE/FORMOTEROL FUMARATE 80-4.5MCG INH

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (PRN) PRN REASON: ALLERGY - Allergy
Start Date 08/30/17-1700 Stop Date 09/29/17 1659
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $429.39
Rx Number 01541287

History
08/30/17 1222 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01541285
08/30/17 1247 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

LEVA1.25 - LEVALBUTEROL HCL 1.25 MG/3 ML VIAL

Dose 1.25 MG (3 ML)

Admin Route NEBULIZER
Frequency EVERY 4 HOURS (PRN) PRN REASON: BRONCHO - Bronchospasm
Start Date 08/29/17-1530 Stop Date 09/28/17 1529
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $282.96
Rx Number 01541082

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1546 - VERIFIED by MHAIMOWITZ
Items Dispensed: 12 Doses Dispensed: 1
For: 08/29/17 - 1530

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/29/17-1530 Stop Date 09/28/17 1529
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01541071

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1543 - VERIFIED by MHAIMOWITZ
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $341.50
Rx Number 01541072

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1543 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BNZN100C - BENZONATATE 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: COUGH - FOR COUGH
Start Date 08/31/17-1345 Stop Date 09/30/17 1344
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $1.95
Rx Number 01541587

History
08/31/17 1344 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01541073
08/31/17 1345 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1345
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/29/17-2000 Stop Date 09/28/17 1959
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541075

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1544 - VERIFIED by MHAIMOWITZ
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2000
For: 09/02/17 - 2000
For: 09/03/17 - 2000
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2000
For: 09/05/17 - 2000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

CRV3.125T - CARVEDILOL 3.125 MG TAB

Dose 3.125 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $3.30
Rx Number 01541076

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1544 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/29/17 2015 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Conflict with New Allergy by PHABKGJOB Eff: 08/29/17 1705
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 2,000 UNIT (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 14 Total Costs $0.00 Total Charges $1.25
Rx Number 01541077

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1544 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 08/29/17-1530 Stop Date 09/28/17 1529
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541078

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1545 - VERIFIED by MHAIMOWITZ
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01541079

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1545 - VERIFIED by MHAIMOWITZ
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

ESCI10TA - ESCITALOPRAM OXALATE 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $95.15
Rx Number 01541080

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1545 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

ESOM20CA - ESOMEPRAZOLE MAG TRIHYDRATE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $98.65
Rx Number 01541098

History
08/29/17 1559 - ENTER by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 8 Total Costs $0.00 Total Charges $1.50
Rx Number 01541083

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1546 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

LVT.088T - LEVOTHYROXINE SODIUM 88 MCG (SYNTHROID) TAB

Dose 88 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/30/17-0700 Stop Date 09/29/17 0659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 8 Total Costs $0.00 Total Charges $14.00
Rx Number 01541086

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1547 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/30/17 - 0700
For: 08/31/17 - 0700
For: 09/01/17 - 0700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/05/17 - 0700
For: 09/06/17 - 0700

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/29/17-1530 Stop Date 09/28/17 1529
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541084

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1547 - VERIFIED by MHAIMOWITZ
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1530 Stop Date 09/28/17 1529
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541085

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1547 - VERIFIED by MHAIMOWITZ
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MNTL10T - MONTELUKAST SODIUM 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 8 Total Costs $0.00 Total Charges $48.75
Rx Number 01541087

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1547 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01541088

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1547 - VERIFIED by MHAIMOWITZ
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/31/17-2100 Stop Date 09/07/17 2059
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 11 Total Costs $0.00 Total Charges $48.18
Rx Number 01541637

History
08/31/17 1455 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01541585
08/31/17 1458 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/29/17-1530 Stop Date 09/28/17 1529
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01541090

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1548 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 2
For: 08/29/17 - 1530
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 08/30/17-1200 Stop Date 09/29/17 1159
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 14 Total Costs $0.00 Total Charges $0.20
Rx Number 01541091

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1548 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1200
For: 08/31/17 - 1200
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1200
For: 09/05/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

VALS40TA2 - VALSARTAN 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $68.00
Rx Number 01541099

History
08/29/17 1601 - ENTER by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

VRP80T - VERAPAMIL HCL 80 MG TAB

Dose 80 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 22 Total Costs $0.00 Total Charges $15.75
Rx Number 01541092

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1549 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 09/03/17 2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542278

History
09/02/17 1859 - POM ORDER by HAZIZI
09/02/17 1901 - VERIFIED by MHAIMOWITZ

BDS.5IN2 - BUDESONIDE INHA SUSP 0.5 MG/2 ML NEB

Dose 0.5 MG (2 ML)

Admin Route NEBULIZER
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659 DC: 08/30/17-1207
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $153.90
Rx Number 01541074

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1544 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 1
For: 08/29/17 - 1700
08/30/17 1209 - DISCONTINUE by EALEXEEV Eff: 08/30/17 1207
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/30/17 1248 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/30/17 1209
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

BUDE10.22 - BUDESONIDE/FORMOTEROL FUMARATE 80-4.5MCG INH

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-1700 Stop Date 09/29/17 1659 DC: 08/30/17-1700
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541285

History
08/30/17 1153 - POM ORDER by EALEXEEV
08/30/17 1222 - DISCONTINUE by EALEXEEV Eff: 08/30/17 1700
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/30/17 1222 - VERIFIED by SYSTEM
Verified in order to DC
08/30/17 1222 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427368
08/30/17 1248 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 08/30/17 1222
Discontinue by EALEXEEV Eff: 08/30/17 1222
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

FLT22013 - FLUTICASONE PROP INH 220 MCG 12 GM INH

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 08/29/17 1700 DC: 08/29/17-1700
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $647.76
Rx Number 01541081

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1546 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1700
08/29/17 1628 - DISCONTINUE by SDAS Eff: 08/29/17 1700
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/29/17 1628 - EDIT by SDAS
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
START: 08/29/17-1700 STOP: 09/28/17 1659 SOFT STOP: 0
TO:
START: 08/29/17-1700 STOP: 08/29/17-1700 SOFT STOP:
08/29/17 1629 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SDAS Eff: 08/29/17 1628
Discontinue by SDAS Eff: 08/29/17 1628
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

SLFL50250 - SALMETEROL XINAF/FLUTICASONE 50-250 MCG/DOSE DISKUS

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659 DC: 08/30/17-1152
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $278.67
Rx Number 01541120

History
08/29/17 1628 - POM ORDER by SDAS
08/29/17 1630 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1700
08/30/17 1153 - DISCONTINUE by EALEXEEV Eff: 08/30/17 1152
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/30/17 1248 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/30/17 1153

SLFL50250 - SALMETEROL XINAF/FLUTICASONE 50-250 MCG/DOSE DISKUS

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-1700 Stop Date 08/30/17 1700 DC: 08/30/17-1700
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541286

History
08/30/17 1153 - POM ORDER by EALEXEEV
08/30/17 1222 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/30/17-1700 STOP: 09/29/17 1659 SOFT STOP: 0
TO:
START: 08/30/17-1700 STOP: 08/30/17-1700 SOFT STOP:
08/30/17 1222 - VERIFIED by SYSTEM
Verified in order to DC
08/30/17 1222 - DISCONTINUE by EALEXEEV Eff: 08/30/17 1700
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/30/17 1248 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by EALEXEEV Eff: 08/30/17 1222
Edit by SYSTEM Eff: 08/30/17 1222
Discontinue by EALEXEEV Eff: 08/30/17 1222
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

BNZN100C - BENZONATATE 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659 DC: 08/31/17-1339
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $9.75
Rx Number 01541073

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1543 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
08/31/17 1344 - DISCONTINUE by EALEXEEV Eff: 08/31/17 1339
Items Auto Credited: 10 Doses Auto Credited: 10
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/31/17 1344 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427653
08/31/17 1345 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EALEXEEV Eff: 08/31/17 1344
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/30/17-0745 Stop Date 08/30/17 0746 DC: 08/30/17-0746
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01541235

Discontinued Comments Reached Stop Date

History
08/30/17 0742 - POM ORDER by SMOHAMED
08/30/17 0759 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0745
08/30/17 0759 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 0746
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/31/17-2100 Stop Date 09/05/17 2059 DC: 08/31/17-2100
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541585

History
08/31/17 1332 - POM ORDER by EALEXEEV
08/31/17 1335 - VERIFIED by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
08/31/17 1455 - DISCONTINUE by EALEXEEV Eff: 08/31/17 2100
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/31/17 1455 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427697
08/31/17 1458 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EALEXEEV Eff: 08/31/17 1455
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 1454 (ONE)
Start Date 08/31/17-1454 Stop Date 08/31/17 1455 DC: 08/31/17-1455
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 1 Total Costs $0.00 Total Charges $8.03
Rx Number 01541638

Discontinued Comments Reached Stop Date

History
08/31/17 1455 - POM ORDER by EALEXEEV
08/31/17 1458 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1454
08/31/17 1459 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 1455
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

TS160800 - TRIMETHOPRIM/SULFAMETHOXAZOLE 160-800 MG TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/31/17-2100 Stop Date 08/31/17 2100 DC: 08/31/17-2100
Ordering Doctor Alexeev,Edward MD PGY-4
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 7 Total Costs $ Total Charges $
Rx Number 01541583

History
08/31/17 1303 - POM ORDER by EALEXEEV
08/31/17 1305 - VERIFIED by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
08/31/17 1331 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 08/31/17-2100 STOP: 09/05/17 2059 SOFT STOP:
DISPENSE: 7
TO:
START: 08/31/17-2100 STOP: 08/31/17-2100 SOFT STOP:
DISPENSE: 0
08/31/17 1331 - DISCONTINUE by EALEXEEV Eff: 08/31/17 2100
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/31/17 1335 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by EALEXEEV Eff: 08/31/17 1331
Discontinue by EALEXEEV Eff: 08/31/17 1331
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/29/17-2100 Stop Date 08/29/17 2101 DC: 08/29/17-2101
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541089

Warnings
Type: BURKE
Range: WARFARIN SOD
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.5 MG/DAY - 15 MG/DAY. Ordered dose of 0 MG/DAY is
below the Low Daily Dose.

Discontinued Comments Reached Stop Date

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1548 - VERIFIED by MHAIMOWITZ
08/29/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/30/17-2100 Stop Date 08/30/17 2101 DC: 08/30/17-2100
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541284

History
08/30/17 1159 - POM ORDER by EALEXEEV
08/30/17 1211 - VERIFIED by AMOLINARI
08/30/17 1225 - DISCONTINUE by EALEXEEV Eff: 08/30/17 2100
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/30/17 1248 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/30/17 1225
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/30/17-2100 Stop Date 08/30/17 2101 DC: 08/30/17-2101
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541288

Discontinued Comments Reached Stop Date

History
08/30/17 1231 - POM ORDER by EALEXEEV
08/30/17 1248 - VERIFIED by AMOLINARI
08/30/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/31/17-2100 Stop Date 08/31/17 2101 DC: 08/31/17-2101
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541588

Discontinued Comments Reached Stop Date

History
08/31/17 1346 - POM ORDER by EALEXEEV
08/31/17 1349 - VERIFIED by AADEGBAMIG
08/31/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/01/17-2100 Stop Date 09/01/17 2101 DC: 09/01/17-2100
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541922

History
09/01/17 1258 - POM ORDER by TKOUTZEVA
09/01/17 1302 - DISCONTINUE by TKOUTZEVA Eff: 09/01/17 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
09/01/17 1302 - VERIFIED by SYSTEM
Verified in order to DC
09/01/17 1403 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SYSTEM Eff: 09/01/17 1302
Discontinue by TKOUTZEVA Eff: 09/01/17 1302

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/01/17-2100 Stop Date 09/01/17 2101 DC: 09/01/17-2101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541923

Discontinued Comments Reached Stop Date

History
09/01/17 1303 - POM ORDER by TKOUTZEVA
09/01/17 1305 - VERIFIED by MHERMOSO
09/01/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659 CAN: 08/29/17-1546
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427161

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1546 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
DUPLICATE ORDER

ESOM40CAP - ESOMEPRAZOLE MAGNESIUM 40 MG CPDR

Dose 20 MG (0.5 CAPSULE DELAYED RELEASES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859 CAN: 08/29/17-1559
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427178

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1559 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO 20MG CAP
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

FRIES,FORTUNA W00001219471 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 40 EA (0 EACHS)
Admin Route PO
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659 CAN: 08/29/17-1600
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427174

History
08/29/17 1535 - POM ORDER by SDAS
08/29/17 1600 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO NF ENTRY
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient GALLUZZI,JOHN M Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219714 Location B2EA Unit Number M000209480
Age/Sex 56/M Room 203 Registered Date 09/02/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 2.03 m2

Weight 201 lb 1.6 oz 91.217 kg
Hem-Onc No

Drug Allergies Penicillins

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/02/17-1700 Stop Date 10/02/17 1659
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542248

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1711 - VERIFIED by MHAIMOWITZ

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.03
Rx Number 01542251

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1712 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

GALLUZZI,JOHN M W00001219714 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 8 Total Costs $0.00 Total Charges $68.30
Rx Number 01542252

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1713 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1700 Stop Date 10/02/17 1659
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542253

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1714 - VERIFIED by MHAIMOWITZ

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: constipation
Start Date 09/02/17-1700 Stop Date 10/02/17 1659
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542257

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1714 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

GALLUZZI,JOHN M W00001219714 (Continued)

LBT200T - LABETALOL HCL 200 MG TAB

Dose 200 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 7 Total Costs $0.00 Total Charges $3.40
Rx Number 01542249

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1711 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/03/17 0859
Ordering Doctor AZIZI,HANA MD
Total Dispensed 6 Total Costs $0.00 Total Charges $0.05
Rx Number 01542250

History
09/02/17 1655 - POM ORDER by HAZIZI
09/02/17 1712 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

GALLUZZI,JOHN M W00001219714 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 09/02/17-1700 Stop Date 10/02/17 1659
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542255

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1714 - VERIFIED by MHAIMOWITZ

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1700 Stop Date 10/02/17 1659
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542254

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1714 - VERIFIED by MHAIMOWITZ

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 8 Total Costs $ Total Charges $
Rx Number 01542256

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1714 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

GALLUZZI,JOHN M W00001219714 (Continued)

SERT25TA - SERTRALINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor AZIZI,HANA MD
Total Dispensed 4 Total Costs $0.00 Total Charges $0.40
Rx Number 01542258

History
09/02/17 1652 - POM ORDER by HAZIZI
09/02/17 1714 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient GARCIA,EDWIN Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001217463 Location B2WEII Unit Number M000208357
Age/Sex 27/M Room 251 Registered Date 07/12/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 2.01 in 157.5 cm Body Surface Area 1.85 m2

Weight 185 lb oz 83.915 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/03/17-1045 CHANGE DOSE/FREQUENCY COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

ART15OP - ARTIFICIAL TEARS OP SOLN 15 ML BTL

Dose 2 DROP (2 DROP APPLICATIONS)

Dose Instructions 2 DROPS to left eye only
Admin Route OPHTHALMIC
Frequency 4 TIMES A DAY (SCH)
Start Date 08/08/17-1300 Stop Date 09/07/17 1259
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535107

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528083
08/08/17 1113 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-1300 STOP: 09/07/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/08/17-1300 STOP: 09/07/17-1259 SOFT STOP: 0
DISPENSE: 0
08/08/17 1113 - VERIFIED by EBALILO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

ART3.5OO - ARTIFICIAL TEARS OP OINT 3.5 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions APPLY TO left EYE LID
Admin Route OPHTHALMIC
Frequency 4 TIMES A DAY (SCH)
Start Date 08/08/17-1300 Stop Date 09/07/17 1259
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $7.11
Rx Number 01535106

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528084
08/08/17 1112 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-1300 STOP: 09/07/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/08/17-1300 STOP: 09/07/17-1259 SOFT STOP: 0
DISPENSE: 0
08/08/17 1112 - VERIFIED by EBALILO
08/11/17 1221 - DEBIT by MHAIMOWITZ
ITEMS: 1
08/18/17 0749 - DEBIT by AMOLINARI
ITEMS: 1
08/30/17 1451 - DEBIT by AMACCA
ITEMS: 1

NS.65NA45 - SODIUM CHLORIDE 0.65% NA SOLN 45 ML BTL

Dose 1 SPRAY (1 NASAL APPLICATION)

Dose Instructions apply to both nostrils.
Admin Route NASAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: DRYNASAL - For Dry Nasal Passages
Start Date 08/30/17-1130 Stop Date 09/29/17 1129
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $7.23
Rx Number 01541253

History
08/30/17 1132 - POM ORDER by YOLEE
08/30/17 1149 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 1130
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/08/17-1115 Stop Date 09/07/17 1114
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $5.25
Rx Number 01535100

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528070
08/08/17 1105 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-1115 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/08/17-1115 STOP: 09/07/17-1114 SOFT STOP: 0
08/08/17 1105 - VERIFIED by EBALILO
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

AMIT25TA2 - AMITRIPTYLINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $2.92
Rx Number 01541252

History
08/30/17 1027 - POM ORDER by YOLEE
08/30/17 1148 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/08/17-1115 Stop Date 09/07/17 1114
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535101

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528073
08/08/17 1106 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-1115 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/08/17-1115 STOP: 09/07/17-1114 SOFT STOP: 0
08/08/17 1106 - VERIFIED by EBALILO
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/08/17-1300 Stop Date 09/07/17 1259
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $19.75
Rx Number 01535102

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528069
08/08/17 1106 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-1300 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/08/17-1300 STOP: 09/07/17-1259 SOFT STOP: 0
08/08/17 1106 - VERIFIED by EBALILO
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 0900
For: 08/11/17 - 1300
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 0900
For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/19/17 - 0900

For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 09/02/17 - 1300

For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/07/17 0859
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 28 Total Costs $0.00 Total Charges $7.80
Rx Number 01535108

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528078
08/08/17 1114 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/09/17-0900 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/09/17-0900 STOP: 09/07/17-0859 SOFT STOP: 0
08/08/17 1114 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/26/17 - 0900

For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-1300 Stop Date 09/30/17 1259
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 34 Total Costs $0.00 Total Charges $4.00
Rx Number 01541525

History
08/31/17 1000 - ENTER by AMOLINARI
Items Dispensed: 22 Doses Dispensed: 11
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/08/17-1115 Stop Date 09/07/17 1114
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535103

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528072
08/08/17 1107 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-1115 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/08/17-1115 STOP: 09/07/17-1114 SOFT STOP: 0
08/08/17 1107 - VERIFIED by EBALILO
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/08/17-1115 Stop Date 09/07/17 1114
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01535104

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528071
08/08/17 1108 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-1115 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/08/17-1115 STOP: 09/07/17-1114 SOFT STOP: 0
08/08/17 1108 - VERIFIED by EBALILO
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/11/17-1700 Stop Date 09/10/17 1659
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 51 Total Costs $0.00 Total Charges $11.50
Rx Number 01536061

History
08/11/17 1424 - POM ORDER by YOLEE
08/11/17 1431 - VERIFIED by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/25/17 - 1700

For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/07/17 0859
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $6.50
Rx Number 01535105

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528080
08/08/17 1108 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/09/17-0900 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/09/17-0900 STOP: 09/07/17-0859 SOFT STOP: 0
08/08/17 1108 - VERIFIED by EBALILO
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

NFD60TCR - NIFEDIPINE 60 MG TABCR

Dose 60 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 51 Total Costs $0.00 Total Charges $231.38
Rx Number 01536063

History
08/11/17 1434 - ENTER by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/26/17 - 0900

For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/07/17 0859
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 28 Total Costs $0.00 Total Charges $1.30
Rx Number 01535109

History
08/08/17 1103 - POM COPY AND EDIT by YOLEE
FROM: Rx #01528090
08/08/17 1114 - EDIT by EBALILO
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/09/17-0900 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/09/17-0900 STOP: 09/07/17-0859 SOFT STOP: 0
08/08/17 1114 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/26/17 - 0900

For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

ART15OP - ARTIFICIAL TEARS OP SOLN 15 ML BTL

Dose 2 DROP (2 DROP APPLICATIONS)

Dose Instructions 2 DROPS to left eye only
Admin Route OPHTHALMIC
Frequency 4 TIMES A DAY (SCH)
Start Date 07/12/17-1700 Stop Date 08/11/17 1659 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 2 Total Costs $0.00 Total Charges $11.88
Rx Number 01528083

History
07/12/17 1416 - POM ORDER by EALEXEEV
07/12/17 1420 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/12/17 - 1700
07/23/17 1021 - DEBIT by AADEGBAMIG
ITEMS: 1
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421447
08/08/17 1113 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

ART3.5OO - ARTIFICIAL TEARS OP OINT 3.5 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions APPLY TO left EYE LID
Admin Route OPHTHALMIC
Frequency 4 TIMES A DAY (SCH)
Start Date 07/12/17-1700 Stop Date 08/11/17 1659 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 3 Total Costs $0.00 Total Charges $7.11
Rx Number 01528084

History
07/12/17 1416 - POM ORDER by EALEXEEV
07/12/17 1420 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/12/17 - 1700
07/15/17 1229 - DEBIT by MHAIMOWITZ
ITEMS: 1
07/23/17 1021 - DEBIT by AADEGBAMIG
ITEMS: 1
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421448
08/08/17 1113 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 07/12/17-1400 Stop Date 08/11/17 1359 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01528070

History
07/12/17 1402 - POM ORDER by EALEXEEV
07/12/17 1405 - VERIFIED by AADEGBAMIG
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421446
08/08/17 1107 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/12/17-1400 Stop Date 08/11/17 1359 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01528073

History
07/12/17 1402 - POM ORDER by EALEXEEV
07/12/17 1406 - VERIFIED by AADEGBAMIG
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421449
08/08/17 1107 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/12/17-1700 Stop Date 08/11/17 1659 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $19.00
Rx Number 01528069

History
07/12/17 1402 - POM ORDER by EALEXEEV
07/12/17 1405 - VERIFIED by AADEGBAMIG
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/17/17 - 0900
For: 07/17/17 - 1300
For: 07/17/17 - 1700
For: 07/18/17 - 0900
For: 07/18/17 - 1300
For: 07/18/17 - 1700
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/19/17 - 0900
For: 07/19/17 - 1300
For: 07/19/17 - 1700
For: 07/20/17 - 0900
For: 07/20/17 - 1300
For: 07/20/17 - 1700
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 07/21/17 - 0900
For: 07/21/17 - 1300
For: 07/21/17 - 1700
For: 07/22/17 - 0900
For: 07/22/17 - 1300
For: 07/22/17 - 1700
For: 07/23/17 - 0900
For: 07/23/17 - 1300
For: 07/23/17 - 1700
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 0900
For: 07/24/17 - 1300
For: 07/24/17 - 1700
For: 07/25/17 - 0900
For: 07/25/17 - 1300
For: 07/25/17 - 1700
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 0900
For: 07/26/17 - 1300
For: 07/26/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 07/27/17 - 0900

For: 07/27/17 - 1300
For: 07/27/17 - 1700
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 07/28/17 - 0900
For: 07/28/17 - 1300
For: 07/28/17 - 1700
For: 07/29/17 - 0900
For: 07/29/17 - 1300
For: 07/29/17 - 1700
For: 07/30/17 - 0900
For: 07/30/17 - 1300
For: 07/30/17 - 1700
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/31/17 - 0900
For: 07/31/17 - 1300
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1300
For: 08/01/17 - 1700
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/02/17 - 0900
For: 08/02/17 - 1300
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1300
For: 08/03/17 - 1700
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/04/17 - 0900
For: 08/04/17 - 1300
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/10/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/10/17 - 1300

For: 08/10/17 - 1700
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421450
08/08/17 1107 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/13/17-0900 Stop Date 08/12/17 0859 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 27 Total Costs $0.00 Total Charges $8.10
Rx Number 01528078

History
07/12/17 1416 - POM ORDER by EALEXEEV
07/12/17 1420 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 07/13/17 - 0900
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0824 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421451
08/08/17 1114 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/21/17-2100 Stop Date 07/31/17 0948 DC: 07/31/17-0948
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 14 Total Costs $0.00 Total Charges $2.00
Rx Number 01530309

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
07/21/17 0909 - POM ORDER by EALEXEEV
07/21/17 0953 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
For: 07/24/17 - 2100
For: 07/25/17 - 2100
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 2100
For: 07/27/17 - 2100
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 2100
For: 07/29/17 - 2100
For: 07/30/17 - 2100
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 2100
For: 08/01/17 - 2100
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 2100
For: 08/03/17 - 2100
07/31/17 0949 - DISCONTINUE by EALEXEEV Eff: 07/31/17 0948
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

Order filed UNV:

Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
07/31/17 0949 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 07/21/17-2100 STOP: 08/20/17 2059 SOFT STOP: 0
DISPENSE: 2
TO:
START: 07/21/17-2100 STOP: 07/31/17-0948 SOFT STOP:
DISPENSE: 10
07/31/17 0949 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01419348
07/31/17 1115 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by EALEXEEV Eff: 07/31/17 0949
Discontinue by EALEXEEV Eff: 07/31/17 0949
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/31/17-2100 Stop Date 08/04/17 0930 DC: 08/04/17-0930
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 17 Total Costs $0.00 Total Charges $1.60
Rx Number 01532902

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
07/31/17 0949 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01530309
Result of Frequency/Schedule Edit
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 07/30/17 - 2100
Last Actual Administration Time: 07/30/17 - 2127
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 07/31/17 - 0948
New Order Start: 07/31/17 - 2100
New Order Stop: 08/20/17 - 2059
07/31/17 1114 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by EALEXEEV Eff: 07/31/17 0949
Ordering Doctor: Alexeev,Edward MD PGY-4
Last Scheduled Administration Time: 07/30/17 - 2100
Last Actual Administration Time: 07/30/17 - 2127
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 07/31/17 - 0948
New Order Start: 07/31/17 - 2100
New Order Stop: 08/20/17 - 2059
07/31/17 1114 - VERIFIED by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 2100
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/05/17 - 0900

For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/04/17 0931 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 07/31/17-2100 STOP: 08/20/17 2059 SOFT STOP:
DISPENSE: 4
TO:
START: 07/31/17-2100 STOP: 08/04/17-0930 SOFT STOP:
DISPENSE: 8
08/04/17 0931 - DISCONTINUE by YOLEE Eff: 08/04/17 0930
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
08/04/17 0931 - POM COPY AND EDIT by YOLEE
TO: Rx #U01420537
08/07/17 1206 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by YOLEE Eff: 08/04/17 0931
Discontinue by YOLEE Eff: 08/04/17 0931
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/04/17-1300 Stop Date 08/07/17 1600 DC: 08/07/17-1205
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $2.00
Rx Number 01534192

Discontinued Comments new orders on file

History
08/04/17 0931 - POM COPY AND EDIT by YOLEE
FROM: Rx #01532902
Result of Frequency/Schedule Edit
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/04/17 - 0900
Last Actual Administration Time: 08/04/17 - 0838
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/04/17 - 0930
New Order Start: 08/04/17 - 1300
New Order Stop: 08/20/17 - 2059
08/04/17 1200 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by YOLEE Eff: 08/04/17 0931
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/04/17 - 0900
Last Actual Administration Time: 08/04/17 - 0838
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/04/17 - 0930
New Order Start: 08/04/17 - 1300
New Order Stop: 08/20/17 - 2059
08/04/17 1200 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 08/04/17 - 1300
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 0900
For: 08/09/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/09/17 - 1700

For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
08/07/17 1120 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 08/04/17-1300 STOP: 08/20/17 2059 SOFT STOP:
DISPENSE: 6
TO:
START: 08/04/17-1300 STOP: 08/07/17-1600 SOFT STOP:
DISPENSE: 10
08/07/17 1120 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421154
08/07/17 1205 - DISCONTINUE by MHAIMOWITZ Eff: 08/07/17 1205
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
new orders on file
08/07/17 1206 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by YOLEE Eff: 08/07/17 1120
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@0900,1600 (SCH)
Start Date 08/07/17-1600 Stop Date 08/20/17 2059 DC: 08/10/17-1019
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $1.20
Rx Number 01534811

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
08/07/17 1120 - POM COPY AND EDIT by YOLEE
FROM: Rx #01534192
Result of Frequency/Schedule Edit
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/07/17 - 0900
Last Actual Administration Time: 08/07/17 - 0810
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: DAILY@0900,1600 (SCH)
Old Order Stop: 08/07/17 - 1600
New Order Start: 08/07/17 - 1600
New Order Stop: 08/20/17 - 2059
08/07/17 1205 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by YOLEE Eff: 08/07/17 1120
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/07/17 - 0900
Last Actual Administration Time: 08/07/17 - 0810
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: DAILY@0900,1600 (SCH)
Old Order Stop: 08/07/17 - 1600
New Order Start: 08/07/17 - 1600
New Order Stop: 08/20/17 - 2059
08/07/17 1205 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/07/17 - 1600
For: 08/08/17 - 0900
For: 08/08/17 - 1600
For: 08/09/17 - 0900
For: 08/09/17 - 1600
For: 08/10/17 - 0900
For: 08/10/17 - 1600
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/12/17 - 0900

For: 08/12/17 - 1600
For: 08/13/17 - 0900
For: 08/13/17 - 1600
08/10/17 1021 - DISCONTINUE by YOLEE Eff: 08/10/17 1019
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/10/17 - 1600
For: 08/11/17 - 0900
For: 08/11/17 - 1600
For: 08/12/17 - 0900
For: 08/12/17 - 1600
For: 08/13/17 - 0900
For: 08/13/17 - 1600
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/10/17 1023 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YOLEE Eff: 08/10/17 1021
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/07/17-2100 Stop Date 08/10/17 1020 DC: 08/10/17-1020
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 14 Total Costs $0.00 Total Charges $1.20
Rx Number 01534812

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
08/07/17 1120 - POM ORDER by YOLEE
08/07/17 1205 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 08/07/17 - 2100
For: 08/08/17 - 2100
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/10/17 1021 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 08/07/17-2100 STOP: 09/06/17 2059 SOFT STOP: 0
TO:
START: 08/07/17-2100 STOP: 08/10/17-1020 SOFT STOP:
08/10/17 1021 - DISCONTINUE by YOLEE Eff: 08/10/17 1020
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
08/10/17 1021 - POM COPY AND EDIT by YOLEE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

TO: Rx #U01421898
08/10/17 1023 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YOLEE Eff: 08/10/17 1021
Discontinue by YOLEE Eff: 08/10/17 1021
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/10/17-1300 Stop Date 08/14/17 1330 DC: 08/14/17-1330
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 46 Total Costs $0.00 Total Charges $5.20
Rx Number 01535569

History
08/10/17 1021 - POM COPY AND EDIT by YOLEE
FROM: Rx #01534812
Result of Frequency/Schedule Edit
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/09/17 - 2100
Last Actual Administration Time: 08/09/17 - 2117
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/10/17 - 1020
New Order Start: 08/10/17 - 1300
New Order Stop: 09/06/17 - 2059
08/10/17 1023 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by YOLEE Eff: 08/10/17 1021
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/09/17 - 2100
Last Actual Administration Time: 08/09/17 - 2117
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/10/17 - 1020
New Order Start: 08/10/17 - 1300
New Order Stop: 09/06/17 - 2059
08/10/17 1023 - VERIFIED by AMOLINARI
Items Dispensed: 22 Doses Dispensed: 11
For: 08/10/17 - 1300
For: 08/10/17 - 1700
For: 08/11/17 - 0900
For: 08/11/17 - 1300
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/14/17 - 0900
For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

08/14/17 0813 - FILL by BGIRLING

Items Dispensed: 12 Doses Dispensed: 6
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/14/17 1333 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 08/10/17-1300 STOP: 09/06/17 2059 SOFT STOP:
DISPENSE: 12
TO:
START: 08/10/17-1300 STOP: 08/14/17-1330 SOFT STOP:
DISPENSE: 26
08/14/17 1333 - DISCONTINUE by YOLEE Eff: 08/14/17 1330
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/14/17 1333 - POM COPY AND EDIT by YOLEE
TO: Rx #U01422863
08/14/17 1340 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by YOLEE Eff: 08/14/17 1333
Discontinue by YOLEE Eff: 08/14/17 1333
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency DAILY@0600,1300 (SCH)
Start Date 08/15/17-0600 Stop Date 09/06/17 2059 DC: 08/15/17-1024
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $0.40
Rx Number 01536562

History
08/14/17 1333 - POM COPY AND EDIT by YOLEE
FROM: Rx #01535569
Result of Frequency/Schedule Edit
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/14/17 - 1300
Last Actual Administration Time: 08/14/17 - 1239
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: DAILY@0600,1300 (SCH)
Old Order Stop: 08/14/17 - 1330
New Order Start: 08/15/17 - 0600
New Order Stop: 09/06/17 - 2059
08/14/17 1340 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by YOLEE Eff: 08/14/17 1333
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/14/17 - 1300
Last Actual Administration Time: 08/14/17 - 1239
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: DAILY@0600,1300 (SCH)
Old Order Stop: 08/14/17 - 1330
New Order Start: 08/15/17 - 0600
New Order Stop: 09/06/17 - 2059
08/14/17 1340 - VERIFIED by EBALILO
Items Dispensed: 14 Doses Dispensed: 7
For: 08/15/17 - 0600
For: 08/15/17 - 1300
For: 08/16/17 - 0600
For: 08/16/17 - 1300
For: 08/17/17 - 0600
For: 08/17/17 - 1300
For: 08/18/17 - 0600
08/15/17 1025 - DISCONTINUE by YOLEE Eff: 08/15/17 1024
Items Auto Credited: 12 Doses Auto Credited: 6
For: 08/15/17 - 1300
For: 08/16/17 - 0600
For: 08/16/17 - 1300
For: 08/17/17 - 0600
For: 08/17/17 - 1300
For: 08/18/17 - 0600
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/15/17 1053 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/15/17 1025
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 800 MG (2 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/14/17-2100 Stop Date 08/15/17 1024 DC: 08/15/17-1024
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 8 Total Costs $0.00 Total Charges $8.00
Rx Number 01536563

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 800 MG/DAY
is below the Low Daily Dose.

History
08/14/17 1333 - POM ORDER by YOLEE
08/14/17 1340 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/14/17 - 2100
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/15/17 1025 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 08/14/17-2100 STOP: 09/13/17 2059 SOFT STOP: 0
DISPENSE: 8
TO:
START: 08/14/17-2100 STOP: 08/15/17-1024 SOFT STOP:
DISPENSE: 2
08/15/17 1025 - DISCONTINUE by YOLEE Eff: 08/15/17 1024
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
08/15/17 1025 - POM COPY AND EDIT by YOLEE
TO: Rx #U01423175
08/15/17 1053 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by YOLEE Eff: 08/15/17 1025
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

Discontinue by YOLEE Eff: 08/15/17 1025

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 800 MG (2 CAPSULES)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/15/17-1300 Stop Date 08/21/17 1050 DC: 08/21/17-1050
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 58 Total Costs $0.00 Total Charges $144.00
Rx Number 01536885

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Maximum Daily Dose is 1,800 MG/DAY. Ordered dose of 2,400 MG/DAY
exceeds the Maximum Daily Dose.

History
08/15/17 1025 - POM COPY AND EDIT by YOLEE
FROM: Rx #01536563
Result of Frequency/Schedule Edit
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/14/17 - 2100
Last Actual Administration Time: 08/14/17 - 2102
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/15/17 - 1024
New Order Start: 08/15/17 - 1300
New Order Stop: 09/13/17 - 2059
08/15/17 1041 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by YOLEE Eff: 08/15/17 1025
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/14/17 - 2100
Last Actual Administration Time: 08/14/17 - 2102
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/15/17 - 1024
New Order Start: 08/15/17 - 1300
New Order Stop: 09/13/17 - 2059
08/15/17 1041 - VERIFIED by EBALILO
Items Dispensed: 16 Doses Dispensed: 8
For: 08/15/17 - 1300
For: 08/15/17 - 1700
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 08/18/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/18/17 - 1300

For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/21/17 1057 - EDIT by JHILL
EDIT DOCTOR: HILL,JUSTIN M.D.
FROM:
START: 08/15/17-1300 STOP: 09/13/17 2059 SOFT STOP:
DISPENSE: 12
TO:
START: 08/15/17-1300 STOP: 08/21/17-1050 SOFT STOP:
DISPENSE: 36
08/21/17 1057 - DISCONTINUE by JHILL Eff: 08/21/17 1050
EDIT DOCTOR: HILL,JUSTIN M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

Dose Warnings differ from order entry

08/21/17 1057 - POM COPY AND EDIT by JHILL
TO: Rx #U01424744
08/21/17 1430 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by JHILL Eff: 08/21/17 1057
Discontinue by JHILL Eff: 08/21/17 1057
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 800 MG (2 CAPSULES)

Admin Route ORAL
Frequency DAILY@0900,1300 (SCH)
Start Date 08/21/17-1300 Stop Date 08/31/17 0956 DC: 08/31/17-0956
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 54 Total Costs $0.00 Total Charges $160.00
Rx Number 01538612

History
08/21/17 1057 - POM COPY AND EDIT by JHILL
FROM: Rx #01536885
Result of Frequency/Schedule Edit
Ordering Doctor: HILL,JUSTIN M.D.
Last Scheduled Administration Time: 08/21/17 - 0900
Last Actual Administration Time: 08/21/17 - 0811
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: DAILY@0900,1300 (SCH)
Old Order Stop: 08/21/17 - 1050
New Order Start: 08/21/17 - 1300
New Order Stop: 09/13/17 - 2059
08/21/17 1425 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by JHILL Eff: 08/21/17 1057
Ordering Doctor: HILL,JUSTIN M.D.
Last Scheduled Administration Time: 08/21/17 - 0900
Last Actual Administration Time: 08/21/17 - 0811
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: DAILY@0900,1300 (SCH)
Old Order Stop: 08/21/17 - 1050
New Order Start: 08/21/17 - 1300
New Order Stop: 09/13/17 - 2059
Administration of Unverified Order by JDEPAOLO Eff: 08/21/17 1253
08/21/17 1425 - VERIFIED by EBALILO
Items Dispensed: 14 Doses Dispensed: 7
For: 08/21/17 - 1300
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/24/17 - 0900
For: 08/24/17 - 1300
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/27/17 - 0900
For: 08/27/17 - 1300
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/28/17 - 1300

For: 08/29/17 - 0900
For: 08/29/17 - 1300
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/31/17 - 0900
For: 08/31/17 - 1300
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/03/17 - 0900
For: 09/03/17 - 1300
08/31/17 0957 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 08/21/17-1300 STOP: 09/13/17 2059 SOFT STOP:
DISPENSE: 12
TO:
START: 08/21/17-1300 STOP: 08/31/17-0956 SOFT STOP:
DISPENSE: 40
08/31/17 0957 - DISCONTINUE by YOLEE Eff: 08/31/17 0956
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

08/31/17 0957 - POM COPY AND EDIT by YOLEE

TO: Rx #U01427599
08/31/17 1000 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YOLEE Eff: 08/31/17 0957
Discontinue by YOLEE Eff: 08/31/17 0957
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 07/12/17-2200 Stop Date 08/11/17 2159 DC: 07/17/17-1612
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 15 Total Costs $0.00 Total Charges $129.92
Rx Number 01528079

History
07/12/17 1416 - POM ORDER by EALEXEEV
07/12/17 1420 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 07/12/17 - 2200
For: 07/13/17 - 0600
For: 07/13/17 - 1400
For: 07/13/17 - 2200
For: 07/14/17 - 0600
For: 07/14/17 - 1400
For: 07/14/17 - 2200
For: 07/15/17 - 0600
For: 07/15/17 - 1400
For: 07/15/17 - 2200
For: 07/16/17 - 0600
For: 07/16/17 - 1400
For: 07/16/17 - 2200
For: 07/17/17 - 0600
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/17/17 - 1400
For: 07/17/17 - 2200
For: 07/18/17 - 0600
For: 07/18/17 - 1400
For: 07/18/17 - 2200
For: 07/19/17 - 0600
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/19/17 - 1400
For: 07/19/17 - 2200
For: 07/20/17 - 0600
For: 07/20/17 - 1400
For: 07/20/17 - 2200
For: 07/21/17 - 0600
07/17/17 1614 - DISCONTINUE by EALEXEEV Eff: 07/17/17 1612
Items Auto Credited: 11 Doses Auto Credited: 11
For: 07/17/17 - 2200
For: 07/18/17 - 0600
For: 07/18/17 - 1400
For: 07/18/17 - 2200
For: 07/19/17 - 0600
For: 07/19/17 - 1400
For: 07/19/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 07/20/17 - 0600

For: 07/20/17 - 1400
For: 07/20/17 - 2200
For: 07/21/17 - 0600
EDIT DOCTOR: Alexeev,Edward MD PGY-4
07/17/17 1614 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01415985
07/17/17 1616 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EALEXEEV Eff: 07/17/17 1614

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 07/17/17-2200 Stop Date 07/18/17 2159 DC: 07/18/17-2159
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 3 Total Costs $0.00 Total Charges $27.84
Rx Number 01529408

Discontinued Comments Reached Stop Date

History
07/17/17 1614 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01528079
07/17/17 1615 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 07/17/17 - 2200
For: 07/18/17 - 0600
For: 07/18/17 - 1400
07/18/17 2200 - DISCONTINUE by PHABKGJOB Eff: 07/18/17 2159
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 07/12/17-1400 Stop Date 08/11/17 1359 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01528072

History
07/12/17 1402 - POM ORDER by EALEXEEV
07/12/17 1406 - VERIFIED by AADEGBAMIG
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421452
08/08/17 1107 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/12/17-1400 Stop Date 08/11/17 1359 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01528071

History
07/12/17 1402 - POM ORDER by EALEXEEV
07/12/17 1406 - VERIFIED by AADEGBAMIG
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421453
08/08/17 1108 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/13/17-0900 Stop Date 08/12/17 0859 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $6.75
Rx Number 01528080

History
07/12/17 1416 - POM ORDER by EALEXEEV
07/12/17 1420 - VERIFIED by AADEGBAMIG
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421454
08/08/17 1108 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

NFD30TCR1 - NIFEDIPINE 30 MG TABCR

Dose 30 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/13/17-0900 Stop Date 08/12/17 0859 DC: 07/27/17-1032
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 15 Total Costs $0.00 Total Charges $79.95
Rx Number 01528081

History
07/12/17 1416 - POM ORDER by EALEXEEV
07/12/17 1420 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 07/13/17 - 0900
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/27/17 1033 - DISCONTINUE by EALEXEEV Eff: 07/27/17 1032
Items Auto Credited: 3 Doses Auto Credited: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
07/27/17 1033 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01418544
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

07/27/17 1033 - REVIEW PROVIDER ACTIVITY by AMACCA

Discontinue by EALEXEEV Eff: 07/27/17 1033

NFD30TCR1 - NIFEDIPINE 30 MG TABCR

Dose 60 MG (2 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 07/28/17-0900
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01532088

History
07/27/17 1033 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01528081
07/27/17 1034 - VERIFIED by SYSTEM
Verified in order to DC
07/27/17 1034 - DISCONTINUE by AMACCA Eff: 07/28/17 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

NFD60TCR - NIFEDIPINE 60 MG TABCR

Dose 60 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 07/31/17-0949
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $20.12
Rx Number 01532089

History
07/27/17 1035 - ENTER by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
07/31/17 0950 - DISCONTINUE by EALEXEEV Eff: 07/31/17 0949
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
07/31/17 0950 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01419349
07/31/17 1115 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 07/31/17 0950
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

NFD90TCR1 - NIFEDIPINE 90 MG TABCR

Dose 90 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/03/17 1030 DC: 08/03/17-1030
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 6 Total Costs $0.00 Total Charges $18.00
Rx Number 01532903

History
07/31/17 1115 - ENTER by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/03/17 1041 - DISCONTINUE by YOLEE Eff: 08/03/17 1030
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/03/17 1041 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 08/01/17-0900 STOP: 08/31/17 0859 SOFT STOP: 0
TO:
START: 08/01/17-0900 STOP: 08/03/17-1030 SOFT STOP:
08/03/17 1041 - POM COPY AND EDIT by YOLEE
TO: Rx #U01420263
08/03/17 1045 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YOLEE Eff: 08/03/17 1041
Discontinue by YOLEE Eff: 08/03/17 1041
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

NFD60TCR - NIFEDIPINE 60 MG TABCR

Dose 60 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/03/17-2100 Stop Date 09/02/17 2059 DC: 08/11/17-1405
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $80.48
Rx Number 01533879

History
08/03/17 1045 - ENTER by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 08/03/17 - 2100
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/11/17 1407 - DISCONTINUE by YOLEE Eff: 08/11/17 1405
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

For: 08/13/17 - 2100

For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/11/17 1407 - POM COPY AND EDIT by YOLEE
TO: Rx #U01422380
08/11/17 1412 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YOLEE Eff: 08/11/17 1407

NFD60TCR - NIFEDIPINE 60 MG TABCR

Dose 90 MG (1.5 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/11/17-2100
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536059

History
08/11/17 1407 - POM COPY AND EDIT by YOLEE
FROM: Rx #01533879
08/11/17 1412 - DISCONTINUE by AMOLINARI Eff: 08/11/17 2100
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/11/17 1412 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

NFD90TCR - NIFEDIPINE 90 MG TABCR

Dose 90 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/11/17-2100
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536060

History
08/11/17 1414 - ENTER by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/11/17 1422 - DISCONTINUE by YOLEE Eff: 08/11/17 2100
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/11/17 1422 - POM COPY AND EDIT by YOLEE
TO: Rx #U01422381
08/11/17 1430 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YOLEE Eff: 08/11/17 1422
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

NFD90TCR - NIFEDIPINE 90 MG TABCR

Dose 60 MG (0.666667 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/11/17-2100
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536062

History
08/11/17 1422 - POM COPY AND EDIT by YOLEE
FROM: Rx #01536060
08/11/17 1433 - VERIFIED by SYSTEM
Verified in order to DC
08/11/17 1433 - DISCONTINUE by AMOLINARI Eff: 08/11/17 2100
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

THM100V - THIAMINE HCL 100 MG/ML VIAL

Dose 100 MG (1 ML)

Admin Route INTRAMUSC.
Frequency DAILY (SCH)
Start Date 07/13/17-0900 Stop Date 07/13/17 0900 DC: 07/13/17-0900
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01528082

History
07/12/17 1416 - POM ORDER by EALEXEEV
07/12/17 1420 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 07/13/17 - 0900
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/12/17 1527 - EDIT by EALEXEEV
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
START: 07/13/17-0900 STOP: 08/12/17 0859 SOFT STOP: 0
DISPENSE: 4
TO:
START: 07/13/17-0900 STOP: 07/13/17-0900 SOFT STOP:
DISPENSE: 0
07/12/17 1527 - DISCONTINUE by EALEXEEV Eff: 07/13/17 0900
EDIT DOCTOR: Alexeev,Edward MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
07/12/17 1529 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by EALEXEEV Eff: 07/12/17 1527
Discontinue by EALEXEEV Eff: 07/12/17 1527
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/13/17-0900 Stop Date 08/12/17 0859 DC: 08/08/17-1103
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 27 Total Costs $0.00 Total Charges $1.35
Rx Number 01528090

History
07/12/17 1527 - POM ORDER by EALEXEEV
07/12/17 1528 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 07/13/17 - 0900
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0815 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0824 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/08/17 1103 - DISCONTINUE by YOLEE Eff: 08/08/17 1103
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/08/17 1103 - POM COPY AND EDIT by YOLEE
TO: Rx #U01421455
08/08/17 1114 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by YOLEE Eff: 08/08/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP - 600 MG

GBPN400C - GABAPENTIN 400 MG CAP - 400 MG

Dose 1,000 MG (3 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 DC: 08/31/17-0956
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 30 Total Costs $0.00 Total Charges $44.00
Rx Number 01538613

History
08/21/17 1430 - ENTER by EBALILO
Items Dispensed: 12 Doses Dispensed: 4
For: 08/21/17 - 2100
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/31/17 0956 - DISCONTINUE by YOLEE Eff: 08/31/17 0956
Items Auto Credited: 12 Doses Auto Credited: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/31/17 1000 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YOLEE Eff: 08/31/17 0956
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 1,000 MG (2.5 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 CAN: 08/21/17-1427
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424745

History
08/21/17 1057 - POM ORDER by JHILL
08/21/17 1427 - CANCEL by EBALILO
EDIT DOCTOR: HILL,JUSTIN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO SPLIT MED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 600 MG (1.5 CAPSULES)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-1300 Stop Date 09/13/17 2059 CAN: 08/31/17-0959
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427599

History
08/31/17 0957 - POM COPY AND EDIT by YOLEE
FROM: Rx #01538612
Result of Frequency/Schedule Edit
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/31/17 - 0900
Last Actual Administration Time: 08/31/17 - 0946
Old Freq/Sch: DAILY@0900,1300 (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/31/17 - 0956
New Order Start: 08/31/17 - 1300
New Order Stop: 09/13/17 - 2059
08/31/17 0959 - CANCEL by AMOLINARI
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 300MG CAP
08/31/17 1000 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by YOLEE Eff: 08/31/17 0957
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/31/17 - 0900
Last Actual Administration Time: 08/31/17 - 0946
Old Freq/Sch: DAILY@0900,1300 (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/31/17 - 0956
New Order Start: 08/31/17 - 1300
New Order Stop: 09/13/17 - 2059
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

NFD60TCR - NIFEDIPINE 60 MG TABCR

Dose 90 MG (1.5 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/31/17 0859 CAN: 07/31/17-1115
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01419349

History
07/31/17 0950 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01532089
07/31/17 1115 - CANCEL by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 90MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

GARCIA,EDWIN W00001217463 (Continued)

NFD90TCR1 - NIFEDIPINE 90 MG TABCR

Dose 60 MG (0.666667 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/03/17-2100 Stop Date 08/31/17 0859 CAN: 08/03/17-1044
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01420263

History
08/03/17 1041 - POM COPY AND EDIT by YOLEE
FROM: Rx #01532903
Result of Frequency/Schedule Edit
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/03/17 - 0900
Last Actual Administration Time: 08/03/17 - 0831
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/03/17 - 1030
New Order Start: 08/03/17 - 2100
New Order Stop: 08/31/17 - 0859
08/03/17 1044 - CANCEL by AMOLINARI
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO 60MG TAB
08/03/17 1045 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by YOLEE Eff: 08/03/17 1041
Ordering Doctor: LEE,YOUNGHOON MD, PGY-3
Last Scheduled Administration Time: 08/03/17 - 0900
Last Actual Administration Time: 08/03/17 - 0831
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/03/17 - 1030
New Order Start: 08/03/17 - 2100
New Order Stop: 08/31/17 - 0859
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient GARCIA,JESUS D Responsible Doctor AMBROSE,ANNE MD

Account Number W00001215931 Location B2WEII Unit Number M000207855
Age/Sex 50/M Room 250 Registered Date 06/15/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 4.02 in 162.6 cm Body Surface Area 1.89 m2

Weight 184 lb 8 oz 83.688 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/09/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 25 Total Costs $0.00 Total Charges $6.90
Rx Number 01536027

History
08/11/17 1143 - POM COPY AND EDIT by SDAS
FROM: Rx #01529128
08/11/17 1209 - EDIT by AMOLINARI
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/12/17-0900 STOP: 09/09/17 SOFT STOP:
TO:
START: 08/12/17-0900 STOP: 09/09/17-0859 SOFT STOP: 0
08/11/17 1209 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/09/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $5.75
Rx Number 01536028

History
08/11/17 1143 - POM COPY AND EDIT by SDAS
FROM: Rx #01529129
08/11/17 1210 - EDIT by AMOLINARI
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/12/17-0900 STOP: 09/09/17 SOFT STOP:
TO:
START: 08/12/17-0900 STOP: 09/09/17-0859 SOFT STOP: 0
08/11/17 1210 - VERIFIED by AMOLINARI
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

For: 09/01/17 - 0900

For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

QTP100T - QUETIAPINE FUMARATE 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 17 Total Costs $0.00 Total Charges $200.16
Rx Number 01540700

History
08/28/17 1343 - ENTER by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

SRTR50T - SERTRALINE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route ORAL
Frequency AFTER BREAKFAST (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $1.60
Rx Number 01541419

History
08/30/17 1729 - ENTER by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/09/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 25 Total Costs $0.00 Total Charges $1.15
Rx Number 01536029

History
08/11/17 1143 - POM COPY AND EDIT by SDAS
FROM: Rx #01529131
08/11/17 1210 - EDIT by AMOLINARI
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/12/17-0900 STOP: 09/09/17 SOFT STOP:
TO:
START: 08/12/17-0900 STOP: 09/09/17-0859 SOFT STOP: 0
08/11/17 1210 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

RFR3.5OO - MINERAL OIL/WHITE PETROL. OP OINT 3.5 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Admin Route OPHTHALMIC
Frequency 4 TIMES A DAY (SCH)
Start Date 06/15/17-1700 Stop Date 07/15/17 1659 DC: 07/15/17-1659
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 2 Total Costs $0.00 Total Charges $56.22
Rx Number 01521254

Discontinued Comments Reached Stop Date

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1620 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 06/15/17 - 1700
06/20/17 0741 - DEBIT by AMOLINARI
ITEMS: 1
07/15/17 1700 - DISCONTINUE by PHABKGJOB Eff: 07/15/17 1659
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 06/15/17-1615 Stop Date 07/15/17 1614 DC: 07/15/17-1614
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01521248

Discontinued Comments Reached Stop Date

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1620 - VERIFIED by AADEGBAMIG
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 0 Doses Dispensed: 0
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 0 Doses Dispensed: 0
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/15/17 1614 - DISCONTINUE by PHABKGJOB Eff: 07/15/17 1614
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 06/15/17-1615 Stop Date 07/15/17 1614 DC: 07/15/17-1614
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01521251

Discontinued Comments Reached Stop Date

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1620 - VERIFIED by AADEGBAMIG
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 0 Doses Dispensed: 0
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 0 Doses Dispensed: 0
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/15/17 1614 - DISCONTINUE by PHABKGJOB Eff: 07/15/17 1614
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 06/15/17-1700 Stop Date 07/15/17 1659 DC: 07/15/17-1659
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $20.75
Rx Number 01521247

Discontinued Comments Reached Stop Date

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1620 - VERIFIED by AADEGBAMIG
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 6 Doses Dispensed: 6
For: 06/19/17 - 0900
For: 06/19/17 - 1300
For: 06/19/17 - 1700
For: 06/20/17 - 0900
For: 06/20/17 - 1300
For: 06/20/17 - 1700
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/21/17 - 0900
For: 06/21/17 - 1300
For: 06/21/17 - 1700
For: 06/22/17 - 0900
For: 06/22/17 - 1300
For: 06/22/17 - 1700
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 06/23/17 - 0900
For: 06/23/17 - 1300
For: 06/23/17 - 1700
For: 06/24/17 - 0900
For: 06/24/17 - 1300
For: 06/24/17 - 1700
For: 06/25/17 - 0900
For: 06/25/17 - 1300
For: 06/25/17 - 1700
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 06/26/17 - 0900
For: 06/26/17 - 1300
For: 06/26/17 - 1700
For: 06/27/17 - 0900
For: 06/27/17 - 1300
For: 06/27/17 - 1700
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 06/28/17 - 0900
For: 06/28/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

For: 06/28/17 - 1700

For: 06/29/17 - 0900
For: 06/29/17 - 1300
For: 06/29/17 - 1700
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 06/30/17 - 0900
For: 06/30/17 - 1300
For: 06/30/17 - 1700
For: 07/01/17 - 0900
For: 07/01/17 - 1300
For: 07/01/17 - 1700
For: 07/02/17 - 0900
For: 07/02/17 - 1300
For: 07/02/17 - 1700
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/03/17 - 0900
For: 07/03/17 - 1300
For: 07/03/17 - 1700
For: 07/04/17 - 0900
For: 07/04/17 - 1300
For: 07/04/17 - 1700
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/05/17 - 0900
For: 07/05/17 - 1300
For: 07/05/17 - 1700
For: 07/06/17 - 0900
For: 07/06/17 - 1300
For: 07/06/17 - 1700
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 07/07/17 - 0900
For: 07/07/17 - 1300
For: 07/07/17 - 1700
For: 07/08/17 - 0900
For: 07/08/17 - 1300
For: 07/08/17 - 1700
For: 07/09/17 - 0900
For: 07/09/17 - 1300
For: 07/09/17 - 1700
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/10/17 - 0900
For: 07/10/17 - 1300
For: 07/10/17 - 1700
For: 07/11/17 - 0900
For: 07/11/17 - 1300
For: 07/11/17 - 1700
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/12/17 - 0900
For: 07/12/17 - 1300
For: 07/12/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

For: 07/13/17 - 0900

For: 07/13/17 - 1300
For: 07/13/17 - 1700
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 07/14/17 - 0900
For: 07/14/17 - 1300
For: 07/14/17 - 1700
For: 07/15/17 - 0900
For: 07/15/17 - 1300
07/15/17 1700 - DISCONTINUE by PHABKGJOB Eff: 07/15/17 1659
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/16/17-0900 Stop Date 07/16/17 0859 DC: 07/15/17-2139
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 30 Total Costs $0.00 Total Charges $9.00
Rx Number 01521252

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1620 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 06/16/17 - 0900
For: 06/17/17 - 0900
For: 06/18/17 - 0900
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/19/17 - 0900
For: 06/20/17 - 0900
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/21/17 - 0900
For: 06/22/17 - 0900
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/26/17 - 0900
For: 06/27/17 - 0900
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

For: 07/07/17 - 0900

For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/14/17 - 0900
For: 07/15/17 - 0900
07/15/17 2139 - DISCONTINUE by GSYRKIN Eff: 07/15/17 2139
EDIT DOCTOR: SYRKIN,GRIGORY MD
07/15/17 2139 - POM COPY AND EDIT by GSYRKIN
TO: Rx #U01415684
07/16/17 1120 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by GSYRKIN Eff: 07/15/17 2139
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/16/17-0900 Stop Date 08/14/17 0859 DC: 08/11/17-1142
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 27 Total Costs $0.00 Total Charges $8.10
Rx Number 01529128

History
07/15/17 2139 - POM COPY AND EDIT by GSYRKIN
FROM: Rx #01521252
07/16/17 1118 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by SANTONY Eff: 07/16/17 0824
07/16/17 1118 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 07/16/17 - 0900
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/16/17 1432 - EDIT by MHAIMOWITZ
EDIT DOCTOR: SYRKIN,GRIGORY MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/16/17-0900 STOP: 08/14/17 SOFT STOP:
TO:
START: 07/16/17-0900 STOP: 08/14/17-0859 SOFT STOP: 0
07/17/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0824 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

07/31/17 0832 - FILL by BGIRLING

Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 1143 - DISCONTINUE by SDAS Eff: 08/11/17 1142
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/12/17 - 0900
For: 08/13/17 - 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/11/17 1143 - POM COPY AND EDIT by SDAS
TO: Rx #U01422347
08/11/17 1210 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SDAS Eff: 08/11/17 1143
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

IBUP200T8 - IBUPROFEN 200 MG TAB

Dose 400 MG (2 TABLETS)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/13/17-1345 Stop Date 08/13/17 1346 DC: 08/13/17-1346
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.35
Rx Number 01536396

Discontinued Comments Reached Stop Date

History
08/13/17 1343 - POM ORDER by NCHANDEL
08/13/17 1347 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 08/13/17 - 1345
08/13/17 1347 - DISCONTINUE by PHABKGJOB Eff: 08/13/17 1346
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

LBT100T - LABETALOL HCL 100 MG TAB

Dose 300 MG (3 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 06/15/17-2200 Stop Date 07/15/17 2159 DC: 06/15/17-2200
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01521257

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1624 - VERIFIED by SYSTEM
Verified in order to DC
06/15/17 1624 - DISCONTINUE by AADEGBAMIG Eff: 06/15/17 2200
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

LBT200T - LABETALOL HCL 200 MG TAB

Dose 300 MG (1.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 06/15/17-2200 Stop Date 07/15/17 2159 DC: 07/15/17-2139
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 180 Total Costs $0.00 Total Charges $248.20
Rx Number 01521256

Discontinued Comments dose adjustment

History
06/15/17 1624 - ENTER by AADEGBAMIG
Items Dispensed: 22 Doses Dispensed: 11
For: 06/15/17 - 2200
For: 06/16/17 - 0600
For: 06/16/17 - 1400
For: 06/16/17 - 2200
For: 06/17/17 - 0600
For: 06/17/17 - 1400
For: 06/17/17 - 2200
For: 06/18/17 - 0600
For: 06/18/17 - 1400
For: 06/18/17 - 2200
For: 06/19/17 - 0600
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 12 Doses Dispensed: 6
For: 06/19/17 - 1400
For: 06/19/17 - 2200
For: 06/20/17 - 0600
For: 06/20/17 - 1400
For: 06/20/17 - 2200
For: 06/21/17 - 0600
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 06/21/17 - 1400
For: 06/21/17 - 2200
For: 06/22/17 - 0600
For: 06/22/17 - 1400
For: 06/22/17 - 2200
For: 06/23/17 - 0600
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 06/23/17 - 1400
For: 06/23/17 - 2200
For: 06/24/17 - 0600
For: 06/24/17 - 1400
For: 06/24/17 - 2200
For: 06/25/17 - 0600
For: 06/25/17 - 1400
For: 06/25/17 - 2200
For: 06/26/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

06/23/17 0822 - FILL by AADEGBAMIG

Items Dispensed: 12 Doses Dispensed: 6
For: 06/26/17 - 1400
For: 06/26/17 - 2200
For: 06/27/17 - 0600
For: 06/27/17 - 1400
For: 06/27/17 - 2200
For: 06/28/17 - 0600
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 06/28/17 - 1400
For: 06/28/17 - 2200
For: 06/29/17 - 0600
For: 06/29/17 - 1400
For: 06/29/17 - 2200
For: 06/30/17 - 0600
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 18 Doses Dispensed: 9
For: 06/30/17 - 1400
For: 06/30/17 - 2200
For: 07/01/17 - 0600
For: 07/01/17 - 1400
For: 07/01/17 - 2200
For: 07/02/17 - 0600
For: 07/02/17 - 1400
For: 07/02/17 - 2200
For: 07/03/17 - 0600
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 07/03/17 - 1400
For: 07/03/17 - 2200
For: 07/04/17 - 0600
For: 07/04/17 - 1400
For: 07/04/17 - 2200
For: 07/05/17 - 0600
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 07/05/17 - 1400
For: 07/05/17 - 2200
For: 07/06/17 - 0600
For: 07/06/17 - 1400
For: 07/06/17 - 2200
For: 07/07/17 - 0600
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 18 Doses Dispensed: 9
For: 07/07/17 - 1400
For: 07/07/17 - 2200
For: 07/08/17 - 0600
For: 07/08/17 - 1400
For: 07/08/17 - 2200
For: 07/09/17 - 0600
For: 07/09/17 - 1400
For: 07/09/17 - 2200
For: 07/10/17 - 0600
07/07/17 0827 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

Items Dispensed: 12 Doses Dispensed: 6

For: 07/10/17 - 1400
For: 07/10/17 - 2200
For: 07/11/17 - 0600
For: 07/11/17 - 1400
For: 07/11/17 - 2200
For: 07/12/17 - 0600
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 07/12/17 - 1400
For: 07/12/17 - 2200
For: 07/13/17 - 0600
For: 07/13/17 - 1400
For: 07/13/17 - 2200
For: 07/14/17 - 0600
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 07/14/17 - 1400
For: 07/14/17 - 2200
For: 07/15/17 - 0600
For: 07/15/17 - 1400
07/15/17 2143 - DISCONTINUE by GSYRKIN Eff: 07/15/17 2139
EDIT DOCTOR: SYRKIN,GRIGORY MD
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dose adjustment
07/16/17 1120 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by GSYRKIN Eff: 07/15/17 2143
dose adjustment
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

LBT200T - LABETALOL HCL 200 MG TAB

Dose 200 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 07/15/17-2200 Stop Date 08/14/17 2159 DC: 07/17/17-1031
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 5 Total Costs $0.00 Total Charges $6.80
Rx Number 01529130

History
07/15/17 2143 - POM ORDER by GSYRKIN
07/16/17 1119 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by ABRONDO Eff: 07/15/17 2224
Administration of Unverified Order by BYOHANNAN Eff: 07/16/17 0539
07/16/17 1119 - VERIFIED by MHAIMOWITZ
Items Dispensed: 11 Doses Dispensed: 11
For: 07/15/17 - 2200
For: 07/16/17 - 0600
For: 07/16/17 - 1400
For: 07/16/17 - 2200
For: 07/17/17 - 0600
For: 07/17/17 - 1400
For: 07/17/17 - 2200
For: 07/18/17 - 0600
For: 07/18/17 - 1400
For: 07/18/17 - 2200
For: 07/19/17 - 0600
07/17/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/19/17 - 1400
For: 07/19/17 - 2200
For: 07/20/17 - 0600
For: 07/20/17 - 1400
For: 07/20/17 - 2200
For: 07/21/17 - 0600
07/17/17 1031 - DISCONTINUE by SDAS Eff: 07/17/17 1031
Items Auto Credited: 12 Doses Auto Credited: 12
For: 07/17/17 - 1400
For: 07/17/17 - 2200
For: 07/18/17 - 0600
For: 07/18/17 - 1400
For: 07/18/17 - 2200
For: 07/19/17 - 0600
For: 07/19/17 - 1400
For: 07/19/17 - 2200
For: 07/20/17 - 0600
For: 07/20/17 - 1400
For: 07/20/17 - 2200
For: 07/21/17 - 0600
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
07/24/17 1100 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

Discontinue by SDAS Eff: 07/17/17 1031

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 06/15/17-1615 Stop Date 07/15/17 1614 DC: 07/15/17-1614
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01521250

Discontinued Comments Reached Stop Date

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1620 - VERIFIED by AADEGBAMIG
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 0 Doses Dispensed: 0
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 0 Doses Dispensed: 0
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/15/17 1614 - DISCONTINUE by PHABKGJOB Eff: 07/15/17 1614
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 06/15/17-1615 Stop Date 07/15/17 1614 DC: 07/15/17-1614
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01521249

Discontinued Comments Reached Stop Date

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1620 - VERIFIED by AADEGBAMIG
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 0 Doses Dispensed: 0
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 0 Doses Dispensed: 0
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/15/17 1614 - DISCONTINUE by PHABKGJOB Eff: 07/15/17 1614
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/16/17-0900 Stop Date 07/16/17 0859 DC: 07/15/17-2139
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $7.50
Rx Number 01521253

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1620 - VERIFIED by AADEGBAMIG
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/19/17 - 0900
For: 06/20/17 - 0900
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/21/17 - 0900
For: 06/22/17 - 0900
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/26/17 - 0900
For: 06/27/17 - 0900
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0827 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/14/17 - 0900
For: 07/15/17 - 0900
07/15/17 2139 - DISCONTINUE by GSYRKIN Eff: 07/15/17 2139
EDIT DOCTOR: SYRKIN,GRIGORY MD
07/15/17 2139 - POM COPY AND EDIT by GSYRKIN
TO: Rx #U01415685
07/16/17 1120 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by GSYRKIN Eff: 07/15/17 2139
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/16/17-0900 Stop Date 08/14/17 0859 DC: 08/11/17-1142
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $0.00 Total Charges $6.50
Rx Number 01529129

History
07/15/17 2139 - POM COPY AND EDIT by GSYRKIN
FROM: Rx #01521253
07/16/17 1118 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by SANTONY Eff: 07/16/17 0824
07/16/17 1118 - VERIFIED by MHAIMOWITZ
07/16/17 1432 - EDIT by MHAIMOWITZ
EDIT DOCTOR: SYRKIN,GRIGORY MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/16/17-0900 STOP: 08/14/17 SOFT STOP:
TO:
START: 07/16/17-0900 STOP: 08/14/17-0859 SOFT STOP: 0
07/17/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0824 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0832 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

08/02/17 0825 - FILL by AMOLINARI

Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 1143 - DISCONTINUE by SDAS Eff: 08/11/17 1142
For: 08/12/17 - 0900
For: 08/13/17 - 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/11/17 1143 - POM COPY AND EDIT by SDAS
TO: Rx #U01422348
08/11/17 1210 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SDAS Eff: 08/11/17 1143
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/22/17-0900 Stop Date 07/24/17 0859 DC: 07/24/17-0859
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $7.25
Rx Number 01522674

Discontinued Comments Reached Stop Date

History
06/21/17 1524 - POM ORDER by GGARRISON
06/21/17 1525 - VERIFIED by MHAIMOWITZ
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/26/17 - 0900
For: 06/27/17 - 0900
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

07/14/17 0818 - FILL by AMOLINARI

Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/24/17 0859 - DISCONTINUE by PHABKGJOB Eff: 07/24/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/24/17-1245 Stop Date 08/25/17 1244 DC: 08/25/17-1244
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01530890

Discontinued Comments Reached Stop Date

History
07/24/17 1234 - POM ORDER by SDAS
07/24/17 1242 - VERIFIED by AADEGBAMIG
07/26/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0832 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 1244 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 1244
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/15/17-2100 Stop Date 07/15/17 2059 DC: 06/16/17-1646
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 2 Total Costs $0.00 Total Charges $19.46
Rx Number 01521279

History
06/15/17 1746 - POM ORDER by GGARRISON
06/15/17 1754 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 06/15/17 - 2100
For: 06/16/17 - 0900
For: 06/16/17 - 2100
For: 06/17/17 - 0900
For: 06/17/17 - 2100
For: 06/18/17 - 0900
For: 06/18/17 - 2100
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 06/19/17 - 0900
For: 06/19/17 - 2100
For: 06/20/17 - 0900
For: 06/20/17 - 2100
06/16/17 1647 - DISCONTINUE by GGARRISON Eff: 06/16/17 1646
Items Auto Credited: 9 Doses Auto Credited: 9
For: 06/16/17 - 2100
For: 06/17/17 - 0900
For: 06/17/17 - 2100
For: 06/18/17 - 0900
For: 06/18/17 - 2100
For: 06/19/17 - 0900
For: 06/19/17 - 2100
For: 06/20/17 - 0900
For: 06/20/17 - 2100
EDIT DOCTOR: GARRISON,GRAHAM MD
06/16/17 1647 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01408430
06/16/17 1649 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by GGARRISON Eff: 06/16/17 1647
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 37.5 MG (1.5 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/16/17-2100 Stop Date 07/16/17 2059 DC: 06/20/17-1250
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 16 Total Costs $0.00 Total Charges $155.60
Rx Number 01521579

History
06/16/17 1647 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01521279
06/16/17 1649 - VERIFIED by MHAIMOWITZ
Items Dispensed: 18 Doses Dispensed: 9
For: 06/16/17 - 2100
For: 06/17/17 - 0900
For: 06/17/17 - 2100
For: 06/18/17 - 0900
For: 06/18/17 - 2100
For: 06/19/17 - 0900
For: 06/19/17 - 2100
For: 06/20/17 - 0900
For: 06/20/17 - 2100
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 06/21/17 - 0900
For: 06/21/17 - 2100
For: 06/22/17 - 0900
For: 06/22/17 - 2100
06/20/17 1251 - DISCONTINUE by GGARRISON Eff: 06/20/17 1250
Items Auto Credited: 10 Doses Auto Credited: 5
For: 06/20/17 - 2100
For: 06/21/17 - 0900
For: 06/21/17 - 2100
For: 06/22/17 - 0900
For: 06/22/17 - 2100
EDIT DOCTOR: GARRISON,GRAHAM MD
06/20/17 1251 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01409104
06/20/17 1255 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/20/17 1251
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/20/17-2100 Stop Date 07/20/17 2059 DC: 06/22/17-1553
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 8 Total Costs $0.00 Total Charges $77.80
Rx Number 01522283

History
06/20/17 1251 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01521579
06/20/17 1255 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 06/20/17 - 2100
For: 06/21/17 - 0900
For: 06/21/17 - 2100
For: 06/22/17 - 0900
For: 06/22/17 - 2100
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 06/23/17 - 0900
For: 06/23/17 - 2100
For: 06/24/17 - 0900
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 2100
06/22/17 1554 - DISCONTINUE by GGARRISON Eff: 06/22/17 1553
Items Auto Credited: 14 Doses Auto Credited: 7
For: 06/22/17 - 2100
For: 06/23/17 - 0900
For: 06/23/17 - 2100
For: 06/24/17 - 0900
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 2100
EDIT DOCTOR: GARRISON,GRAHAM MD FELLOW
06/22/17 1554 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01409736
06/22/17 1607 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by GGARRISON Eff: 06/22/17 1554
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 62.5 MG (2.5 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/22/17-2100 Stop Date 07/22/17 2059 DC: 06/23/17-1448
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 6 Total Costs $0.00 Total Charges $58.36
Rx Number 01522948

History
06/22/17 1554 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01522283
06/22/17 1607 - VERIFIED by MHAIMOWITZ
Items Dispensed: 21 Doses Dispensed: 7
For: 06/22/17 - 2100
For: 06/23/17 - 0900
For: 06/23/17 - 2100
For: 06/24/17 - 0900
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 2100
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 4
For: 06/26/17 - 0900
For: 06/26/17 - 2100
For: 06/27/17 - 0900
For: 06/27/17 - 2100
06/23/17 1449 - DISCONTINUE by GGARRISON Eff: 06/23/17 1448
Items Auto Credited: 27 Doses Auto Credited: 9
For: 06/23/17 - 2100
For: 06/24/17 - 0900
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 2100
For: 06/26/17 - 0900
For: 06/26/17 - 2100
For: 06/27/17 - 0900
For: 06/27/17 - 2100
EDIT DOCTOR: GARRISON,GRAHAM MD FELLOW
06/23/17 1449 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01410038
06/23/17 1450 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/23/17 1449
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 75 MG (3 TABLETS)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/23/17-2100 Stop Date 07/23/17 2059 DC: 06/27/17-1524
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 24 Total Costs $0.00 Total Charges $233.44
Rx Number 01523254

History
06/23/17 1449 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01522948
06/23/17 1451 - VERIFIED by AMACCA
Items Dispensed: 27 Doses Dispensed: 9
For: 06/23/17 - 2100
For: 06/24/17 - 0900
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 2100
For: 06/26/17 - 0900
For: 06/26/17 - 2100
For: 06/27/17 - 0900
For: 06/27/17 - 2100
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 4
For: 06/28/17 - 0900
For: 06/28/17 - 2100
For: 06/29/17 - 0900
For: 06/29/17 - 2100
06/27/17 1525 - DISCONTINUE by GGARRISON Eff: 06/27/17 1524
Items Auto Credited: 15 Doses Auto Credited: 5
For: 06/27/17 - 2100
For: 06/28/17 - 0900
For: 06/28/17 - 2100
For: 06/29/17 - 0900
For: 06/29/17 - 2100
EDIT DOCTOR: GARRISON,GRAHAM MD FELLOW
06/27/17 1525 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01410899
06/27/17 1535 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by GGARRISON Eff: 06/27/17 1525
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 87.5 MG (3.5 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/27/17-2100 Stop Date 07/27/17 2059 DC: 06/30/17-1451
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 24 Total Costs $0.00 Total Charges $233.40
Rx Number 01524126

History
06/27/17 1525 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01523254
06/27/17 1534 - VERIFIED by MHAIMOWITZ
Items Dispensed: 20 Doses Dispensed: 5
For: 06/27/17 - 2100
For: 06/28/17 - 0900
For: 06/28/17 - 2100
For: 06/29/17 - 0900
For: 06/29/17 - 2100
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 24 Doses Dispensed: 6
For: 06/30/17 - 0900
For: 06/30/17 - 2100
For: 07/01/17 - 0900
For: 07/01/17 - 2100
For: 07/02/17 - 0900
For: 07/02/17 - 2100
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 16 Doses Dispensed: 4
For: 07/03/17 - 0900
For: 07/03/17 - 2100
For: 07/04/17 - 0900
For: 07/04/17 - 2100
06/30/17 1451 - DISCONTINUE by JVALLES Eff: 06/30/17 1451
Items Auto Credited: 36 Doses Auto Credited: 9
For: 06/30/17 - 2100
For: 07/01/17 - 0900
For: 07/01/17 - 2100
For: 07/02/17 - 0900
For: 07/02/17 - 2100
For: 07/03/17 - 0900
For: 07/03/17 - 2100
For: 07/04/17 - 0900
For: 07/04/17 - 2100
EDIT DOCTOR: VALLES,JENNIE MD
06/30/17 1451 - POM COPY AND EDIT by JVALLES
TO: Rx #U01411782
06/30/17 1518 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by JVALLES Eff: 06/30/17 1451
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP100T - QUETIAPINE FUMARATE 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/30/17-2100 Stop Date 07/30/17 2059 DC: 07/27/17-1042
Ordering Doctor VALLES,JENNIE MD
Total Dispensed 54 Total Costs $0.00 Total Charges $900.72
Rx Number 01525065

History
06/30/17 1515 - ENTER by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 06/30/17 - 2100
For: 07/01/17 - 0900
For: 07/01/17 - 2100
For: 07/02/17 - 0900
For: 07/02/17 - 2100
For: 07/03/17 - 0900
For: 07/03/17 - 2100
For: 07/04/17 - 0900
For: 07/04/17 - 2100
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/05/17 - 0900
For: 07/05/17 - 2100
For: 07/06/17 - 0900
For: 07/06/17 - 2100
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/07/17 - 0900
For: 07/07/17 - 2100
For: 07/08/17 - 0900
For: 07/08/17 - 2100
For: 07/09/17 - 0900
For: 07/09/17 - 2100
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/10/17 - 0900
For: 07/10/17 - 2100
For: 07/11/17 - 0900
For: 07/11/17 - 2100
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/12/17 - 0900
For: 07/12/17 - 2100
For: 07/13/17 - 0900
For: 07/13/17 - 2100
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/14/17 - 0900
For: 07/14/17 - 2100
For: 07/15/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

For: 07/15/17 - 2100

For: 07/16/17 - 0900
For: 07/16/17 - 2100
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/17/17 - 0900
For: 07/17/17 - 2100
For: 07/18/17 - 0900
For: 07/18/17 - 2100
07/17/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/19/17 - 0900
For: 07/19/17 - 2100
For: 07/20/17 - 0900
For: 07/20/17 - 2100
07/19/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 2100
For: 07/22/17 - 0900
For: 07/22/17 - 2100
For: 07/23/17 - 0900
For: 07/23/17 - 2100
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 2100
For: 07/25/17 - 0900
For: 07/25/17 - 2100
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 2100
For: 07/27/17 - 0900
For: 07/27/17 - 2100
07/26/17 0824 - FILL by BGIRLING
Items Dispensed: 5 Doses Dispensed: 5
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
07/27/17 1042 - DISCONTINUE by SDAS Eff: 07/27/17 1042
Items Auto Credited: 6 Doses Auto Credited: 6
For: 07/27/17 - 2100
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
07/27/17 1042 - POM COPY AND EDIT by SDAS
TO: Rx #U01418552
07/27/17 1044 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SDAS Eff: 07/27/17 1042
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP100T - QUETIAPINE FUMARATE 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/27/17-2100 Stop Date 08/03/17 1527 DC: 08/03/17-1527
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 21 Total Costs $0.00 Total Charges $233.52
Rx Number 01532093

History
07/27/17 1042 - POM COPY AND EDIT by SDAS
FROM: Rx #01525065
07/27/17 1045 - EDIT by AMACCA
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/27/17-2100 STOP: 08/26/17 SOFT STOP:
TO:
START: 07/27/17-2100 STOP: 08/26/17-2059 SOFT STOP:
07/27/17 1045 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 07/27/17 - 2100
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
For: 07/30/17 - 2100
07/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/17 - 0900
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 2100
07/31/17 0832 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
08/02/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/03/17 1529 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 07/27/17-2100 STOP: 08/26/17 2059 SOFT STOP:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

DISPENSE: 6
TO:
START: 07/27/17-2100 STOP: 08/03/17-1527 SOFT STOP:
DISPENSE: 14
08/03/17 1529 - DISCONTINUE by JRUSSO Eff: 08/03/17 1527
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/03/17 1529 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01420397
08/03/17 1530 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by JRUSSO Eff: 08/03/17 1529
Discontinue by JRUSSO Eff: 08/03/17 1529
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP100T - QUETIAPINE FUMARATE 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/04/17-0900 Stop Date 08/26/17 2059 DC: 08/07/17-1230
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $66.72
Rx Number 01534026

History
08/03/17 1529 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01532093
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/03/17 - 0900
Last Actual Administration Time: 08/03/17 - 0831
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/03/17 - 1527
New Order Start: 08/04/17 - 0900
New Order Stop: 08/26/17 - 2059
08/03/17 1531 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by JRUSSO Eff: 08/03/17 1529
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/03/17 - 0900
Last Actual Administration Time: 08/03/17 - 0831
Old Freq/Sch: EVERY 12 HOURS (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/03/17 - 1527
New Order Start: 08/04/17 - 0900
New Order Stop: 08/26/17 - 2059
08/03/17 1531 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/07/17 1231 - DISCONTINUE by SDAS Eff: 08/07/17 1230
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/08/17 - 0900
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/07/17 1242 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SDAS Eff: 08/07/17 1231
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 75 MG (3 TABLETS)
Admin Route ORAL
Frequency DAILY@2100 (SCH)
Start Date 08/03/17-2100 Stop Date 08/07/17 1230 DC: 08/07/17-1230
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 24 Total Costs $0.00 Total Charges $116.72
Rx Number 01534027

History
08/03/17 1529 - POM ORDER by JRUSSO
08/03/17 1531 - VERIFIED by AMACCA
Items Dispensed: 12 Doses Dispensed: 4
For: 08/03/17 - 2100
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/07/17 1231 - EDIT by SDAS
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
START: 08/03/17-2100 STOP: 09/02/17 2059 SOFT STOP: 0
DISPENSE: 6
TO:
START: 08/03/17-2100 STOP: 08/07/17-1230 SOFT STOP:
DISPENSE: 12
08/07/17 1231 - DISCONTINUE by SDAS Eff: 08/07/17 1230
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/07/17 1231 - POM COPY AND EDIT by SDAS
TO: Rx #U01421210
08/07/17 1242 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by SDAS Eff: 08/07/17 1231
Discontinue by SDAS Eff: 08/07/17 1231
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 75 MG (3 TABLETS)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/07/17-2100 Stop Date 09/02/17 2059 DC: 08/11/17-1604
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 24 Total Costs $0.00 Total Charges $233.44
Rx Number 01534847

History
08/07/17 1231 - POM COPY AND EDIT by SDAS
FROM: Rx #01534027
Result of Frequency/Schedule Edit
Ordering Doctor: DAS,SOUMABHA MD PGY-3
Last Scheduled Administration Time: 08/06/17 - 2100
Last Actual Administration Time: 08/06/17 - 1957
Old Freq/Sch: DAILY@2100 (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/07/17 - 1230
New Order Start: 08/07/17 - 2100
New Order Stop: 09/02/17 - 2059
08/07/17 1238 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by SDAS Eff: 08/07/17 1231
Ordering Doctor: DAS,SOUMABHA MD PGY-3
Last Scheduled Administration Time: 08/06/17 - 2100
Last Actual Administration Time: 08/06/17 - 1957
Old Freq/Sch: DAILY@2100 (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/07/17 - 1230
New Order Start: 08/07/17 - 2100
New Order Stop: 09/02/17 - 2059
08/07/17 1238 - VERIFIED by EBALILO
Items Dispensed: 21 Doses Dispensed: 7
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

For: 08/15/17 - 0900

For: 08/15/17 - 2100
08/11/17 1605 - DISCONTINUE by SDAS Eff: 08/11/17 1604
Items Auto Credited: 27 Doses Auto Credited: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/11/17 1605 - POM COPY AND EDIT by SDAS
TO: Rx #U01422459
08/11/17 1612 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SDAS Eff: 08/11/17 1605
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/11/17-2100
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536138

History
08/11/17 1605 - POM COPY AND EDIT by SDAS
FROM: Rx #01534847
08/11/17 1613 - VERIFIED by AMACCA
Items Dispensed: 18 Doses Dispensed: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/11/17 1641 - DISCONTINUE by SDAS Eff: 08/11/17 2100
Items Auto Credited: 18 Doses Auto Credited: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/11/17 1641 - POM COPY AND EDIT by SDAS
TO: Rx #U01422509
08/11/17 1652 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SDAS Eff: 08/11/17 1641
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 75 MG (3 TABLETS)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/14/17-1545
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $175.08
Rx Number 01536184

History
08/11/17 1641 - POM COPY AND EDIT by SDAS
FROM: Rx #01536138
08/11/17 1652 - VERIFIED by AMACCA
Items Dispensed: 27 Doses Dispensed: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/14/17 1546 - DISCONTINUE by SDAS Eff: 08/14/17 1545
Items Auto Credited: 21 Doses Auto Credited: 7
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/14/17 1546 - POM COPY AND EDIT by SDAS
TO: Rx #U01422931
08/14/17 1555 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SDAS Eff: 08/14/17 1546
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 100 MG (4 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/14/17-2100 Stop Date 09/13/17 2059 DC: 08/14/17-2100
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536634

History
08/14/17 1546 - POM COPY AND EDIT by SDAS
FROM: Rx #01536184
08/14/17 1556 - DISCONTINUE by AMACCA Eff: 08/14/17 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/14/17 1556 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP100T - QUETIAPINE FUMARATE 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/14/17-2100 Stop Date 09/13/17 2059 DC: 08/25/17-1151
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 22 Total Costs $0.00 Total Charges $366.96
Rx Number 01536635

History
08/14/17 1557 - ENTER by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

For: 08/29/17 - 2100

08/25/17 1153 - DISCONTINUE by SDAS Eff: 08/25/17 1151
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/25/17 1233 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SDAS Eff: 08/25/17 1153
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 75 MG (3 TABLETS)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059 DC: 08/28/17-1000
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 18 Total Costs $0.00 Total Charges $175.08
Rx Number 01539971

History
08/25/17 1153 - POM ORDER by SDAS
08/25/17 1233 - VERIFIED by AMOLINARI
Items Dispensed: 27 Doses Dispensed: 9
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/28/17 1004 - DISCONTINUE by SDAS Eff: 08/28/17 1000
Items Auto Credited: 21 Doses Auto Credited: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/28/17 1004 - POM COPY AND EDIT by SDAS
TO: Rx #U01426735
08/28/17 1109 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by SDAS Eff: 08/28/17 1004
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 100 MG (4 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059 DC: 08/28/17-2100
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540605

Discontinued Comments CHANGE TO 100MG TABLET

History
08/28/17 1004 - POM COPY AND EDIT by SDAS
FROM: Rx #01539971
08/28/17 1154 - VERIFIED by MHAIMOWITZ
Items Dispensed: 28 Doses Dispensed: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/28/17 1342 - DISCONTINUE by MHAIMOWITZ Eff: 08/28/17 2100
Items Auto Credited: 28 Doses Auto Credited: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
CHANGE TO 100MG TABLET
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/28/17-1000 Stop Date 08/28/17 1001 DC: 08/28/17-1001
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $19.45
Rx Number 01540604

Discontinued Comments Reached Stop Date

History
08/28/17 1004 - POM ORDER by SDAS
08/28/17 1152 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by JJOSE Eff: 08/28/17 1043
08/28/17 1152 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 1
For: 08/28/17 - 1000
08/28/17 1152 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 1001
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

SERT25TA - SERTRALINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency AFTER BREAKFAST (SCH)
Start Date 08/10/17-0900 Stop Date 09/09/17 0859 DC: 08/30/17-1715
Ordering Doctor AMBROSE,ANNE MD
Total Dispensed 21 Total Costs $0.00 Total Charges $8.40
Rx Number 01535399

History
08/09/17 0955 - POM ORDER by AAMBROSE
08/09/17 1220 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/10/17 - 0900
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/30/17 1715 - DISCONTINUE by SDAS Eff: 08/30/17 1715
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/30/17 1715 - POM COPY AND EDIT by SDAS
TO: Rx #U01427503
08/30/17 1728 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by SDAS Eff: 08/30/17 1715

SERT25TA - SERTRALINE HCL 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency AFTER BREAKFAST (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859 DC: 08/31/17-0900
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541418

History
08/30/17 1715 - POM COPY AND EDIT by SDAS
FROM: Rx #01535399
08/30/17 1728 - DISCONTINUE by AMACCA Eff: 08/31/17 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/30/17 1728 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/16/17-0900 Stop Date 07/16/17 0859 DC: 07/15/17-2139
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 30 Total Costs $0.00 Total Charges $1.50
Rx Number 01521255

History
06/15/17 1615 - POM ORDER by GGARRISON
06/15/17 1621 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 06/16/17 - 0900
For: 06/17/17 - 0900
For: 06/18/17 - 0900
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/19/17 - 0900
For: 06/20/17 - 0900
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/21/17 - 0900
For: 06/22/17 - 0900
06/21/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/26/17 - 0900
For: 06/27/17 - 0900
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0840 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

For: 07/07/17 - 0900

For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/14/17 - 0900
For: 07/15/17 - 0900
07/15/17 2139 - DISCONTINUE by GSYRKIN Eff: 07/15/17 2139
EDIT DOCTOR: SYRKIN,GRIGORY MD
07/15/17 2139 - POM COPY AND EDIT by GSYRKIN
TO: Rx #U01415686
07/16/17 1120 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by GSYRKIN Eff: 07/15/17 2139
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/16/17-0900 Stop Date 08/14/17 0859 DC: 08/11/17-1142
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 27 Total Costs $0.00 Total Charges $1.35
Rx Number 01529131

History
07/15/17 2139 - POM COPY AND EDIT by GSYRKIN
FROM: Rx #01521255
07/16/17 1120 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by SANTONY Eff: 07/16/17 0824
07/16/17 1120 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 07/16/17 - 0900
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/16/17 1433 - EDIT by MHAIMOWITZ
EDIT DOCTOR: SYRKIN,GRIGORY MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/16/17-0900 STOP: 08/14/17 SOFT STOP:
TO:
START: 07/16/17-0900 STOP: 08/14/17-0859 SOFT STOP: 0
07/17/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0824 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

07/31/17 0832 - FILL by BGIRLING

Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 1143 - DISCONTINUE by SDAS Eff: 08/11/17 1142
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/12/17 - 0900
For: 08/13/17 - 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/11/17 1143 - POM COPY AND EDIT by SDAS
TO: Rx #U01422349
08/11/17 1210 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SDAS Eff: 08/11/17 1143
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

GARCIA,JESUS D W00001215931 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 100 MG (4 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/30/17-2100 Stop Date 07/30/17 2059 CAN: 06/30/17-1513
Ordering Doctor VALLES,JENNIE MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01411782

History
06/30/17 1451 - POM COPY AND EDIT by JVALLES
FROM: Rx #01524126
06/30/17 1513 - CANCEL by EBALILO
EDIT DOCTOR: VALLES,JENNIE MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 100MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient GAUDENZI,GENE Responsible Doctor ELASHVILI, MERY

Account Number W00001219550 Location B2EA Unit Number M000209392
Age/Sex 70/M Room 216 Registered Date 08/30/17
Status ADM IN Bed 02 Discharged Date

Height 6 ft 0.01 in 182.9 cm Body Surface Area 2.20 m2

Weight 214 lb 11.2 oz 97.386 kg
Hem-Onc No

Drug Allergies No Known Allergies (NKA)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

LD2G10 - LIDOCAINE HCL 2% GEL URO-JET 10 ML SYR

Dose 10 ML (1 SYRINGE)
Admin Route URETHRAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/30/17-1700 Stop Date 09/29/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 6 Total Costs $0.00 Total Charges $115.38
Rx Number 01541326

History
08/30/17 1335 - POM ORDER by MELASHVI
08/30/17 1350 - EDIT by MHAIMOWITZ
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
BULK: Y
DISPENSE: 1
CHARGE: $115.38
TO:
BULK: N
DISPENSE: 6
CHARGE: $19.23
08/30/17 1350 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

GAUDENZI,GENE W00001219550 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/30/17-1330 Stop Date 09/29/17 1329
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541314

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1345 - VERIFIED by MHAIMOWITZ
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

ASPI325T5 - ASPIRIN 325 MG TABEC

Dose 325 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 6 Total Costs $0.00 Total Charges $0.60
Rx Number 01541325

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1349 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

GAUDENZI,GENE W00001219550 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/30/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 6 Total Costs $0.00 Total Charges $2.25
Rx Number 01541337

History
08/30/17 1451 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01541329
08/30/17 1453 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/30/17-1330 Stop Date 09/29/17 1329
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541318

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1347 - VERIFIED by MHAIMOWITZ
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

GAUDENZI,GENE W00001219550 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 6 Total Costs $0.00 Total Charges $64.52
Rx Number 01541330

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1356 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/30/17-1700 Stop Date 09/29/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541319

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1348 - VERIFIED by MHAIMOWITZ
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

GAUDENZI,GENE W00001219550 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 13 Total Costs $0.00 Total Charges $74.24
Rx Number 01541315

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1346 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/30/17-1330 Stop Date 09/29/17 1329
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541321

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1348 - VERIFIED by MHAIMOWITZ
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

GAUDENZI,GENE W00001219550 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/30/17-1330 Stop Date 09/29/17 1329
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541320

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1348 - VERIFIED by MHAIMOWITZ
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 10/01/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01541322

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1348 - VERIFIED by MHAIMOWITZ
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

GAUDENZI,GENE W00001219550 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/30/17-1330 Stop Date 09/29/17 1329
Ordering Doctor ELASHVILI, MERY
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01541323

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1348 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 1
For: 08/30/17 - 1330
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 7 Total Costs $0.00 Total Charges $69.00
Rx Number 01541324

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1349 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

GAUDENZI,GENE W00001219550 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059 DC: 08/30/17-2100
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541329

History
08/30/17 1355 - ENTER by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/30/17 1451 - DISCONTINUE by TKOUTZEVA Eff: 08/30/17 2100
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/30/17 1451 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427417
08/30/17 1453 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/30/17 1451
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

GAUDENZI,GENE W00001219550 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency ONETIME@2000 (ONE)
Start Date 09/01/17-2000 Stop Date 09/01/17 2001 DC: 09/01/17-2001
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541952

Discontinued Comments Reached Stop Date

History
09/01/17 1320 - POM ORDER by EALEXEEV
09/01/17 1324 - VERIFIED by MHERMOSO
09/01/17 2001 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2001
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 5 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency ONETIME@2000 (ONE)
Start Date 09/01/17-2000 Stop Date 09/01/17 2001 DC: 09/01/17-2001
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541953

Discontinued Comments Reached Stop Date

History
09/01/17 1320 - POM ORDER by EALEXEEV
09/01/17 1324 - VERIFIED by MHERMOSO
09/01/17 2001 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2001
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

GAUDENZI,GENE W00001219550 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059 CAN: 08/30/17-1354
Ordering Doctor ELASHVILI, MERY
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427401

History
08/30/17 1334 - POM ORDER by MELASHVI
08/30/17 1354 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO 80MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient GEISS,JOSEPH Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001219543 Location B2WEII Unit Number M000208881
Age/Sex 54/M Room 247 Registered Date 08/25/17
Status ADM IN Bed 01 Discharged Date

Height 6 ft 3.51 in 191.8 cm Body Surface Area 2.61 m2

Weight 296 lb oz 134.263 kg
Hem-Onc No

Drug Allergies ciprofloxacin

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/25/17-1741 DRUG REGIMEN REVIEW COMPLETE
08/30/17-1057 DRUG REGIMEN REVIEW PENDING

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/27/17-1200 Stop Date 09/26/17 1159
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01540458

History
08/27/17 1057 - POM ORDER by RMINASSIAN
08/27/17 1137 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/27/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

LEVA1.25 - LEVALBUTEROL HCL 1.25 MG/3 ML VIAL

Dose 1.25 MG (3 ML)

Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 09/01/17-1700 Stop Date 10/01/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $282.96
Rx Number 01541997

History
09/01/17 1524 - POM ORDER by SDAS
09/01/17 1528 - VERIFIED by MHAIMOWITZ
Items Dispensed: 12 Doses Dispensed: 1
For: 09/01/17 - 1700

LD2G10 - LIDOCAINE HCL 2% GEL URO-JET 10 ML SYR

Dose 10 ML (1 SYRINGE)
Dose Instructions pain at the foley site.
Admin Route URETHRAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: pain at foley site
Start Date 08/25/17-1730 Stop Date 09/24/17 1729
Ordering Doctor ELASHVILI, MERY
Total Dispensed 6 Total Costs $0.00 Total Charges $115.38
Rx Number 01540209

History
08/25/17 1729 - POM ORDER by MELASHVI
08/25/17 1737 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 1
For: 08/25/17 - 1730
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Water 350 cc 4 times per day

Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541599

History
08/31/17 1407 - POM ORDER by RMINASSIAN
08/31/17 1410 - EDIT by AMOLINARI
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
LABEL COMMENTS:
TO:
ORDER TYPE: BULK - BULK ORDER
LABEL COMMENTS:
Water 350 cc 4 times per day
08/31/17 1411 - VERIFIED by AMOLINARI

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $28.41
Rx Number 01540176

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1640 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

ZINC454O - ZINC OXIDE 454 GM JAR

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions to wound
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $101.40
Rx Number 01540181

History
08/25/17 1630 - POM ORDER by RMINASSIAN
08/25/17 1640 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/26/17 - 0900

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/25/17-1615 Stop Date 09/24/17 1614
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01540160

History
08/25/17 1617 - POM ORDER by RMINASSIAN
08/25/17 1637 - VERIFIED by AMACCA
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $5.04
Rx Number 01540166

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1638 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 23 Total Costs $0.00 Total Charges $291.24
Rx Number 01540167

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1639 - VERIFIED by AMACCA
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $0.90
Rx Number 01540168

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1639 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $6.75
Rx Number 01540183

History
08/25/17 1642 - ENTER by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1615 Stop Date 09/24/17 1614
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540161

History
08/25/17 1617 - POM ORDER by RMINASSIAN
08/25/17 1637 - VERIFIED by AMACCA
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1630 Stop Date 09/24/17 1629
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540169

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1639 - VERIFIED by AMACCA
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

CLN300C - CLINDAMYCIN HCL 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/28/17-2100 Stop Date 09/07/17 2059
Ordering Doctor DOHLE,CAROLIN MD
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 33 Total Costs $0.00 Total Charges $26.45
Rx Number 01540846

History
08/28/17 1744 - POM ORDER by CDOHLE
08/28/17 1746 - VERIFIED by AADEGBAMIG
Items Dispensed: 13 Doses Dispensed: 13
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

DGX.125T - DIGOXIN 0.125 MG TAB

Dose 0.125 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $279.45
Rx Number 01540170

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1639 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/25/17-1615 Stop Date 09/24/17 1614
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $7.00
Rx Number 01540165

History
08/25/17 1617 - POM ORDER by RMINASSIAN
08/25/17 1617 - NOW DOSE by RMINASSIAN
Now Dose: 08/25/17 1615
08/25/17 1617 - KEEP NEXT DOSE by System
Keep Next Dose: 08/25/17 1700
08/25/17 1638 - REVIEW PROVIDER ACTIVITY by AMACCA
Now Dose by RMINASSIAN Eff: 08/25/17 1617
Now Dose 08/25/17 - 1615
Keep Next Dose 08/25/17 - 1700
08/25/17 1638 - VERIFIED by AMACCA
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

ESCI10TA - ESCITALOPRAM OXALATE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $171.27
Rx Number 01540171

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1639 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

FENT1PAT - FENTANYL 25 MCG/HR 1 EA TDSY

Dose 1 EA (1 TRANSDERMAL SYSTEM)

Admin Route TRANSDERM.
Frequency Q72H (SCH)
Start Date 09/04/17-0830 Stop Date 09/10/17 0836
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542296

History
09/03/17 0836 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540899
09/03/17 1056 - EDIT by MHAIMOWITZ
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/04/17-0830 STOP: 09/10/17 SOFT STOP:
TO:
START: 09/04/17-0830 STOP: 09/10/17-0836 SOFT STOP: 0
09/03/17 1056 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-1700 Stop Date 09/26/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 13 Total Costs $0.00 Total Charges $1.60
Rx Number 01541365

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
08/30/17 1602 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01540725
Result of Frequency/Schedule Edit
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: 08/30/17 - 1300
Last Actual Administration Time: 08/30/17 - 1323
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/30/17 - 1559
New Order Start: 08/30/17 - 1700
New Order Stop: 09/26/17 - 2059
08/30/17 1605 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by RMINASSIAN Eff: 08/30/17 1602
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: 08/30/17 - 1300
Last Actual Administration Time: 08/30/17 - 1323
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/30/17 - 1559
New Order Start: 08/30/17 - 1700
New Order Stop: 09/26/17 - 2059
08/30/17 1605 - VERIFIED by AMACCA
Items Dispensed: 9 Doses Dispensed: 9
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

For: 09/04/17 - 0900

For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 14 Total Costs $0.00 Total Charges $1.60
Rx Number 01541366

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
08/30/17 1602 - POM ORDER by RMINASSIAN
08/30/17 1605 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 50 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/25/17-2200 Stop Date 09/24/17 2159
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 70 Total Costs $0.00 Total Charges $13.20
Rx Number 01540172

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1639 - VERIFIED by AMACCA
Items Dispensed: 28 Doses Dispensed: 14
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

For: 09/05/17 - 1400

For: 09/05/17 - 2200
For: 09/06/17 - 0600

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 2 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/30/17-1600 Stop Date 09/06/17 1559
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541361

History
08/30/17 1552 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01540179
08/30/17 1553 - EDIT by AMACCA
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/30/17-1600 STOP: 09/06/17 SOFT STOP:
TO:
START: 08/30/17-1600 STOP: 09/06/17-1559 SOFT STOP:
08/30/17 1553 - VERIFIED by AMACCA
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 4 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/01/17-1245 Stop Date 09/08/17 1244
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01541934

History
09/01/17 1235 - POM COPY AND EDIT by SDAS
FROM: Rx #01540457
09/01/17 1310 - EDIT by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1245 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1245 STOP: 09/08/17-1244 SOFT STOP: 0
09/01/17 1310 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by OWHELAN Eff: 09/01/17 1254
09/01/17 1310 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

ISM60TCR - ISOSORBIDE MONONITRATE 60 MG TABCR 24HR

Dose 60 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $8.64
Rx Number 01540173

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1639 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/25/17-1615 Stop Date 09/24/17 1614
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540163

History
08/25/17 1617 - POM ORDER by RMINASSIAN
08/25/17 1638 - VERIFIED by AMACCA
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1615 Stop Date 09/24/17 1614
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540162

History
08/25/17 1617 - POM ORDER by RMINASSIAN
08/25/17 1637 - VERIFIED by AMACCA
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01540174

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1639 - VERIFIED by AMACCA
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 46 Total Costs $0.00 Total Charges $3.40
Rx Number 01540175

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1639 - VERIFIED by AMACCA
Items Dispensed: 18 Doses Dispensed: 9
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 24 Total Costs $0.00 Total Charges $1.80
Rx Number 01540164

History
08/25/17 1617 - POM ORDER by RMINASSIAN
08/25/17 1638 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $155.25
Rx Number 01540177

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1640 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $2.07
Rx Number 01540180

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1640 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 10 UNIT (0.1 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01536206

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1708 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/12/17 - 0900
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 1 UNIT (0.01 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859 DC: 08/27/17-1054
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01540210

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1743 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/26/17 - 0900
08/27/17 1057 - DISCONTINUE by RMINASSIAN Eff: 08/27/17 1054
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/27/17 1523 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RMINASSIAN Eff: 08/27/17 1057
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/11/17-1700 Stop Date 09/10/17 1659 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01536182

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1652 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 1700
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

INSU100V26 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose 1 UNIT (0.01 ML)

Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659 DC: 08/27/17-1048
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01540211

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1743 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 1700
08/27/17 1052 - DISCONTINUE by RMINASSIAN Eff: 08/27/17 1048
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/27/17 1523 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RMINASSIAN Eff: 08/27/17 1052
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659 DC: 08/27/17-1046
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01540193

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1706 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 1700
08/27/17 1047 - DISCONTINUE by RMINASSIAN Eff: 08/27/17 1046
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/27/17 1523 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RMINASSIAN Eff: 08/27/17 1047

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Dose Instructions to groin rash
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/11/17-1700 Stop Date 09/10/17 1659 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $28.41
Rx Number 01536196

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1656 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 1700
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/26/17-1600 Stop Date 08/26/17 1601 DC: 08/26/17-1601
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01540389

Discontinued Comments Reached Stop Date

History
08/26/17 1604 - POM ORDER by HAZIZI
08/26/17 1609 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/26/17 - 1600
08/26/17 1609 - DISCONTINUE by PHABKGJOB Eff: 08/26/17 1601
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/28/17-1300 Stop Date 08/28/17 1301 DC: 08/28/17-1301
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01540724

Discontinued Comments Reached Stop Date

History
08/28/17 1306 - POM ORDER by CDOHLE
08/28/17 1411 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1300
08/28/17 1411 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 1301
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 50 MLS/HR Duration 10 HR
Frequency .Q10H (SCH)
Start Date 08/14/17-1630 Stop Date 08/15/17 1229 DC: 08/14/17-2230
Ordering Doctor Koutzeva,Totka MD PGY-4
Last Bag 1
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01536663

Discontinued Comments DC'd by Discharge

History
08/14/17 1629 - ENTER by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1630
For: 08/15/17 - 0230
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/15/17 - 0230
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/11/17-1630 Stop Date 09/10/17 1629 DC: 08/12/17-1202
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01536170

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1647 - VERIFIED by MHAIMOWITZ
08/12/17 1207 - DISCONTINUE by EGITLER Eff: 08/12/17 1202
EDIT DOCTOR: GITLER, ELLEN M.D.
08/12/17 1246 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EGITLER Eff: 08/12/17 1207
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Dose Instructions FOR MILD PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/12/17-1215 Stop Date 09/11/17 1214 DC: 08/14/17-2230
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01536343

Discontinued Comments DC'd by Discharge

History
08/12/17 1207 - POM ORDER by EGITLER
08/12/17 1246 - VERIFIED by AMACCA
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/12/17-1215 Stop Date 09/11/17 1214 DC: 08/14/17-2230
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01536344

Discontinued Comments DC'd by Discharge

History
08/12/17 1207 - POM ORDER by EGITLER
08/12/17 1246 - VERIFIED by AMACCA
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/14/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $1.89
Rx Number 01536171

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1647 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/14/17 1616 - DISCONTINUE by TKOUTZEVA Eff: 08/14/17 1615
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/14/17 1616 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01422939
08/14/17 1618 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by TKOUTZEVA Eff: 08/14/17 1616
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 140
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/15/17-0900 Stop Date 09/14/17 0859 DC: 08/15/17-0900
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536646

Discontinued Comments DC'd by Discharge

History
08/14/17 1616 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01536171
08/14/17 1618 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/15/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 2X DAILY BRKFST/DIN (SCH)
Start Date 08/11/17-1700 Stop Date 09/10/17 1659 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 7 Total Costs $0.00 Total Charges $113.26
Rx Number 01536172

Discontinued Comments DC'd by Discharge

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1647 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 1700
For: 08/12/17 - 0800
For: 08/12/17 - 1700
For: 08/13/17 - 0800
For: 08/13/17 - 1700
For: 08/14/17 - 0800
For: 08/14/17 - 1700
For: 08/15/17 - 0800
For: 08/15/17 - 1700
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0800
For: 08/16/17 - 1700
For: 08/17/17 - 0800
For: 08/17/17 - 1700
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 6 Doses Auto Credited: 6
For: 08/15/17 - 0800
For: 08/15/17 - 1700
For: 08/16/17 - 0800
For: 08/16/17 - 1700
For: 08/17/17 - 0800
For: 08/17/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.30
Rx Number 01536173

Discontinued Comments DC'd by Discharge

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1648 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059 DC: 08/25/17-2100
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540182

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1641 - DISCONTINUE by AMACCA Eff: 08/25/17 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/25/17 1641 - VERIFIED by SYSTEM
Verified in order to DC

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/12/17-2100 Stop Date 09/11/17 2059 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $2.25
Rx Number 01536198

Discontinued Comments DC'd by Discharge

History
08/11/17 1659 - ENTER by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 2100
For: 08/13/17 - 2100
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/11/17-1630 Stop Date 09/10/17 1629 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01536175

Discontinued Comments DC'd by Discharge

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1648 - VERIFIED by MHAIMOWITZ
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

DGX.125T - DIGOXIN 0.125 MG TAB

Dose 0.125 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $78.30
Rx Number 01536176

Discontinued Comments DC'd by Discharge

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1648 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/11/17-1700 Stop Date 09/10/17 1659 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01536178

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1649 - VERIFIED by MHAIMOWITZ
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
For: 08/15/17 - 0900
For: 08/15/17 - 2100
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

ESCI10TA - ESCITALOPRAM OXALATE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $57.09
Rx Number 01536179

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1649 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

FENT1PAT - FENTANYL 25 MCG/HR 1 EA TDSY

Dose 1 EA (1 TRANSDERMAL SYSTEM)

Admin Route TRANSDERM.
Frequency Q72H (SCH)
Start Date 08/27/17-0900 Stop Date 09/03/17 0859 DC: 08/30/17-1550
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540217

History
08/25/17 1743 - POM ORDER by RMINASSIAN
08/25/17 1752 - VERIFIED by AADEGBAMIG
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 0900
08/30/17 1552 - DISCONTINUE by RMINASSIAN Eff: 08/30/17 1550
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/30/17 1553 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RMINASSIAN Eff: 08/30/17 1552

FENT1PAT - FENTANYL 25 MCG/HR 1 EA TDSY

Dose 1 EA (1 TRANSDERMAL SYSTEM)

Dose Instructions please apply to right collar
Admin Route TRANSDERM.
Frequency Q72H (PRN) PRN REASON: pain
Start Date 08/26/17-1030 Stop Date 09/02/17 1029 DC: 08/26/17-1116
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540314

History
08/26/17 1030 - POM ORDER by HAZIZI
08/26/17 1116 - DISCONTINUE by AADEGBAMIG Eff: 08/26/17 1116
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/26/17 1116 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

FENT1PAT - FENTANYL 25 MCG/HR 1 EA TDSY

Dose 1 EA (1 TRANSDERMAL SYSTEM)

Admin Route TRANSDERM.
Frequency Q72H (SCH)
Start Date 08/29/17-0830 Stop Date 09/05/17 0829 DC: 09/03/17-0836
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540899

History
08/29/17 0827 - POM ORDER by SDAS
08/29/17 0833 - VERIFIED by AMACCA
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0830
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0830
09/03/17 0836 - DISCONTINUE by JRUSSO Eff: 09/03/17 0836
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/03/17 0836 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01428328
09/03/17 1056 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by JRUSSO Eff: 09/03/17 0836
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.84
Rx Number 01536177

Discontinued Comments DC'd by Discharge

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1649 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/11/17-2200 Stop Date 09/10/17 2159 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 20 Total Costs $0.00 Total Charges $4.00
Rx Number 01536180

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1651 - VERIFIED by MHAIMOWITZ
Items Dispensed: 28 Doses Dispensed: 14
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 20 Doses Auto Credited: 10
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/25/17-2200 Stop Date 08/27/17 1057 DC: 08/27/17-1057
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 14 Total Costs $0.00 Total Charges $0.75
Rx Number 01540178

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1640 - VERIFIED by AMACCA
Items Dispensed: 14 Doses Dispensed: 14
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/27/17 1059 - EDIT by RMINASSIAN
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
FROM:
START: 08/25/17-2200 STOP: 09/24/17 2159 SOFT STOP: 0
DISPENSE: 14
TO:
START: 08/25/17-2200 STOP: 08/27/17-1057 SOFT STOP:
DISPENSE: 5
08/27/17 1059 - DISCONTINUE by RMINASSIAN Eff: 08/27/17 1057
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

Order filed UNV:

Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
08/27/17 1059 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01426590
08/27/17 1523 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by RMINASSIAN Eff: 08/27/17 1059
Discontinue by RMINASSIAN Eff: 08/27/17 1059
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/27/17-1700 Stop Date 09/24/17 2159 DC: 08/28/17-1307
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $0.30
Rx Number 01540459

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 200 MG/DAY
is below the Low Daily Dose.

History
08/27/17 1059 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01540178
Result of Frequency/Schedule Edit
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: 08/27/17 - 0600
Last Actual Administration Time: 08/27/17 - 0503
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/27/17 - 1057
New Order Start: 08/27/17 - 1700
New Order Stop: 09/24/17 - 2159
08/27/17 1137 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by RMINASSIAN Eff: 08/27/17 1059
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: 08/27/17 - 0600
Last Actual Administration Time: 08/27/17 - 0503
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/27/17 - 1057
New Order Start: 08/27/17 - 1700
New Order Stop: 09/24/17 - 2159
08/27/17 1137 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

08/28/17 1309 - DISCONTINUE by CDOHLE Eff: 08/28/17 1307

Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
EDIT DOCTOR: DOHLE,CAROLIN MD
08/28/17 1746 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by CDOHLE Eff: 08/28/17 1309
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/27/17-2100 Stop Date 08/28/17 1307 DC: 08/28/17-1307
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $0.20
Rx Number 01540460

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/27/17 1059 - POM ORDER by RMINASSIAN
08/27/17 1138 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/28/17 1309 - EDIT by CDOHLE
EDIT DOCTOR: DOHLE,CAROLIN MD
FROM:
START: 08/27/17-2100 STOP: 09/26/17 2059 SOFT STOP: 0
DISPENSE: 2
TO:
START: 08/27/17-2100 STOP: 08/28/17-1307 SOFT STOP:
DISPENSE: 1
08/28/17 1309 - DISCONTINUE by CDOHLE Eff: 08/28/17 1307
EDIT DOCTOR: DOHLE,CAROLIN MD
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
08/28/17 1309 - POM COPY AND EDIT by CDOHLE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
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GEISS,JOSEPH W00001219543 (Continued)

TO: Rx #U01426824
08/28/17 1746 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by CDOHLE Eff: 08/28/17 1309
Discontinue by CDOHLE Eff: 08/28/17 1309
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/28/17-1700 Stop Date 08/30/17 1559 DC: 08/30/17-1559
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 19 Total Costs $0.00 Total Charges $1.20
Rx Number 01540725

History
08/28/17 1309 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01540460
Result of Frequency/Schedule Edit
Ordering Doctor: DOHLE,CAROLIN MD
Last Scheduled Administration Time: 08/27/17 - 2100
Last Actual Administration Time: 08/27/17 - 2117
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/28/17 - 1307
New Order Start: 08/28/17 - 1700
New Order Stop: 09/26/17 - 2059
08/28/17 1411 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by CDOHLE Eff: 08/28/17 1309
Ordering Doctor: DOHLE,CAROLIN MD
Last Scheduled Administration Time: 08/27/17 - 2100
Last Actual Administration Time: 08/27/17 - 2117
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/28/17 - 1307
New Order Start: 08/28/17 - 1700
New Order Stop: 09/26/17 - 2059
08/28/17 1411 - VERIFIED by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 10
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
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GEISS,JOSEPH W00001219543 (Continued)

For: 09/03/17 - 1300

For: 09/03/17 - 1700
08/30/17 1602 - EDIT by RMINASSIAN
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
FROM:
START: 08/28/17-1700 STOP: 09/26/17 2059 SOFT STOP:
DISPENSE: 9
TO:
START: 08/28/17-1700 STOP: 08/30/17-1559 SOFT STOP:
DISPENSE: 6
08/30/17 1602 - DISCONTINUE by RMINASSIAN Eff: 08/30/17 1559
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/30/17 1602 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01427445
08/30/17 1604 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by RMINASSIAN Eff: 08/30/17 1602
Discontinue by RMINASSIAN Eff: 08/30/17 1602
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
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GEISS,JOSEPH W00001219543 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 100 MG (4 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/11/17-2200 Stop Date 09/10/17 2159 DC: 08/14/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 36 Total Costs $0.00 Total Charges $7.20
Rx Number 01536181

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1652 - VERIFIED by MHAIMOWITZ
Items Dispensed: 56 Doses Dispensed: 14
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 24 Doses Dispensed: 6
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
08/14/17 1616 - DISCONTINUE by TKOUTZEVA Eff: 08/14/17 1615
Items Auto Credited: 44 Doses Auto Credited: 11
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/14/17 1616 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01422938
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

08/14/17 1618 - REVIEW PROVIDER ACTIVITY by EBALILO

Discontinue by TKOUTZEVA Eff: 08/14/17 1616

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 50 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/14/17-2200 Stop Date 09/13/17 2159 DC: 08/14/17-2230
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 2 Total Costs $0.00 Total Charges $0.60
Rx Number 01536645

Discontinued Comments DC'd by Discharge

History
08/14/17 1616 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01536181
08/14/17 1617 - VERIFIED by EBALILO
Items Dispensed: 22 Doses Dispensed: 11
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 20 Doses Auto Credited: 10
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 2 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/25/17-1630 Stop Date 09/01/17 1629 DC: 08/30/17-1551
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01540179

History
08/25/17 1629 - POM ORDER by RMINASSIAN
08/25/17 1640 - VERIFIED by AMACCA
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 1552 - DISCONTINUE by RMINASSIAN Eff: 08/30/17 1551
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/30/17 1552 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01427440
08/30/17 1553 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RMINASSIAN Eff: 08/30/17 1552
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 4 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/27/17-1100 Stop Date 09/03/17 1059 DC: 09/01/17-1235
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.50
Rx Number 01540457

History
08/27/17 1059 - POM ORDER by RMINASSIAN
08/27/17 1136 - VERIFIED by AADEGBAMIG
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 1235 - DISCONTINUE by SDAS Eff: 09/01/17 1235
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
09/01/17 1235 - POM COPY AND EDIT by SDAS
TO: Rx #U01427974
09/01/17 1311 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SDAS Eff: 09/01/17 1235
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
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GEISS,JOSEPH W00001219543 (Continued)

ISM60TCR - ISOSORBIDE MONONITRATE 60 MG TABCR 24HR

Dose 60 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $3.24
Rx Number 01536183

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1652 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/11/17-1630 Stop Date 09/10/17 1629 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536186

Discontinued Comments DC'd by Discharge

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1653 - VERIFIED by MHAIMOWITZ
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/11/17-1630 Stop Date 09/10/17 1629 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536185

Discontinued Comments DC'd by Discharge

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1653 - VERIFIED by MHAIMOWITZ
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

MTL2.5T - METOLAZONE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $14.19
Rx Number 01536187

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1653 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 14 Total Costs $0.00 Total Charges $1.20
Rx Number 01536188

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1654 - VERIFIED by MHAIMOWITZ
Items Dispensed: 18 Doses Dispensed: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 12 Doses Auto Credited: 6
For: 08/15/17 - 0900
For: 08/15/17 - 2100
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/11/17-1630 Stop Date 08/14/17 1405 DC: 08/14/17-1405
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 6 Total Costs $ Total Charges $
Rx Number 01536194

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1654 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 1630
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 1406 - DISCONTINUE by TKOUTZEVA Eff: 08/14/17 1405
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/14/17 1406 - EDIT by TKOUTZEVA
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
START: 08/11/17-1630 STOP: 09/10/17 1629 SOFT STOP: 0
DISPENSE: 0
TO:
START: 08/11/17-1630 STOP: 08/14/17-1405 SOFT STOP:
DISPENSE: 6
08/14/17 1406 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01422870
08/14/17 1407 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by TKOUTZEVA Eff: 08/14/17 1406
Discontinue by TKOUTZEVA Eff: 08/14/17 1406
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/14/17-2100 Stop Date 09/10/17 1629 DC: 08/14/17-2230
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 2 Total Costs $0.00 Total Charges $0.20
Rx Number 01536569

Discontinued Comments DC'd by Discharge

History
08/14/17 1406 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01536194
Result of Frequency/Schedule Edit
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: NIGHTLY (PRN)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/14/17 - 1405
New Order Start: 08/14/17 - 2100
New Order Stop: 09/10/17 - 1629
08/14/17 1407 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by TKOUTZEVA Eff: 08/14/17 1406
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: NIGHTLY (PRN)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/14/17 - 1405
New Order Start: 08/14/17 - 2100
New Order Stop: 09/10/17 - 1629
08/14/17 1407 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/14/17 - 2100
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 6 Doses Auto Credited: 3
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/14/17-2230
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 4 Total Costs $0.00 Total Charges $69.00
Rx Number 01536195

Discontinued Comments DC'd by Discharge

History
08/11/17 1630 - POM ORDER by CDOHLE
08/11/17 1655 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/14/17 2356 - DISCONTINUE by DISCHARGE Eff: 08/14/17 2230
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/15/17 - 2100
For: 08/16/17 - 2100
For: 08/17/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

GEISS,JOSEPH W00001219543 (Continued)

NORM150I5 - 0.9 % SODIUM CHLORIDE 150 ML BAG SOLN

Dose 1,000 ML (6.6666667 BAGS)

Dose Instructions 50ml/hr
Admin Route INTRAVEN.
Frequency ONETIME (ONE)
Start Date 08/14/17-1630 Stop Date 08/14/17 1631 CAN: 08/14/17-1622
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01422941

History
08/14/17 1621 - POM ORDER by TKOUTZEVA
08/14/17 1622 - CANCEL by EBALILO
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
ENTERED AS LVP

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/12/17-2100 Stop Date 09/11/17 2059 CAN: 08/11/17-1656
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01422487

History
08/11/17 1629 - POM ORDER by CDOHLE
08/11/17 1656 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO 80MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient GILKAROV,YAKOV Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219443 Location B2WEII Unit Number M000209387
Age/Sex 36/M Room 243 Registered Date 08/30/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 5.98 in 167.6 cm Body Surface Area 1.77 m2

Weight 150 lb oz 68.039 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA S/P SUB OCCIPITAL CRANIECTOMY
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/30/17-1830 Stop Date 09/29/17 1829
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541460

History
08/30/17 1829 - POM ORDER by SDAS
08/30/17 1905 - VERIFIED by MHAIMOWITZ
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $0.40
Rx Number 01541487

History
08/30/17 2115 - POM ORDER by SDAS
08/30/17 2117 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY OTHER NIGHT (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 4 Total Costs $0.00 Total Charges $1.50
Rx Number 01541477

History
08/30/17 2009 - ENTER by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/30/17 - 2100
For: 09/01/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/30/17-1830 Stop Date 09/29/17 1829
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541463

History
08/30/17 1829 - POM ORDER by SDAS
08/30/17 1907 - VERIFIED by MHAIMOWITZ
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01541462

History
08/30/17 1834 - POM ORDER by SDAS
08/30/17 1907 - VERIFIED by MHAIMOWITZ
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $1.40
Rx Number 01541488

History
08/30/17 2113 - POM ORDER by YIVANOV
08/30/17 2117 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/30/17-2200 Stop Date 09/29/17 2159
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 20 Total Costs $0.00 Total Charges $111.36
Rx Number 01541464

History
08/30/17 1834 - POM ORDER by SDAS
08/30/17 1908 - VERIFIED by MHAIMOWITZ
Items Dispensed: 14 Doses Dispensed: 14
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/30/17-1830 Stop Date 09/29/17 1829
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541465

History
08/30/17 1829 - POM ORDER by SDAS
08/30/17 1908 - VERIFIED by MHAIMOWITZ
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/30/17-1830 Stop Date 09/29/17 1829
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541468

History
08/30/17 1829 - POM ORDER by SDAS
08/30/17 1909 - VERIFIED by MHAIMOWITZ
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/30/17-2145 Stop Date 09/29/17 2144
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01541499

History
08/30/17 2136 - POM COPY AND EDIT by YIVANOV
FROM: Rx #01541466
08/31/17 0736 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 2145
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01541472

History
08/30/17 1938 - POM ORDER by SDAS
08/30/17 1946 - VERIFIED by MHAIMOWITZ
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 10/02/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01541470

History
08/30/17 1834 - POM ORDER by SDAS
08/30/17 1909 - VERIFIED by MHAIMOWITZ
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $0.40
Rx Number 01541467

History
08/30/17 1834 - POM ORDER by SDAS
08/30/17 1909 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 08/31/17 0900 DC: 08/31/17-0900
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01541461

History
08/30/17 1832 - POM ORDER by SDAS
08/30/17 1906 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/30/17 2115 - EDIT by SDAS
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
START: 08/31/17-0900 STOP: 09/30/17 0859 SOFT STOP: 0
DISPENSE: 4
TO:
START: 08/31/17-0900 STOP: 08/31/17-0900 SOFT STOP:
DISPENSE: 0
08/30/17 2115 - DISCONTINUE by SDAS Eff: 08/31/17 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/30/17 2117 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SDAS Eff: 08/30/17 2115
Discontinue by SDAS Eff: 08/30/17 2115
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059 DC: 08/30/17-2100
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541471

Discontinued Comments CHANGED TO EVERY OTHER NIGHT

History
08/30/17 1922 - ENTER by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/30/17 2015 - DISCONTINUE by MHAIMOWITZ Eff: 08/30/17 2100
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
CHANGED TO EVERY OTHER NIGHT
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059 DC: 08/30/17-2135
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01541466

History
08/30/17 1832 - POM ORDER by SDAS
08/30/17 1908 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/30/17 2136 - DISCONTINUE by YIVANOV Eff: 08/30/17 2135
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
08/30/17 2136 - POM COPY AND EDIT by YIVANOV
TO: Rx #U01427567
08/31/17 0736 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YIVANOV Eff: 08/30/17 2136
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/30/17-2200 Stop Date 09/29/17 2159 DC: 08/30/17-2200
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541469

History
08/30/17 1832 - POM ORDER by SDAS
08/30/17 1909 - VERIFIED by MHAIMOWITZ
Items Dispensed: 28 Doses Dispensed: 14
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
08/30/17 2135 - DISCONTINUE by YIVANOV Eff: 08/30/17 2200
Items Auto Credited: 28 Doses Auto Credited: 14
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
08/30/17 2135 - POM COPY AND EDIT by YIVANOV
TO: Rx #U01427566
08/31/17 0736 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YIVANOV Eff: 08/30/17 2135
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: AGITATION - for Agitation
Start Date 08/30/17-2200 Stop Date 08/30/17 2200 DC: 08/30/17-2200
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541489

History
08/30/17 2135 - POM COPY AND EDIT by YIVANOV
FROM: Rx #01541469
08/30/17 2139 - EDIT by YIVANOV
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
FROM:
START: 08/30/17-2200 STOP: 09/29/17 2159 SOFT STOP: 0
DISPENSE: 10
TO:
START: 08/30/17-2200 STOP: 08/30/17-2200 SOFT STOP:
DISPENSE: 0
08/30/17 2139 - VERIFIED by SYSTEM
Verified in order to DC
08/30/17 2139 - DISCONTINUE by YIVANOV Eff: 08/30/17 2200
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
08/31/17 0736 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by YIVANOV Eff: 08/30/17 2139
Edit by SYSTEM Eff: 08/30/17 2139
Discontinue by YIVANOV Eff: 08/30/17 2139

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059 CAN: 08/30/17-1908
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427540

History
08/30/17 1834 - POM ORDER by SDAS
08/30/17 1908 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO 80MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

GILKAROV,YAKOV W00001219443 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency EVERY OTHER NIGHT (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059 CAN: 08/30/17-2009
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427548

History
08/30/17 1938 - POM ORDER by SDAS
08/30/17 2009 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
change to 80mg tab

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859 CAN: 08/30/17-1907
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427531

History
08/30/17 1829 - POM ORDER by SDAS
08/30/17 1907 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
DUPLICATE ORDER
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient GORELICK,VICTOR Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219474 Location B1WE Unit Number M000202882
Age/Sex 76/M Room 154 Registered Date 08/28/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 10 in 177.8 cm Body Surface Area 2.06 m2

Weight 194 lb oz 87.997 kg
Hem-Onc No

Drug Allergies [mercury], mercury (elemental)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1530 Stop Date 09/27/17 1529
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540757

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1544 - VERIFIED by AADEGBAMIG

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Dose Instructions PRN Pain
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/28/17-1530 Stop Date 09/27/17 1529
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540760

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1544 - VERIFIED by AADEGBAMIG
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

ALLP100T - ALLOPURINOL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $4.20
Rx Number 01540761

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1544 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $4.08
Rx Number 01540762

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1544 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

C500T - ASCORBIC ACID 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01540763

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1545 - VERIFIED by AADEGBAMIG
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 2,000 UNIT (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/28/17-1700 Stop Date 09/27/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 18 Total Costs $0.00 Total Charges $1.50
Rx Number 01540768

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1545 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 1700
For: 08/29/17 - 1700
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 1,000 MCG (1 TABLET)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/28/17-1700 Stop Date 09/27/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 9 Total Costs $0.00 Total Charges $0.48
Rx Number 01540769

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1545 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 1700
For: 08/29/17 - 1700
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1530 Stop Date 09/27/17 1529
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540759

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1544 - VERIFIED by AADEGBAMIG
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/29/17-2100 Stop Date 09/27/17 1529
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01541097

History
08/29/17 1555 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540758
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/29/17 - 2100
New Order Start: 08/29/17 - 2100
New Order Stop: 09/27/17 - 1529
08/29/17 1556 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by NBALCETIS Eff: 08/29/17 1555
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 08/29/17 - 2100
New Order Start: 08/29/17 - 2100
New Order Stop: 09/27/17 - 1529
08/29/17 1556 - VERIFIED by AADEGBAMIG
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01540770

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1545 - VERIFIED by AADEGBAMIG
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $1.68
Rx Number 01540777

History
08/28/17 1531 - POM ORDER by NBALCETIS
08/28/17 1546 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CARB1TAB10 - LEVODOPA/CARBIDOPA 25/100 1 EA TAB

Dose 0.5 EA (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@0600,1200,1800 (SCH)
Start Date 08/31/17-1800 Stop Date 09/27/17 1759
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 17 Total Costs $0.00 Total Charges $19.17
Rx Number 01541735

History
08/31/17 1609 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540764
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/31/17 - 1000
Last Actual Administration Time: 08/31/17 - 0919
Old Freq/Sch: DAILY@0600,1000,1800 (SCH)
New Freq/Sch: DAILY@0600,1200,1800 (SCH)
Old Order Stop: 08/31/17 - 1605
New Order Start: 08/31/17 - 1800
New Order Stop: 09/27/17 - 1759
08/31/17 1617 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by NBALCETIS Eff: 08/31/17 1609
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/31/17 - 1000
Last Actual Administration Time: 08/31/17 - 0919
Old Freq/Sch: DAILY@0600,1000,1800 (SCH)
New Freq/Sch: DAILY@0600,1200,1800 (SCH)
Old Order Stop: 08/31/17 - 1605
New Order Start: 08/31/17 - 1800
New Order Stop: 09/27/17 - 1759
08/31/17 1617 - VERIFIED by AMACCA
Items Dispensed: 11 Doses Dispensed: 11
For: 08/31/17 - 1800
For: 09/01/17 - 0600
For: 09/01/17 - 1200
For: 09/01/17 - 1800
For: 09/02/17 - 0600
For: 09/02/17 - 1200
For: 09/02/17 - 1800
For: 09/03/17 - 0600
For: 09/03/17 - 1200
For: 09/03/17 - 1800
For: 09/04/17 - 0600
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1200
For: 09/04/17 - 1800
For: 09/05/17 - 0600
For: 09/05/17 - 1200
For: 09/05/17 - 1800
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

LVCR50200 - LEVODOPA/CARBIDOPA 50-200 TABCR

Dose 1 EA (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 9 Total Costs $0.00 Total Charges $13.38
Rx Number 01540781

History
08/28/17 1550 - POM ORDER by NBALCETIS
08/28/17 1551 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1530 Stop Date 09/27/17 1529
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540755

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1544 - VERIFIED by AADEGBAMIG
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

MELA5TAB22 - MELATONIN 5 MG TABLET

Dose 5 MG (1 TABLET)
Dose Instructions PATIENT'S OWN MEDICATION

WHOLE BOTTLE SENT TO FLOOR

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 9 Total Costs $0.00 Total Charges $0.00
Rx Number 01540843

History
08/28/17 1744 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

MIDO5TAB4 - MIDODRINE HCL 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/28/17-2200 Stop Date 09/27/17 2159
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 52 Total Costs $0.00 Total Charges $102.60
Rx Number 01540771

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1546 - VERIFIED by AADEGBAMIG
Items Dispensed: 22 Doses Dispensed: 11
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/29/17-0800 Stop Date 09/28/17 0759
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $5.28
Rx Number 01540772

History
08/28/17 1531 - POM ORDER by NBALCETIS
08/28/17 1546 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0800
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

PRAM0.5T14 - PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY@0600,1200,1400 (SCH)
Start Date 08/31/17-1800 Stop Date 09/27/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 17 Total Costs $0.00 Total Charges $122.64
Rx Number 01541736

History
08/31/17 1609 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01541422
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/31/17 - 1400
Last Actual Administration Time: 08/31/17 - 1353 (Not Given)
Old Freq/Sch: DAILY@0600,1000,1400 (SCH)
New Freq/Sch: DAILY@0600,1200,1400 (SCH)
Old Order Stop: 08/31/17 - 1605
New Order Start: 08/31/17 - 1800
New Order Stop: 09/27/17 - 1659
08/31/17 1609 - NOW DOSE by NBALCETIS
Now Dose: 08/31/17 1800
08/31/17 1609 - KEEP NEXT DOSE by System
Keep Next Dose: 09/01/17 0600
08/31/17 1618 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by NBALCETIS Eff: 08/31/17 1609
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/31/17 - 1400
Last Actual Administration Time: 08/31/17 - 1353 (Not Given)
Old Freq/Sch: DAILY@0600,1000,1400 (SCH)
New Freq/Sch: DAILY@0600,1200,1400 (SCH)
Old Order Stop: 08/31/17 - 1605
New Order Start: 08/31/17 - 1800
New Order Stop: 09/27/17 - 1659
Now Dose by NBALCETIS Eff: 08/31/17 1609
Now Dose 08/31/17 - 1800
Keep Next Dose 09/01/17 - 0600
08/31/17 1618 - VERIFIED by AMACCA
Items Dispensed: 11 Doses Dispensed: 11
For: 08/31/17 - 1800
For: 09/01/17 - 0600
For: 09/01/17 - 1200
For: 09/01/17 - 1400
For: 09/02/17 - 0600
For: 09/02/17 - 1200
For: 09/02/17 - 1400
For: 09/03/17 - 0600
For: 09/03/17 - 1200
For: 09/03/17 - 1400
For: 09/04/17 - 0600
09/01/17 0820 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 09/04/17 - 1200
For: 09/04/17 - 1400
For: 09/05/17 - 0600
For: 09/05/17 - 1200
For: 09/05/17 - 1400
For: 09/06/17 - 0600

SACC250C - SACCHAROMYCES BOULARDII 250 MG CAP

Dose 250 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/28/17-1700 Stop Date 09/27/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 17 Total Costs $0.00 Total Charges $17.16
Rx Number 01540774

History
08/28/17 1531 - POM ORDER by NBALCETIS
08/28/17 1546 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

SMV20T - SIMVASTATIN 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 9 Total Costs $0.00 Total Charges $1.80
Rx Number 01540775

History
08/28/17 1531 - POM ORDER by NBALCETIS
08/28/17 1546 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

SPIR25TA12 - SPIRONOLACTONE 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 16 Total Costs $0.00 Total Charges $8.10
Rx Number 01540778

History
08/28/17 1531 - POM ORDER by NBALCETIS
08/28/17 1546 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

SILV85CR - SILVER SULFADIAZINE 85 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/20/16-2100 Stop Date 09/27/16 2059 DC: 09/22/16-1557
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Clinical Indication OTHER
Total Dispensed 1 Total Costs $0.00 Total Charges $43.89
Rx Number 01451018

History
09/20/16 1724 - POM ORDER by HMOHAMED
09/20/16 1729 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 09/20/16 - 2100
09/22/16 1557 - DISCONTINUE by AMIRCHANDA Eff: 09/22/16 1557
EDIT DOCTOR: MIRCHANDANI,ANISH MD
09/22/16 1557 - POM COPY AND EDIT by AMIRCHANDA
TO: Rx #U01340467
09/22/16 1559 - REVIEW PROVIDER ACTIVITY by EBALILO
by AMIRCHANDA Eff: 09/22/16 1557
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

SILV85CR - SILVER SULFADIAZINE 85 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/22/16-2100 Stop Date 09/29/16 2059 DC: 09/27/16-1215
Ordering Doctor MIRCHANDANI,ANISH MD
Clinical Indication OTHER
Total Dispensed 2 Total Costs $0.00 Total Charges $87.78
Rx Number 01451634

History
09/22/16 1557 - POM COPY AND EDIT by AMIRCHANDA
FROM: Rx #01451018
09/22/16 1558 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 09/22/16 - 2100
09/22/16 1559 - CREDIT by EBALILO
ITEMS: 1
09/25/16 1046 - DEBIT by AADEGBAMIG
ITEMS: 1
09/27/16 1108 - DEBIT by AMOLINARI
ITEMS: 1
09/27/16 1216 - DISCONTINUE by SEROSA Eff: 09/27/16 1215
EDIT DOCTOR: EROSA,STEPHEN MD
09/27/16 1216 - POM COPY AND EDIT by SEROSA
TO: Rx #U01341427
09/27/16 1217 - REVIEW PROVIDER ACTIVITY by EBALILO
by SEROSA Eff: 09/27/16 1216
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

SILV85CR - SILVER SULFADIAZINE 85 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/27/16-2100 Stop Date 10/04/16 2059 DC: 09/30/16-0954
Ordering Doctor EROSA,STEPHEN MD PGY-4
Clinical Indication OTHER
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01452581

History
09/27/16 1216 - POM COPY AND EDIT by SEROSA
FROM: Rx #01451634
09/27/16 1216 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 09/27/16 - 2100
09/27/16 1217 - CREDIT by EBALILO
ITEMS: 1
09/30/16 0956 - DISCONTINUE by VHUANG Eff: 09/30/16 0954
EDIT DOCTOR: HUANG,VINCENT MD
10/31/16 0009 - REVIEW PROVIDER ACTIVITY by SYSTEM
(Discontinue by VHUANG Eff: 09/30/16 0956)
Removed by File Maintenance.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/20/16-1515 Stop Date 10/20/16 1514 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01450922

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1526 - VERIFIED by EBALILO
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

ALLP300T - ALLOPURINOL 300 MG TAB

Dose 300 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/21/16-0900 Stop Date 10/21/16 0859 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 14 Total Costs $0.00 Total Charges $20.02
Rx Number 01450935

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1528 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/21/16 - 0900
For: 09/22/16 - 0900
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 0900
For: 09/24/16 - 0900
For: 09/25/16 - 0900
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 0900
For: 09/27/16 - 0900
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 0900
For: 09/29/16 - 0900
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 0900
For: 10/01/16 - 0900
For: 10/02/16 - 0900
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 0900
For: 10/04/16 - 0900
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 2 Doses Auto Credited: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

C500T - ASCORBIC ACID 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/21/16-0900 Stop Date 10/21/16 0859 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 0 Total Costs $0.00 Total Charges $3.50
Rx Number 01450923

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1526 - VERIFIED by EBALILO
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 0900
For: 09/24/16 - 0900
For: 09/25/16 - 0900
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 0900
For: 09/27/16 - 0900
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 0900
For: 09/29/16 - 0900
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 0900
For: 10/01/16 - 0900
For: 10/02/16 - 0900
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 0900
For: 10/04/16 - 0900
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/21/16-0900 Stop Date 10/21/16 0859 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 14 Total Costs $0.00 Total Charges $0.42
Rx Number 01450937

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1529 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/21/16 - 0900
For: 09/22/16 - 0900
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 0900
For: 09/24/16 - 0900
For: 09/25/16 - 0900
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 0900
For: 09/27/16 - 0900
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 0900
For: 09/29/16 - 0900
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 0900
For: 10/01/16 - 0900
For: 10/02/16 - 0900
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 0900
For: 10/04/16 - 0900
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 2 Doses Auto Credited: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 09/20/16-2000 Stop Date 10/20/16 1959 DC: 09/20/16-2000
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01450924

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1526 - VERIFIED by EBALILO
09/20/16 1552 - DISCONTINUE by VHUANG Eff: 09/20/16 2000
EDIT DOCTOR: HUANG,VINCENT MD
09/20/16 1552 - POM COPY AND EDIT by VHUANG
TO: Rx #U01339842
09/20/16 1553 - REVIEW PROVIDER ACTIVITY by EBALILO
by VHUANG Eff: 09/20/16 1552

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (PRN) PRN REASON: constipation
Start Date 09/20/16-2000 Stop Date 10/20/16 1959 DC: 10/04/16-1114
Ordering Doctor HUANG,VINCENT MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01450970

Discontinued Comments DC'd by Discharge

History
09/20/16 1552 - POM COPY AND EDIT by VHUANG
FROM: Rx #01450924
09/20/16 1553 - VERIFIED by EBALILO
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 2,000 UNIT (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/21/16-0900 Stop Date 10/21/16 0859 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 28 Total Costs $0.00 Total Charges $3.50
Rx Number 01450933

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1527 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 2
For: 09/21/16 - 0900
For: 09/22/16 - 0900
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 09/23/16 - 0900
For: 09/24/16 - 0900
For: 09/25/16 - 0900
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/26/16 - 0900
For: 09/27/16 - 0900
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 4 Doses Dispensed: 2
For: 09/28/16 - 0900
For: 09/29/16 - 0900
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 09/30/16 - 0900
For: 10/01/16 - 0900
For: 10/02/16 - 0900
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 10/03/16 - 0900
For: 10/04/16 - 0900
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 4 Doses Auto Credited: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CLCH.6T - COLCHICINE 0.6 MG TAB

Dose 0.6 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY OTHER DAY (SCH)
Start Date 09/22/16-0900 Stop Date 10/22/16 0859 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 7 Total Costs $0.00 Total Charges $101.85
Rx Number 01450936

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1528 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 09/22/16 - 0900
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 09/24/16 - 0900
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/26/16 - 0900
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 1 Doses Dispensed: 1
For: 09/28/16 - 0900
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 09/30/16 - 0900
For: 10/02/16 - 0900
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 10/04/16 - 0900
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 10/06/16 - 0900
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 1 Doses Auto Credited: 1
For: 10/06/16 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 1,000 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/21/16-0900 Stop Date 10/21/16 0859 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 14 Total Costs $0.00 Total Charges $1.12
Rx Number 01450934

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1528 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/21/16 - 0900
For: 09/22/16 - 0900
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 0900
For: 09/24/16 - 0900
For: 09/25/16 - 0900
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 0900
For: 09/27/16 - 0900
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 0900
For: 09/29/16 - 0900
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 0900
For: 10/01/16 - 0900
For: 10/02/16 - 0900
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 0900
For: 10/04/16 - 0900
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 2 Doses Auto Credited: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 09/20/16-1515 Stop Date 10/20/16 1514 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01450926

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1526 - VERIFIED by EBALILO
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 09/20/16-1700 Stop Date 10/20/16 1659 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 0 Total Costs $0.00 Total Charges $10.25
Rx Number 01450925

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1526 - VERIFIED by EBALILO
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 09/23/16 - 0900
For: 09/23/16 - 1300
For: 09/23/16 - 1700
For: 09/24/16 - 0900
For: 09/24/16 - 1300
For: 09/24/16 - 1700
For: 09/25/16 - 0900
For: 09/25/16 - 1300
For: 09/25/16 - 1700
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/26/16 - 0900
For: 09/26/16 - 1300
For: 09/26/16 - 1700
For: 09/27/16 - 0900
For: 09/27/16 - 1300
For: 09/27/16 - 1700
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 6 Doses Dispensed: 6
For: 09/28/16 - 0900
For: 09/28/16 - 1300
For: 09/28/16 - 1700
For: 09/29/16 - 0900
For: 09/29/16 - 1300
For: 09/29/16 - 1700
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 09/30/16 - 0900
For: 09/30/16 - 1300
For: 09/30/16 - 1700
For: 10/01/16 - 0900
For: 10/01/16 - 1300
For: 10/01/16 - 1700
For: 10/02/16 - 0900
For: 10/02/16 - 1300
For: 10/02/16 - 1700
09/30/16 0813 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 10/03/16 - 0900
For: 10/03/16 - 1300
For: 10/03/16 - 1700
For: 10/04/16 - 0900
For: 10/04/16 - 1300
For: 10/04/16 - 1700
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 10/05/16 - 0900
For: 10/05/16 - 1300
For: 10/05/16 - 1700
For: 10/06/16 - 0900
For: 10/06/16 - 1300
For: 10/06/16 - 1700
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
DC COMMENTS:
DC'd by Discharge

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1530 Stop Date 08/29/17 2100 DC: 08/29/17-2100
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540758

Discontinued Comments Reached Stop Date

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1544 - VERIFIED by AADEGBAMIG
08/29/17 1555 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/28/17-1530 STOP: 09/27/17 1529 SOFT STOP: 0
TO:
START: 08/28/17-1530 STOP: 08/29/17-2100 SOFT STOP:
08/29/17 1555 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427189
08/29/17 1556 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by NBALCETIS Eff: 08/29/17 1555
08/29/17 2100 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/21/16-0900 Stop Date 10/21/16 0859 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 14 Total Costs $0.00 Total Charges $5.59
Rx Number 01450938

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1529 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/21/16 - 0900
For: 09/22/16 - 0900
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 0900
For: 09/24/16 - 0900
For: 09/25/16 - 0900
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 0900
For: 09/27/16 - 0900
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 0900
For: 09/29/16 - 0900
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 0900
For: 10/01/16 - 0900
For: 10/02/16 - 0900
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 0900
For: 10/04/16 - 0900
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 2 Doses Auto Credited: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 09/20/16-2100 Stop Date 10/20/16 2059 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 28 Total Costs $0.00 Total Charges $4.20
Rx Number 01450939

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 200 MG/DAY
is below the Low Daily Dose.

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1529 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 09/20/16 - 2100
For: 09/21/16 - 2100
For: 09/22/16 - 2100
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 09/23/16 - 2100
For: 09/24/16 - 2100
For: 09/25/16 - 2100
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/26/16 - 2100
For: 09/27/16 - 2100
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 4 Doses Dispensed: 2
For: 09/28/16 - 2100
For: 09/29/16 - 2100
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 09/30/16 - 2100
For: 10/01/16 - 2100
For: 10/02/16 - 2100
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 10/03/16 - 2100
For: 10/04/16 - 2100
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 10/05/16 - 2100
For: 10/06/16 - 2100
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

Items Auto Credited: 6 Doses Auto Credited: 3

For: 10/04/16 - 2100
For: 10/05/16 - 2100
For: 10/06/16 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CARB1TAB10 - LEVODOPA/CARBIDOPA 25/100 1 EA TAB

Dose 0.5 EA (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@06,10,18 (SCH)
Start Date 09/20/16-1800 Stop Date 10/20/16 1759 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 42 Total Costs $0.00 Total Charges $89.46
Rx Number 01450944

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1533 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 8
For: 09/20/16 - 1800
For: 09/21/16 - 0600
For: 09/21/16 - 1000
For: 09/21/16 - 1800
For: 09/22/16 - 0600
For: 09/22/16 - 1000
For: 09/22/16 - 1800
For: 09/23/16 - 0600
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 09/23/16 - 1000
For: 09/23/16 - 1800
For: 09/24/16 - 0600
For: 09/24/16 - 1000
For: 09/24/16 - 1800
For: 09/25/16 - 0600
For: 09/25/16 - 1000
For: 09/25/16 - 1800
For: 09/26/16 - 0600
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/26/16 - 1000
For: 09/26/16 - 1800
For: 09/27/16 - 0600
For: 09/27/16 - 1000
For: 09/27/16 - 1800
For: 09/28/16 - 0600
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 6 Doses Dispensed: 6
For: 09/28/16 - 1000
For: 09/28/16 - 1800
For: 09/29/16 - 0600
For: 09/29/16 - 1000
For: 09/29/16 - 1800
For: 09/30/16 - 0600
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 09/30/16 - 1000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

For: 09/30/16 - 1800

For: 10/01/16 - 0600
For: 10/01/16 - 1000
For: 10/01/16 - 1800
For: 10/02/16 - 0600
For: 10/02/16 - 1000
For: 10/02/16 - 1800
For: 10/03/16 - 0600
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 10/03/16 - 1000
For: 10/03/16 - 1800
For: 10/04/16 - 0600
For: 10/04/16 - 1000
For: 10/04/16 - 1800
For: 10/05/16 - 0600
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 10/05/16 - 1000
For: 10/05/16 - 1800
For: 10/06/16 - 0600
For: 10/06/16 - 1000
For: 10/06/16 - 1800
For: 10/07/16 - 0600
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 8 Doses Auto Credited: 8
For: 10/04/16 - 1800
For: 10/05/16 - 0600
For: 10/05/16 - 1000
For: 10/05/16 - 1800
For: 10/06/16 - 0600
For: 10/06/16 - 1000
For: 10/06/16 - 1800
For: 10/07/16 - 0600
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CARB1TAB10 - LEVODOPA/CARBIDOPA 25/100 1 EA TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY@14 (SCH)
Start Date 09/21/16-1400 Stop Date 10/21/16 1359 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 13 Total Costs $0.00 Total Charges $27.69
Rx Number 01450945

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1533 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/21/16 - 1400
For: 09/22/16 - 1400
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 1400
For: 09/24/16 - 1400
For: 09/25/16 - 1400
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 1400
For: 09/27/16 - 1400
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 1400
For: 09/29/16 - 1400
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 1400
For: 10/01/16 - 1400
For: 10/02/16 - 1400
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 1400
For: 10/04/16 - 1400
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 1400
For: 10/06/16 - 1400
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 3 Doses Auto Credited: 3
For: 10/04/16 - 1400
For: 10/05/16 - 1400
For: 10/06/16 - 1400
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CARB1TAB10 - LEVODOPA/CARBIDOPA 25/100 1 EA TAB

Dose 0.5 EA (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@0600,1000,1800 (SCH)
Start Date 08/28/17-1800 Stop Date 08/31/17 1605 DC: 08/31/17-1605
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 20 Total Costs $0.00 Total Charges $19.17
Rx Number 01540764

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1545 - VERIFIED by AADEGBAMIG
Items Dispensed: 11 Doses Dispensed: 11
For: 08/28/17 - 1800
For: 08/29/17 - 0600
For: 08/29/17 - 1000
For: 08/29/17 - 1800
For: 08/30/17 - 0600
For: 08/30/17 - 1000
For: 08/30/17 - 1800
For: 08/31/17 - 0600
For: 08/31/17 - 1000
For: 08/31/17 - 1800
For: 09/01/17 - 0600
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1000
For: 09/01/17 - 1800
For: 09/02/17 - 0600
For: 09/02/17 - 1000
For: 09/02/17 - 1800
For: 09/03/17 - 0600
For: 09/03/17 - 1000
For: 09/03/17 - 1800
For: 09/04/17 - 0600
08/31/17 1608 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/28/17-1800 STOP: 09/27/17 1759 SOFT STOP: 0
TO:
START: 08/28/17-1800 STOP: 08/31/17-1605 SOFT STOP:
08/31/17 1608 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1605
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

Allergies/Duplicates/Interactions differ from order entry

08/31/17 1609 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427802
08/31/17 1617 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by NBALCETIS Eff: 08/31/17 1608
Discontinue by NBALCETIS Eff: 08/31/17 1608
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CARB1TAB10 - LEVODOPA/CARBIDOPA 25/100 1 EA TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY@1400 (SCH)
Start Date 08/29/17-1400 Stop Date 09/28/17 1359 DC: 08/31/17-1605
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $2.13
Rx Number 01540765

Discontinued Comments dc

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1545 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 1400
For: 08/30/17 - 1400
For: 08/31/17 - 1400
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1400
For: 09/02/17 - 1400
For: 09/03/17 - 1400
08/30/17 1242 - HOLD/RESUME by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM: 08/30/17-1237
TO: 08/31/17-1500
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/30/17 - 1400
For: 08/31/17 - 1400
HOLD/RESUME COMMENTS
hyperactivity
08/30/17 1711 - RESUME by NBALCETIS Eff: 08/30/17 1710
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDITED RESUME FROM: 08/31/17-1500
Items Auto Debited: 1 Doses Auto Debited: 1
For: 08/31/17 - 1400
RESUME COMMENTS
hyperactivity
08/31/17 1608 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1605
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/01/17 - 1400
For: 09/02/17 - 1400
For: 09/03/17 - 1400
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/31/17 1617 - REVIEW PROVIDER ACTIVITY by AMACCA
Hold/Resume by NBALCETIS Eff: 08/30/17 1242
hyperactivity
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

Hold/Resume by NBALCETIS Eff: 08/30/17 1711

hyperactivity
Discontinue by NBALCETIS Eff: 08/31/17 1608
dc

CARB1TAB10 - LEVODOPA/CARBIDOPA 25/100 1 EA TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency 1522 (ONE)
Start Date 08/28/17-1522 Stop Date 08/28/17 1523 DC: 08/28/17-1523
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01540766

Discontinued Comments Reached Stop Date

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1545 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1522
08/28/17 1546 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 1523
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

CARB1TAB10 - LEVODOPA/CARBIDOPA 25/100 1 EA TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 08/28/17 2100 DC: 08/28/17-2100
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01540767

Discontinued Comments dc

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1545 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/28/17 1550 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/28/17-2100 STOP: 09/27/17 2059 SOFT STOP: 0
DISPENSE: 4
DC COMMENTS:
TO:
START: 08/28/17-2100 STOP: 08/28/17-2100 SOFT STOP:
DISPENSE: 0
DC COMMENTS:
dc
08/28/17 1550 - DISCONTINUE by NBALCETIS Eff: 08/28/17 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
DC COMMENTS:
dc
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/28/17 1551 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by NBALCETIS Eff: 08/28/17 1550
Discontinue by NBALCETIS Eff: 08/28/17 1550
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

LVCR50200 - LEVODOPA/CARBIDOPA 50-200 TABCR

Dose 1 EA (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 09/20/16-2100 Stop Date 10/20/16 2059 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 14 Total Costs $0.00 Total Charges $31.22
Rx Number 01450946

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1534 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 09/20/16 - 2100
For: 09/21/16 - 2100
For: 09/22/16 - 2100
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 2100
For: 09/24/16 - 2100
For: 09/25/16 - 2100
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 2100
For: 09/27/16 - 2100
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 2100
For: 09/29/16 - 2100
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 2100
For: 10/01/16 - 2100
For: 10/02/16 - 2100
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 2100
For: 10/04/16 - 2100
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 2100
For: 10/06/16 - 2100
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 3 Doses Auto Credited: 3
For: 10/04/16 - 2100
For: 10/05/16 - 2100
For: 10/06/16 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 09/20/16-1515 Stop Date 10/20/16 1514 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01450927

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1527 - VERIFIED by EBALILO
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/20/16-1515 Stop Date 10/20/16 1514 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01450928

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1527 - VERIFIED by EBALILO
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 4.5 MG (1.5 TABLETS)

Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 09/20/16-2100 Stop Date 10/20/16 2059 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 28 Total Costs $0.00 Total Charges $5.60
Rx Number 01450969

Discontinued Comments DC'd by Discharge

History
09/20/16 1552 - ENTER by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 09/20/16 - 2100
For: 09/21/16 - 2100
For: 09/22/16 - 2100
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 09/23/16 - 2100
For: 09/24/16 - 2100
For: 09/25/16 - 2100
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/26/16 - 2100
For: 09/27/16 - 2100
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 4 Doses Dispensed: 2
For: 09/28/16 - 2100
For: 09/29/16 - 2100
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 09/30/16 - 2100
For: 10/01/16 - 2100
For: 10/02/16 - 2100
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 10/03/16 - 2100
For: 10/04/16 - 2100
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 10/05/16 - 2100
For: 10/06/16 - 2100
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 6 Doses Auto Credited: 3
For: 10/04/16 - 2100
For: 10/05/16 - 2100
For: 10/06/16 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 5 MG (1.66667 TABLETS)

Dose Instructions pt wil use his own meds
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059 DC: 08/28/17-2100
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540844

History
08/28/17 1624 - POM ORDER by NBALCETIS
08/28/17 1744 - DISCONTINUE by AADEGBAMIG Eff: 08/28/17 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/28/17 1744 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/21/16-0900 Stop Date 10/21/16 0859 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 14 Total Costs $0.00 Total Charges $22.56
Rx Number 01450941

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1530 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/21/16 - 0900
For: 09/22/16 - 0900
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 0900
For: 09/24/16 - 0900
For: 09/25/16 - 0900
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 0900
For: 09/27/16 - 0900
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 0900
For: 09/29/16 - 0900
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 0900
For: 10/01/16 - 0900
For: 10/02/16 - 0900
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 0900
For: 10/04/16 - 0900
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 2 Doses Auto Credited: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 09/21/16-0800 Stop Date 10/21/16 0759 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 14 Total Costs $0.00 Total Charges $12.32
Rx Number 01450942

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1530 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/21/16 - 0800
For: 09/22/16 - 0800
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 0800
For: 09/24/16 - 0800
For: 09/25/16 - 0800
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 0800
For: 09/27/16 - 0800
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 0800
For: 09/29/16 - 0800
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 0800
For: 10/01/16 - 0800
For: 10/02/16 - 0800
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 0800
For: 10/04/16 - 0800
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 0800
For: 10/06/16 - 0800
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 2 Doses Auto Credited: 2
For: 10/05/16 - 0800
For: 10/06/16 - 0800
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 09/20/16-1515 Stop Date 10/20/16 1514 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01450940

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1530 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/20/16 - 1515
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 0 Doses Dispensed: 0
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

NFR150C - POLYSACCHARIDE IRON COMPLEX 150 MG CAP

Dose 150 MG (1 CAPSULE)

Dose Instructions Ferrex 1 po daily
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/21/16-0900 Stop Date 10/21/16 0859 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 14 Total Costs $0.00 Total Charges $39.90
Rx Number 01450947

Discontinued Comments DC'd by Discharge

History
09/20/16 1539 - ENTER by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/21/16 - 0900
For: 09/22/16 - 0900
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 0900
For: 09/24/16 - 0900
For: 09/25/16 - 0900
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 0900
For: 09/27/16 - 0900
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 0900
For: 09/29/16 - 0900
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 0900
For: 10/01/16 - 0900
For: 10/02/16 - 0900
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 0900
For: 10/04/16 - 0900
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 2 Doses Auto Credited: 2
For: 10/05/16 - 0900
For: 10/06/16 - 0900
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

PRAM0.5T14 - PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY@06,10,18 (SCH)
Start Date 09/20/16-1800 Stop Date 10/20/16 1759 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 42 Total Costs $0.00 Total Charges $608.16
Rx Number 01450948

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1539 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 8
For: 09/20/16 - 1800
For: 09/21/16 - 0600
For: 09/21/16 - 1000
For: 09/21/16 - 1800
For: 09/22/16 - 0600
For: 09/22/16 - 1000
For: 09/22/16 - 1800
For: 09/23/16 - 0600
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 09/23/16 - 1000
For: 09/23/16 - 1800
For: 09/24/16 - 0600
For: 09/24/16 - 1000
For: 09/24/16 - 1800
For: 09/25/16 - 0600
For: 09/25/16 - 1000
For: 09/25/16 - 1800
For: 09/26/16 - 0600
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/26/16 - 1000
For: 09/26/16 - 1800
For: 09/27/16 - 0600
For: 09/27/16 - 1000
For: 09/27/16 - 1800
For: 09/28/16 - 0600
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 6 Doses Dispensed: 6
For: 09/28/16 - 1000
For: 09/28/16 - 1800
For: 09/29/16 - 0600
For: 09/29/16 - 1000
For: 09/29/16 - 1800
For: 09/30/16 - 0600
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 09/30/16 - 1000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

For: 09/30/16 - 1800

For: 10/01/16 - 0600
For: 10/01/16 - 1000
For: 10/01/16 - 1800
For: 10/02/16 - 0600
For: 10/02/16 - 1000
For: 10/02/16 - 1800
For: 10/03/16 - 0600
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 10/03/16 - 1000
For: 10/03/16 - 1800
For: 10/04/16 - 0600
For: 10/04/16 - 1000
For: 10/04/16 - 1800
For: 10/05/16 - 0600
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 10/05/16 - 1000
For: 10/05/16 - 1800
For: 10/06/16 - 0600
For: 10/06/16 - 1000
For: 10/06/16 - 1800
For: 10/07/16 - 0600
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 8 Doses Auto Credited: 8
For: 10/04/16 - 1800
For: 10/05/16 - 0600
For: 10/05/16 - 1000
For: 10/05/16 - 1800
For: 10/06/16 - 0600
For: 10/06/16 - 1000
For: 10/06/16 - 1800
For: 10/07/16 - 0600
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

PRMP1T - PRAMIPEXOLE DIHYDROCHLORIDE 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@14 (SCH)
Start Date 09/21/16-1400 Stop Date 10/21/16 1359 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 13 Total Costs $0.00 Total Charges $197.34
Rx Number 01450949

Warnings
Type: BURKE
Range: PRAMIPEXOLE DIHYDROCHLORIDE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1.5 MG/DAY - 4.5 MG/DAY. Ordered dose of 1 MG/DAY is
below the Low Daily Dose.

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1540 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 09/21/16 - 1400
For: 09/22/16 - 1400
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 1400
For: 09/24/16 - 1400
For: 09/25/16 - 1400
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 1400
For: 09/27/16 - 1400
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 1400
For: 09/29/16 - 1400
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 1400
For: 10/01/16 - 1400
For: 10/02/16 - 1400
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 1400
For: 10/04/16 - 1400
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 1400
For: 10/06/16 - 1400
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 3 Doses Auto Credited: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

For: 10/04/16 - 1400

For: 10/05/16 - 1400
For: 10/06/16 - 1400
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

PRMP1T - PRAMIPEXOLE DIHYDROCHLORIDE 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/28/17-1700 Stop Date 09/27/17 1659 DC: 08/28/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540773

History
08/28/17 1531 - POM ORDER by NBALCETIS
08/28/17 1546 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 08/31/17 - 2100
08/28/17 1550 - DISCONTINUE by NBALCETIS Eff: 08/28/17 1700
Items Auto Credited: 14 Doses Auto Credited: 14
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 08/31/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/28/17 1550 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01426897
08/28/17 1551 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 08/28/17 1550
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

PRMP1T - PRAMIPEXOLE DIHYDROCHLORIDE 1 MG TAB

Dose 0.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/28/17-1700 Stop Date 09/27/17 1659 DC: 08/28/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540784

History
08/28/17 1550 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540773
08/28/17 1553 - VERIFIED by SYSTEM
Verified in order to DC
08/28/17 1553 - DISCONTINUE by AADEGBAMIG Eff: 08/28/17 1700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

PRAM0.5T14 - PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/28/17-1700 Stop Date 08/30/17 1707 DC: 08/30/17-1707
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 26 Total Costs $0.00 Total Charges $107.31
Rx Number 01540783

History
08/28/17 1553 - ENTER by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
For: 09/03/17 - 2100
08/30/17 1710 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/28/17-1700 STOP: 09/27/17 1659 SOFT STOP: 0
DISPENSE: 12
TO:
START: 08/28/17-1700 STOP: 08/30/17-1707 SOFT STOP:
DISPENSE: 9
08/30/17 1710 - DISCONTINUE by NBALCETIS Eff: 08/30/17 1707
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/30/17 1710 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427501
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

08/30/17 1733 - REVIEW PROVIDER ACTIVITY by AMACCA

Edit by NBALCETIS Eff: 08/30/17 1710
Discontinue by NBALCETIS Eff: 08/30/17 1710
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
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GORELICK,VICTOR W00001219474 (Continued)

PRAM0.5T14 - PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY@0600,1000,1400 (SCH)
Start Date 08/31/17-0600 Stop Date 08/31/17 1605 DC: 08/31/17-1605
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $30.66
Rx Number 01541422

History
08/30/17 1710 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540783
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/30/17 - 1700
Last Actual Administration Time: 08/30/17 - 1246 (Not Given)
Old Freq/Sch: 4 TIMES A DAY (SCH)
New Freq/Sch: DAILY@0600,1000,1400 (SCH)
Old Order Stop: 08/30/17 - 1707
New Order Start: 08/31/17 - 0600
New Order Stop: 09/27/17 - 1659
08/30/17 1733 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by NBALCETIS Eff: 08/30/17 1710
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/30/17 - 1700
Last Actual Administration Time: 08/30/17 - 1246 (Not Given)
Old Freq/Sch: 4 TIMES A DAY (SCH)
New Freq/Sch: DAILY@0600,1000,1400 (SCH)
Old Order Stop: 08/30/17 - 1707
New Order Start: 08/31/17 - 0600
New Order Stop: 09/27/17 - 1659
08/30/17 1733 - VERIFIED by AMACCA
Items Dispensed: 13 Doses Dispensed: 13
For: 08/31/17 - 0600
For: 08/31/17 - 1000
For: 08/31/17 - 1400
For: 09/01/17 - 0600
For: 09/01/17 - 1000
For: 09/01/17 - 1400
For: 09/02/17 - 0600
For: 09/02/17 - 1000
For: 09/02/17 - 1400
For: 09/03/17 - 0600
For: 09/03/17 - 1000
For: 09/03/17 - 1400
For: 09/04/17 - 0600
08/31/17 1608 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/31/17-0600 STOP: 09/27/17 1659 SOFT STOP:
DISPENSE: 13
TO:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

START: 08/31/17-0600 STOP: 08/31/17-1605 SOFT STOP:

DISPENSE: 3
08/31/17 1608 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1605
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/31/17 1609 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427803
08/31/17 1617 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by NBALCETIS Eff: 08/31/17 1608
Discontinue by NBALCETIS Eff: 08/31/17 1608
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
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GORELICK,VICTOR W00001219474 (Continued)

PRAM0.5T14 - PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/30/17-1800 Stop Date 09/29/17 1759 DC: 08/31/17-1605
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $15.33
Rx Number 01541423

Discontinued Comments dc

History
08/30/17 1710 - POM ORDER by NBALCETIS
08/30/17 1733 - REVIEW PROVIDER ACTIVITY by AMACCA
Administration of Unverified Order by AADAMS Eff: 08/30/17 1714
08/30/17 1733 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/30/17 - 1800
For: 08/31/17 - 1800
For: 09/01/17 - 1800
For: 09/02/17 - 1800
For: 09/03/17 - 1800
08/31/17 1608 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1605
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/31/17 - 1800
For: 09/01/17 - 1800
For: 09/02/17 - 1800
For: 09/03/17 - 1800
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/31/17 1617 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/31/17 1608
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 09/21/16-1200 Stop Date 10/21/16 1159 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 26 Total Costs $0.00 Total Charges $2.60
Rx Number 01450932

Discontinued Comments DC'd by Discharge

History
09/20/16 1519 - POM ORDER by AMIRCHANDA
09/20/16 1527 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 2
For: 09/21/16 - 1200
For: 09/22/16 - 1200
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 09/23/16 - 1200
For: 09/24/16 - 1200
For: 09/25/16 - 1200
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/26/16 - 1200
For: 09/27/16 - 1200
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 4 Doses Dispensed: 2
For: 09/28/16 - 1200
For: 09/29/16 - 1200
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 09/30/16 - 1200
For: 10/01/16 - 1200
For: 10/02/16 - 1200
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 10/03/16 - 1200
For: 10/04/16 - 1200
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 10/05/16 - 1200
For: 10/06/16 - 1200
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 6 Doses Auto Credited: 3
For: 10/04/16 - 1200
For: 10/05/16 - 1200
For: 10/06/16 - 1200
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

GORELICK,VICTOR W00001219474 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions Constipation
374mg=2 tablets
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1530 Stop Date 09/27/17 1529 DC: 08/28/17-1548
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01540756

Discontinued Comments dc

History
08/28/17 1530 - POM ORDER by NBALCETIS
08/28/17 1544 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1530
08/28/17 1550 - DISCONTINUE by NBALCETIS Eff: 08/28/17 1548
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/28/17 1551 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 08/28/17 1550
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
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GORELICK,VICTOR W00001219474 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@1300,1700 (SCH)
Start Date 08/28/17-1700 Stop Date 09/27/17 1659 DC: 08/29/17-1554
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.40
Rx Number 01540776

Discontinued Comments dc

History
08/28/17 1531 - POM ORDER by NBALCETIS
08/28/17 1546 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 7
For: 08/28/17 - 1700
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/29/17 1555 - DISCONTINUE by NBALCETIS Eff: 08/29/17 1554
Items Auto Credited: 10 Doses Auto Credited: 5
For: 08/29/17 - 1700
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 1300
For: 08/31/17 - 1700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/29/17 1556 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 08/29/17 1555
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
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GORELICK,VICTOR W00001219474 (Continued)

SMV20T - SIMVASTATIN 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/20/16-2100 Stop Date 10/20/16 2059 DC: 10/04/16-1114
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed 14 Total Costs $0.00 Total Charges $4.20
Rx Number 01450943

Discontinued Comments DC'd by Discharge

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1531 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 09/20/16 - 2100
For: 09/21/16 - 2100
For: 09/22/16 - 2100
09/21/16 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/23/16 - 2100
For: 09/24/16 - 2100
For: 09/25/16 - 2100
09/23/16 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/26/16 - 2100
For: 09/27/16 - 2100
09/26/16 0842 - FILL by JSATTARELL
Items Dispensed: 2 Doses Dispensed: 2
For: 09/28/16 - 2100
For: 09/29/16 - 2100
09/28/16 0817 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 09/30/16 - 2100
For: 10/01/16 - 2100
For: 10/02/16 - 2100
09/30/16 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/03/16 - 2100
For: 10/04/16 - 2100
10/03/16 0820 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 10/05/16 - 2100
For: 10/06/16 - 2100
10/04/16 1114 - DISCONTINUE by DISCHARGE Eff: 10/04/16 1114
Items Auto Credited: 3 Doses Auto Credited: 3
For: 10/04/16 - 2100
For: 10/05/16 - 2100
For: 10/06/16 - 2100
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
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GORELICK,VICTOR W00001219474 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 5 MG (1.66667 TABLETS)

Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 09/20/16-2100 Stop Date 10/20/16 2059 CAN: 09/20/16-1545
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01339791

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1545 - CANCEL by EBALILO
EDIT DOCTOR: MIRCHANDANI,ANISH MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
CANCELLATION COMMENTS:
CHANGED DOSE TO 4.5MG PER MD

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (0 EACHS)
Dose Instructions Ferrex 1 PO Daily
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/21/16-0900 Stop Date 10/21/16 0859 CAN: 09/20/16-1541
Ordering Doctor MIRCHANDANI,ANISH MD
Total Dispensed Total Costs $ Total Charges $
Rx Number U01339787

History
09/20/16 1520 - POM ORDER by AMIRCHANDA
09/20/16 1541 - CANCEL by EBALILO
EDIT DOCTOR: MIRCHANDANI,ANISH MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
CANCELLATION COMMENTS:
entered as formulary med
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient HALL,STEPHEN N Responsible Doctor NOVITCH, RICHARD MD.

Account Number W00001218071 Location B1WE Unit Number M000208765
Age/Sex 75/M Room 154 Registered Date 08/01/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 10.98 in 180.3 cm Body Surface Area 1.64 m2

Weight 110 lb 14.4 oz 50.303 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/01/17-1556 DRUG REGIMEN REVIEW COMPLETE
08/02/17-1119 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: COPD
Secondary Diagnosis:

BUDE6HFA - BUDESONIDE/FORMOTEROL FUMARATE 160/4.5MCG INH

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $493.95
Rx Number 01541546

History
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01533511
08/31/17 1048 - EDIT by AMACCA
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-1700 STOP: 09/30/17 SOFT STOP:
TO:
START: 08/31/17-1700 STOP: 09/30/17-1659 SOFT STOP:
08/31/17 1048 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

TIOT18CA6 - TIOTROPIUM BROMIDE 18 MCG BOX

Dose 18 MCG (1 BOX)

Admin Route INHALATION
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/30/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $243.09
Rx Number 01541547

History
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01533510
08/31/17 1048 - EDIT by AMACCA
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-0900 STOP: 09/30/17 SOFT STOP:
TO:
START: 09/01/17-0900 STOP: 09/30/17-0859 SOFT STOP:
08/31/17 1048 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 08/31/17-1300 Stop Date 09/30/17 1259
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01541540

History
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01533495
08/31/17 1047 - EDIT by AMACCA
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-1300 STOP: 09/30/17 SOFT STOP:
TO:
START: 08/31/17-1300 STOP: 09/30/17-1259 SOFT STOP:
08/31/17 1047 - VERIFIED by AMACCA
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/30/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 5 Total Costs $0.00 Total Charges $48.54
Rx Number 01541542

History
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01533515
08/31/17 1048 - EDIT by AMACCA
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-0900 STOP: 09/30/17 SOFT STOP:
TO:
START: 09/01/17-0900 STOP: 09/30/17-0859 SOFT STOP:
08/31/17 1048 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/30/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 5 Total Costs $0.00 Total Charges $0.09
Rx Number 01541544

History
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01533492
08/31/17 1048 - EDIT by AMACCA
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-0900 STOP: 09/30/17 SOFT STOP:
TO:
START: 09/01/17-0900 STOP: 09/30/17-0859 SOFT STOP:
08/31/17 1048 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

CALC1TAB - CALCIUM CARBONATE/VITAMIN D2 (CALTRATE-600/VIT D.) TABLET

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY AT LUNCH (SCH)
Start Date 08/11/17-1230 Stop Date 09/10/17 1229
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 26 Total Costs $0.00 Total Charges $6.00
Rx Number 01535680

History
08/10/17 1440 - POM ORDER by NBALCETIS
08/10/17 1452 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 1230
For: 08/12/17 - 1230
For: 08/13/17 - 1230
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1230
For: 08/15/17 - 1230
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 1230
For: 08/17/17 - 1230
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 1230
For: 08/19/17 - 1230
For: 08/20/17 - 1230
08/18/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 1230
For: 08/22/17 - 1230
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 1230
For: 08/24/17 - 1230
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1230
For: 08/26/17 - 1230
For: 08/27/17 - 1230
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1230
For: 08/29/17 - 1230
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1230
For: 08/31/17 - 1230
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

For: 09/01/17 - 1230

For: 09/02/17 - 1230
For: 09/03/17 - 1230
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1230
For: 09/05/17 - 1230
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 2,000 UNIT (2 CAPSULES)

Admin Route ORAL
Frequency DAILY AT LUNCH (SCH)
Start Date 08/11/17-1230 Stop Date 09/10/17 1229
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 52 Total Costs $0.00 Total Charges $6.00
Rx Number 01535681

History
08/10/17 1440 - POM ORDER by NBALCETIS
08/10/17 1452 - VERIFIED by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 1230
For: 08/12/17 - 1230
For: 08/13/17 - 1230
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 1230
For: 08/15/17 - 1230
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 1230
For: 08/17/17 - 1230
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 1230
For: 08/19/17 - 1230
For: 08/20/17 - 1230
08/18/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 1230
For: 08/22/17 - 1230
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1230
For: 08/24/17 - 1230
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1230
For: 08/26/17 - 1230
For: 08/27/17 - 1230
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1230
For: 08/29/17 - 1230
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1230
For: 08/31/17 - 1230
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

For: 09/01/17 - 1230

For: 09/02/17 - 1230
For: 09/03/17 - 1230
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1230
For: 09/05/17 - 1230

CYAN1TAB4 - CYANOCOBALAMIN/FA/PYRIDOXINE (FOLTX) TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 11 Total Costs $0.00 Total Charges $26.82
Rx Number 01540184

History
08/25/17 1628 - POM ORDER by NBALCETIS
08/25/17 1642 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/05/17-2115 Stop Date 09/04/17 2114
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534683

History
08/05/17 2111 - POM ORDER by HAZIZI
08/06/17 1107 - VERIFIED by MHAIMOWITZ
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/05/17-2115 Stop Date 09/06/17 2114
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534684

History
08/05/17 2111 - POM ORDER by HAZIZI
08/06/17 1107 - VERIFIED by MHAIMOWITZ
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

PRD5T - PREDNISONE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/08/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 10 Total Costs $0.00 Total Charges $3.00
Rx Number 01541550

History
08/31/17 1044 - POM ORDER by RNOVITCH
08/31/17 1049 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/05/17-2115 Stop Date 09/04/17 2114
Ordering Doctor AZIZI,HANA MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.20
Rx Number 01534685

History
08/05/17 2111 - POM ORDER by HAZIZI
08/06/17 1107 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by MVARIATH Eff: 08/05/17 2151
08/06/17 1107 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 1
For: 08/05/17 - 2115
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

BUDE6HFA - BUDESONIDE/FORMOTEROL FUMARATE 160/4.5MCG INH

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency 2 TIMES A DAY (SCH)
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/31/17-1044
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 2 Total Costs $0.00 Total Charges $987.90
Rx Number 01533511

History
08/01/17 1555 - POM ORDER by RNOVITCH
08/01/17 1556 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/01/17 - 1700
08/17/17 1648 - DEBIT by AMACCA
ITEMS: 1
08/31/17 1044 - DISCONTINUE by RNOVITCH Eff: 08/31/17 1044
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01427620
08/31/17 1048 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/31/17 1044
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

TIOT18CA6 - TIOTROPIUM BROMIDE 18 MCG BOX

Dose 18 MCG (1 BOX)

Admin Route INHALATION
Frequency DAILY (SCH)
Start Date 08/02/17-0900 Stop Date 09/01/17 0859 DC: 08/31/17-1044
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 5 Total Costs $0.00 Total Charges $1215.45
Rx Number 01533510

History
08/01/17 1555 - POM ORDER by RNOVITCH
08/01/17 1556 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/02/17 - 0900
08/05/17 1219 - DEBIT by JSATTARELL
ITEMS: 1
08/13/17 0941 - DEBIT by AMACCA
ITEMS: 1
08/19/17 1022 - DEBIT by AADEGBAMIG
ITEMS: 1
08/25/17 0911 - DEBIT by AMOLINARI
ITEMS: 1
08/31/17 1044 - DISCONTINUE by RNOVITCH Eff: 08/31/17 1044
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01427621
08/31/17 1048 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/31/17 1044
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/31/17-1044
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $29.75
Rx Number 01533495

History
08/01/17 1544 - POM ORDER by RNOVITCH
08/01/17 1547 - VERIFIED by AMACCA
08/02/17 0820 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 12
For: 08/04/17 - 0900
For: 08/04/17 - 1300
For: 08/04/17 - 1700
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
For: 08/06/17 - 2100
08/04/17 0827 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
For: 08/08/17 - 2100
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
For: 08/10/17 - 2100
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 08/11/17 - 0900
For: 08/11/17 - 1300
For: 08/11/17 - 1700
For: 08/11/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

For: 08/12/17 - 0900

For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/14/17 - 0900
For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
For: 08/17/17 - 2100
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
For: 08/20/17 - 2100
08/18/17 0818 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
For: 08/22/17 - 2100
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/23/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

For: 08/23/17 - 1300

For: 08/23/17 - 1700
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 12
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 1300
08/31/17 1044 - DISCONTINUE by RNOVITCH Eff: 08/31/17 1044
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01427617
08/31/17 1047 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/31/17 1044
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/02/17-0900 Stop Date 09/01/17 0859 DC: 08/31/17-1044
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 30 Total Costs $0.00 Total Charges $485.40
Rx Number 01533515

History
08/01/17 1544 - POM ORDER by RNOVITCH
08/01/17 1559 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0827 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

For: 08/23/17 - 0900

For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/31/17 1044 - DISCONTINUE by RNOVITCH Eff: 08/31/17 1044
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01427618
08/31/17 1047 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/31/17 1044
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/02/17-0900 Stop Date 09/01/17 0859 DC: 08/31/17-1044
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 30 Total Costs $0.00 Total Charges $0.90
Rx Number 01533492

History
08/01/17 1544 - POM ORDER by RNOVITCH
08/01/17 1547 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0820 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0827 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

For: 08/23/17 - 0900

For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/31/17 1044 - DISCONTINUE by RNOVITCH Eff: 08/31/17 1044
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/31/17 1044 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01427619
08/31/17 1047 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/31/17 1044
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

CFR250T - CEFUROXIME AXETIL 250 MG TAB

Dose 500 MG (2 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/01/17-1700 Stop Date 08/08/17 1659 DC: 08/08/17-1659
Ordering Doctor NOVITCH, RICHARD MD.
Clinical Indication EMPIRIC THERAPY
Total Dispensed 28 Total Costs $0.00 Total Charges $118.30
Rx Number 01533493

Discontinued Comments Reached Stop Date

History
08/01/17 1544 - POM ORDER by RNOVITCH
08/01/17 1547 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 08/01/17 - 1700
For: 08/02/17 - 0900
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1700
08/02/17 0820 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
08/04/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
08/08/17 1659 - DISCONTINUE by PHABKGJOB Eff: 08/08/17 1659
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

PRD20T - PREDNISONE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/02/17-0900 Stop Date 08/04/17 0901 DC: 08/04/17-0901
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 3 Total Costs $0.00 Total Charges $1.74
Rx Number 01533494

Discontinued Comments Reached Stop Date

History
08/01/17 1544 - POM ORDER by RNOVITCH
08/01/17 1547 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0820 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/04/17 - 0900
08/04/17 0901 - DISCONTINUE by PHABKGJOB Eff: 08/04/17 0901
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

PRD5T - PREDNISONE 5 MG TAB

Dose 15 MG (3 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/05/17-0900 Stop Date 08/11/17 0901 DC: 08/11/17-0901
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 21 Total Costs $0.00 Total Charges $10.50
Rx Number 01534442

Discontinued Comments Reached Stop Date

History
08/04/17 1752 - POM ORDER by RNOVITCH
08/04/17 1753 - VERIFIED by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 1
For: 08/11/17 - 0900
08/10/17 1453 - EDIT by AMOLINARI
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/05/17-0900 STOP: 08/12/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/05/17-0900 STOP: 08/11/17-0901 SOFT STOP: 0
DISPENSE: 21
08/11/17 0901 - DISCONTINUE by PHABKGJOB Eff: 08/11/17 0901
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

PRD5T - PREDNISONE 5 MG TAB

Dose 12.5 MG (2.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 08/16/17 0901 DC: 08/16/17-0901
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 15 Total Costs $0.00 Total Charges $7.50
Rx Number 01535683

Discontinued Comments Reached Stop Date

History
08/10/17 1440 - POM ORDER by NBALCETIS
08/10/17 1453 - VERIFIED by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 1
For: 08/16/17 - 0900
08/16/17 0901 - DISCONTINUE by PHABKGJOB Eff: 08/16/17 0901
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

PRD5T - PREDNISONE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 08/24/17 0859 DC: 08/23/17-1549
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 14 Total Costs $0.00 Total Charges $7.00
Rx Number 01537143

History
08/16/17 1106 - POM ORDER by RNOVITCH
08/16/17 1119 - VERIFIED by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 1
For: 08/23/17 - 0900
08/23/17 1549 - DISCONTINUE by NBALCETIS Eff: 08/23/17 1549
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/23/17 1549 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425525
08/23/17 1550 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/23/17 1549
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

PRD5T - PREDNISONE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 08/30/17 0859 DC: 08/30/17-0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $6.00
Rx Number 01539348

Discontinued Comments Reached Stop Date

History
08/23/17 1549 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01537143
08/23/17 1550 - EDIT by AMACCA
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/24/17-0900 STOP: 08/30/17 SOFT STOP:
TO:
START: 08/24/17-0900 STOP: 08/30/17-0859 SOFT STOP:
08/23/17 1550 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/30/17 0900 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

HALL,STEPHEN N W00001218071 (Continued)

PRD5T - PREDNISONE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency 1043 (ONE)
Start Date 08/31/17-1043 Stop Date 08/31/17 1044 DC: 08/31/17-1044
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 2 Total Costs $0.00 Total Charges $1.00
Rx Number 01541551

Discontinued Comments Reached Stop Date

History
08/31/17 1044 - POM ORDER by RNOVITCH
08/31/17 1049 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 08/31/17 - 1043
08/31/17 1049 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 1044
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient HARRIS,JOHN F Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219209 Location B1WE Unit Number M000209187
Age/Sex 65/M Room 148 Registered Date 08/21/17
Status ADM IN Bed 01 Discharged Date

Height 6 ft 3.98 in 193 cm Body Surface Area 2.50 m2

Weight 266 lb 6.4 oz 120.837 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/22/17-2138 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-2000 Stop Date 09/20/17 1959
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538798

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2007 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Dose Instructions PRN Pain
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/21/17-2000 Stop Date 09/20/17 1959
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01538789

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $0.39
Rx Number 01538791

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $9.75
Rx Number 01538807

History
08/21/17 2020 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 2100
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-2000 Stop Date 09/20/17 1959
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538787

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-2000 Stop Date 09/20/17 1959
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01538788

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

DULO30CA2 - DULOXETINE HCL 30 MG CPDR

Dose 60 MG (2 CAPSULE DELAYED RELEASES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $145.40
Rx Number 01541267

History
08/30/17 1200 - ENTER by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

ENLP2.5T - ENALAPRIL MALEATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/23/17-1700 Stop Date 09/21/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 27 Total Costs $0.00 Total Charges $44.00
Rx Number 01539282

History
08/23/17 1354 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538806
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/23/17 - 0900
Last Actual Administration Time: 08/23/17 - 0910
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/23/17 - 1350
New Order Start: 08/23/17 - 1700
New Order Stop: 09/21/17 - 0859
08/23/17 1417 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by NBALCETIS Eff: 08/23/17 1354
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/23/17 - 0900
Last Actual Administration Time: 08/23/17 - 0910
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/23/17 - 1350
New Order Start: 08/23/17 - 1700
New Order Stop: 09/21/17 - 0859
08/23/17 1417 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

For: 08/31/17 - 0900

For: 08/31/17 - 1700
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01538790

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

FNST5T - FINASTERIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $40.95
Rx Number 01538795

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 30 Total Costs $0.00 Total Charges $7.00
Rx Number 01538794

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 08/22/17 - 0900
For: 08/22/17 - 1700
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

For: 09/05/17 - 1700

GLPZ25TCR - GLIPIZIDE XL 2.5 MG TABCR

Dose 2.5 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $2.19
Rx Number 01541641

History
08/31/17 1452 - POM ORDER by NBALCETIS
08/31/17 1500 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

GUAI100S17 - GUAIFENESIN 100 MG/5 ML UDC

Dose 100 MG (5 ML)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: cough
Start Date 08/21/17-2000 Stop Date 09/20/17 1959
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01538792

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-2000 Stop Date 09/20/17 1959
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538786

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MELA3TAB - MELATONIN 3 MG TAB

Dose 6 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 8 Total Costs $0.00 Total Charges $0.80
Rx Number 01542165

History
09/02/17 0031 - POM ORDER by RMINASSIAN
09/02/17 1043 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by MVARIATH Eff: 09/02/17 0039
09/02/17 1043 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

MTF850T - METFORMIN HCL 850 MG TAB

Dose 850 MG (1 TABLET)

Admin Route ORAL
Frequency BEFORE MEALS (SCH)
Start Date 08/23/17-0800 Stop Date 09/21/17 0859
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 42 Total Costs $0.00 Total Charges $90.90
Rx Number 01539153

History
08/22/17 2128 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01538811
Result of Frequency/Schedule Edit
Ordering Doctor: DOHLE,CAROLIN MD
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time: 08/22/17 - 0827
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: BEFORE MEALS (SCH)
Old Order Stop: 08/22/17 - 2122
New Order Start: 08/23/17 - 0800
New Order Stop: 09/21/17 - 0859
08/22/17 2134 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by CDOHLE Eff: 08/22/17 2128
Ordering Doctor: DOHLE,CAROLIN MD
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time: 08/22/17 - 0827
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: BEFORE MEALS (SCH)
Old Order Stop: 08/22/17 - 2122
New Order Start: 08/23/17 - 0800
New Order Stop: 09/21/17 - 0859
08/22/17 2134 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0800
For: 08/23/17 - 1200
For: 08/23/17 - 1700
For: 08/24/17 - 0800
For: 08/24/17 - 1200
For: 08/24/17 - 1700
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0800
For: 08/25/17 - 1200
For: 08/25/17 - 1700
For: 08/26/17 - 0800
For: 08/26/17 - 1200
For: 08/26/17 - 1700
For: 08/27/17 - 0800
For: 08/27/17 - 1200
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

For: 08/28/17 - 0800

For: 08/28/17 - 1200
For: 08/28/17 - 1700
For: 08/29/17 - 0800
For: 08/29/17 - 1200
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0800
For: 08/30/17 - 1200
For: 08/30/17 - 1700
For: 08/31/17 - 0800
For: 08/31/17 - 1200
For: 08/31/17 - 1700
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0800
For: 09/01/17 - 1200
For: 09/01/17 - 1700
For: 09/02/17 - 0800
For: 09/02/17 - 1200
For: 09/02/17 - 1700
For: 09/03/17 - 0800
For: 09/03/17 - 1200
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0800
For: 09/04/17 - 1200
For: 09/04/17 - 1700
For: 09/05/17 - 0800
For: 09/05/17 - 1200
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

MTP100TCR - METOPROLOL SUCCINATE XL 100 MG TABCR

Dose 100 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $33.96
Rx Number 01538926

History
08/22/17 1110 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538799
08/22/17 1120 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01538801

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2007 - VERIFIED by AADEGBAMIG
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/22/17-0800 Stop Date 09/21/17 0759
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $271.44
Rx Number 01538810

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2027 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0800
For: 08/23/17 - 0800
For: 08/24/17 - 0800
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/29/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 11 Total Costs $0.00 Total Charges $8.10
Rx Number 01541642

History
08/31/17 1457 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540946
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/31/17 - 0900
Last Actual Administration Time: 08/31/17 - 0903
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/31/17 - 1456
New Order Start: 08/31/17 - 1700
New Order Stop: 09/29/17 - 0859
08/31/17 1501 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by NBALCETIS Eff: 08/31/17 1457
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/31/17 - 0900
Last Actual Administration Time: 08/31/17 - 0903
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/31/17 - 1456
New Order Start: 08/31/17 - 1700
New Order Stop: 09/29/17 - 0859
08/31/17 1501 - VERIFIED by AADEGBAMIG
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions Constipation
374mg=2 tablets
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-2000 Stop Date 09/20/17 1959
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 4 Total Costs $0.00 Total Charges $0.20
Rx Number 01538797

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2007 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2000
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

TMSL.4C - TAMSULOSIN HCL 0.4 MG CAP

Dose 0.4 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $224.25
Rx Number 01538803

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2008 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

VITA-243 - VITAMIN B COMP W-C 1 EA TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $3.90
Rx Number 01538861

History
08/21/17 2237 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

WRF3T - WARFARIN SOD 3 MG TAB

Dose 9 MG (3 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 09/04/17 2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542108

History
09/01/17 1809 - POM ORDER by NBALCETIS
09/01/17 1822 - VERIFIED by AADEGBAMIG

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 DC: 08/21/17-2100
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538805

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2008 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 2100
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/21/17 2008 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/26/17-2100 Stop Date 09/25/17 2059 DC: 08/27/17-1013
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540440

Discontinued Comments dc per Dr. Ivanov

History
08/26/17 2049 - POM ORDER by HAZIZI
08/27/17 1013 - DISCONTINUE by AADEGBAMIG Eff: 08/27/17 1013
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc per Dr. Ivanov
08/27/17 1013 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

DULO20CA - DULOXETINE HCL 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 DC: 08/30/17-1125
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 9 Total Costs $0.00 Total Charges $145.80
Rx Number 01538793

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2006 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/30/17 1127 - DISCONTINUE by NBALCETIS Eff: 08/30/17 1125
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/30/17 1127 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427354
08/30/17 1200 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/30/17 1127
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

ENLP2.5T - ENALAPRIL MALEATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/23/17 1350 DC: 08/23/17-1350
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $4.00
Rx Number 01538806

History
08/21/17 2019 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/23/17 1354 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/22/17-0900 STOP: 09/21/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/22/17-0900 STOP: 08/23/17-1350 SOFT STOP:
DISPENSE: 2
08/23/17 1354 - DISCONTINUE by NBALCETIS Eff: 08/23/17 1350
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/23/17 1354 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425463
08/23/17 1417 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by NBALCETIS Eff: 08/23/17 1354
Discontinue by NBALCETIS Eff: 08/23/17 1354
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

GLIP10TA - GLIPIZIDE XL 10 MG TABCR

Dose 10 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/22/17 2122 DC: 08/22/17-2122
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $1.43
Rx Number 01538796

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2007 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/22/17 2128 - EDIT by CDOHLE
EDIT DOCTOR: DOHLE,CAROLIN MD
FROM:
START: 08/22/17-0900 STOP: 09/21/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/22/17-0900 STOP: 08/22/17-2122 SOFT STOP:
DISPENSE: 1
08/22/17 2128 - DISCONTINUE by CDOHLE Eff: 08/22/17 2122
EDIT DOCTOR: DOHLE,CAROLIN MD
08/22/17 2128 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01425336
08/22/17 2130 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by CDOHLE Eff: 08/22/17 2128
Discontinue by CDOHLE Eff: 08/22/17 2128
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

GLIP10TA - GLIPIZIDE XL 10 MG TABCR

Dose 20 MG (2 TABLET, CONTROLLED-RELEASES)

Admin Route ORAL
Frequency 2X DAILY BRKFST/DIN (SCH)
Start Date 08/23/17-0800 Stop Date 09/21/17 0859 DC: 08/23/17-0800
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539152

Discontinued Comments CALLED MD- MAX FOR ER PRODUCT IS 20MG, IR MAX IS 40MG
CHANGE TO IR TABLETS 20MG 2XDAY

History
08/22/17 2128 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01538796
Result of Frequency/Schedule Edit
Ordering Doctor: DOHLE,CAROLIN MD
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time: 08/22/17 - 0827
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2X DAILY BRKFST/DIN (SCH)
Old Order Stop: 08/22/17 - 2122
New Order Start: 08/23/17 - 0800
New Order Stop: 09/21/17 - 0859
08/22/17 2134 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by CDOHLE Eff: 08/22/17 2128
Ordering Doctor: DOHLE,CAROLIN MD
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time: 08/22/17 - 0827
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2X DAILY BRKFST/DIN (SCH)
Old Order Stop: 08/22/17 - 2122
New Order Start: 08/23/17 - 0800
New Order Stop: 09/21/17 - 0859
08/22/17 2134 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 4
For: 08/23/17 - 0800
For: 08/23/17 - 1700
For: 08/24/17 - 0800
For: 08/24/17 - 1700
08/22/17 2137 - DISCONTINUE by AMACCA Eff: 08/23/17 0800
Items Auto Credited: 8 Doses Auto Credited: 4
For: 08/23/17 - 0800
For: 08/23/17 - 1700
For: 08/24/17 - 0800
For: 08/24/17 - 1700
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
CALLED MD- MAX FOR ER PRODUCT IS 20MG, IR MAX IS 40MG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

CHANGE TO IR TABLETS 20MG 2XDAY

GLIP10TA - GLIPIZIDE XL 10 MG TABCR

Dose 10 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 2122 (ONE)
Start Date 08/22/17-2122 Stop Date 08/22/17 2123 DC: 08/22/17-2123
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01539150

Discontinued Comments Reached Stop Date

History
08/22/17 2128 - POM ORDER by CDOHLE
08/22/17 2131 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 2122
08/22/17 2131 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 2123
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

GLPZ5T - GLIPIZIDE 5 MG TAB

Dose 20 MG (4 TABLETS)
Admin Route ORAL
Frequency 2X DAILY BRKFST/DIN (SCH)
Start Date 08/23/17-0800 Stop Date 08/23/17 1755 DC: 08/23/17-1755
Ordering Doctor DOHLE,CAROLIN
Total Dispensed 40 Total Costs $0.00 Total Charges $0.40
Rx Number 01539154

History
08/22/17 2138 - ENTER by AMACCA
Items Dispensed: 16 Doses Dispensed: 4
For: 08/23/17 - 0800
For: 08/23/17 - 1700
For: 08/24/17 - 0800
For: 08/24/17 - 1700
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 24 Doses Dispensed: 6
For: 08/25/17 - 0800
For: 08/25/17 - 1700
For: 08/26/17 - 0800
For: 08/26/17 - 1700
For: 08/27/17 - 0800
For: 08/27/17 - 1700
08/23/17 1756 - DISCONTINUE by NBALCETIS Eff: 08/23/17 1755
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/23/17 1756 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/23/17-0800 STOP: 09/22/17 0759 SOFT STOP: 0
DISPENSE: 24
TO:
START: 08/23/17-0800 STOP: 08/23/17-1755 SOFT STOP:
DISPENSE: 8
08/23/17 1756 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425628
08/24/17 1206 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by NBALCETIS Eff: 08/23/17 1756
Discontinue by NBALCETIS Eff: 08/23/17 1756
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

GLPZ5T - GLIPIZIDE 5 MG TAB

Dose 20 MG (4 TABLETS)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/22/17-2200 Stop Date 08/22/17 2201 DC: 08/22/17-2201
Ordering Doctor DOHLE,CAROLIN
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01539156

Discontinued Comments Reached Stop Date

History
08/22/17 2152 - ENTER by AMACCA
Items Dispensed: 4 Doses Dispensed: 1
For: 08/22/17 - 2200
08/22/17 2201 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 2201
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

GLPZ5T - GLIPIZIDE 5 MG TAB

Dose 20 MG (4 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/22/17 0759 DC: 08/25/17-1301
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $0.80
Rx Number 01539454

History
08/23/17 1756 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01539154
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/23/17 - 1700
Last Actual Administration Time: 08/23/17 - 1700 (Not Given)
Old Freq/Sch: 2X DAILY BRKFST/DIN (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/23/17 - 1755
New Order Start: 08/24/17 - 0900
New Order Stop: 09/22/17 - 0759
08/23/17 1759 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by NBALCETIS Eff: 08/23/17 1756
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/23/17 - 1700
Last Actual Administration Time: 08/23/17 - 1700 (Not Given)
Old Freq/Sch: 2X DAILY BRKFST/DIN (SCH)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/23/17 - 1755
New Order Start: 08/24/17 - 0900
New Order Stop: 09/22/17 - 0759
08/23/17 1759 - VERIFIED by AADEGBAMIG
Items Dispensed: 16 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/25/17 1302 - DISCONTINUE by NBALCETIS Eff: 08/25/17 1301
Items Auto Credited: 16 Doses Auto Credited: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/25/17 1302 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01426205
08/25/17 1435 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by NBALCETIS Eff: 08/25/17 1302
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

GLPZ5T - GLIPIZIDE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859 DC: 08/31/17-1445
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $1.20
Rx Number 01540024

Discontinued Comments dc

History
08/25/17 1302 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01539454
08/25/17 1311 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1451 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1445
Items Auto Credited: 6 Doses Auto Credited: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/31/17 1501 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by NBALCETIS Eff: 08/31/17 1451
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

MTF850T - METFORMIN HCL 850 MG TAB

Dose 850 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/22/17 2122 DC: 08/22/17-2122
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $3.03
Rx Number 01538811

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2027 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/22/17 2128 - EDIT by CDOHLE
EDIT DOCTOR: DOHLE,CAROLIN MD
FROM:
START: 08/22/17-0900 STOP: 09/21/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/22/17-0900 STOP: 08/22/17-2122 SOFT STOP:
DISPENSE: 1
08/22/17 2128 - DISCONTINUE by CDOHLE Eff: 08/22/17 2122
EDIT DOCTOR: DOHLE,CAROLIN MD
08/22/17 2128 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01425337
08/22/17 2130 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by CDOHLE Eff: 08/22/17 2128
Discontinue by CDOHLE Eff: 08/22/17 2128
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

MTF850T - METFORMIN HCL 850 MG TAB

Dose 850 MG (1 TABLET)

Admin Route ORAL
Frequency 2122 (ONE)
Start Date 08/22/17-2122 Stop Date 08/22/17 2123 DC: 08/22/17-2123
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01539151

Discontinued Comments Reached Stop Date

History
08/22/17 2128 - POM ORDER by CDOHLE
08/22/17 2131 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 2122
08/22/17 2131 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 2123
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

MTHL5T - METHYLPHENIDATE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/25/17 0859 DC: 08/25/17-0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01538808

Discontinued Comments Reached Stop Date

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2023 - VERIFIED by AADEGBAMIG
08/25/17 0900 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

MTP100TCR - METOPROLOL SUCCINATE XL 100 MG TABCR

Dose 100 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 DC: 08/22/17-1109
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $2.83
Rx Number 01538799

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2007 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/22/17 1110 - DISCONTINUE by NBALCETIS Eff: 08/22/17 1109
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/22/17 1110 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425120
08/22/17 1120 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by NBALCETIS Eff: 08/22/17 1110
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

MRTZ15T - MIRTAZAPINE 15 MG TAB

Dose 7.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 DC: 08/30/17-1125
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 9 Total Costs $0.00 Total Charges $5.22
Rx Number 01538800

Discontinued Comments dc

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2007 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 2100
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/30/17 1126 - DISCONTINUE by NBALCETIS Eff: 08/30/17 1125
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/30/17 - 2100
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/30/17 1200 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/30/17 1126
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Enalapril 2.5mg

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 DC: 08/22/17-0900
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538804

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2008 - DISCONTINUE by AADEGBAMIG Eff: 08/22/17 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/21/17 2008 - VERIFIED by SYSTEM
Verified in order to DC

NF-MED - NON FORMULARY MEDICATION

Dose Instructions nephrocap

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 DC: 08/22/17-0900
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538862

History
08/21/17 2200 - POM ORDER by HMOHAMED
08/21/17 2237 - VERIFIED by SYSTEM
Verified in order to DC
08/21/17 2237 - DISCONTINUE by AADEGBAMIG Eff: 08/22/17 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency BEFORE BREAKFAST (SCH)
Start Date 08/22/17-0800 Stop Date 09/21/17 0759 DC: 08/22/17-0800
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538809

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2027 - VERIFIED by SYSTEM
Verified in order to DC
08/21/17 2027 - DISCONTINUE by AADEGBAMIG Eff: 08/22/17 0800
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 08/29/17 0859 DC: 08/29/17-0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 3 Total Costs $0.00 Total Charges $4.05
Rx Number 01540113

Discontinued Comments Reached Stop Date

History
08/25/17 1503 - POM ORDER by NBALCETIS
08/25/17 1504 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
08/29/17 0859 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 1459 (ONE)
Start Date 08/25/17-1459 Stop Date 08/25/17 1500 DC: 08/25/17-1500
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $1.35
Rx Number 01540114

Discontinued Comments Reached Stop Date

History
08/25/17 1503 - POM ORDER by NBALCETIS
08/25/17 1504 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 1459
08/25/17 1504 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 1500
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 08/31/17 1456 DC: 08/31/17-1456
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $2.70
Rx Number 01540946

History
08/29/17 1236 - POM ORDER by NBALCETIS
08/29/17 1237 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1457 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/30/17-0900 STOP: 09/29/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/30/17-0900 STOP: 08/31/17-1456 SOFT STOP:
DISPENSE: 2
08/31/17 1457 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1456
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/31/17 1457 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427702
08/31/17 1501 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by NBALCETIS Eff: 08/31/17 1457
Discontinue by NBALCETIS Eff: 08/31/17 1457
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 20 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 1233 (ONE)
Start Date 08/29/17-1233 Stop Date 08/29/17 1234 DC: 08/29/17-1234
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $1.35
Rx Number 01540947

Discontinued Comments Reached Stop Date

History
08/29/17 1236 - POM ORDER by NBALCETIS
08/29/17 1237 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1233
08/29/17 1237 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 1234
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/26/17-2100 Stop Date 09/25/17 2059 DC: 08/27/17-1013
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540441

Discontinued Comments dc per Dr. Ivanov

History
08/26/17 2049 - POM ORDER by HAZIZI
08/27/17 1013 - DISCONTINUE by AADEGBAMIG Eff: 08/27/17 1013
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc per Dr. Ivanov
08/27/17 1013 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/21/17-2100 Stop Date 08/21/17 2101 DC: 08/21/17-2101
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538802

Discontinued Comments Reached Stop Date

History
08/21/17 2003 - POM ORDER by HMOHAMED
08/21/17 2007 - VERIFIED by AADEGBAMIG
08/21/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/21/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF3T - WARFARIN SOD 3 MG TAB

Dose 9 MG (3 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/22/17-2100 Stop Date 08/22/17 2101 DC: 08/22/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539111

Discontinued Comments Reached Stop Date

History
08/22/17 1808 - POM ORDER by NBALCETIS
08/22/17 1809 - VERIFIED by AMACCA
08/22/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/23/17-2100 Stop Date 08/23/17 2101 DC: 08/23/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539378

Discontinued Comments Reached Stop Date

History
08/23/17 1630 - POM ORDER by NBALCETIS
08/23/17 1635 - VERIFIED by AMACCA
08/23/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/24/17-2100 Stop Date 08/24/17 2101 DC: 08/24/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539545

Discontinued Comments Reached Stop Date

History
08/24/17 1204 - POM ORDER by NBALCETIS
08/24/17 1206 - VERIFIED by MHAIMOWITZ
08/24/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 08/27/17 2101 DC: 08/27/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540087

Discontinued Comments Reached Stop Date

History
08/25/17 1405 - POM ORDER by NBALCETIS
08/25/17 1435 - VERIFIED by MHAIMOWITZ
08/27/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/27/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 08/30/17 2101 DC: 08/30/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540697

Discontinued Comments Reached Stop Date

History
08/28/17 1251 - POM ORDER by NBALCETIS
08/28/17 1339 - VERIFIED by AADEGBAMIG
08/30/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

WRF3T - WARFARIN SOD 3 MG TAB

Dose 9 MG (3 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/31/17-2100 Stop Date 08/31/17 2101 DC: 08/31/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541644

Discontinued Comments Reached Stop Date

History
08/31/17 1502 - POM ORDER by NBALCETIS
08/31/17 1505 - VERIFIED by AMACCA
08/31/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF6T - WARFARIN SOD 6 MG TAB

Dose 12 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/01/17-2100 Stop Date 09/01/17 2101 DC: 09/01/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542107

Discontinued Comments Reached Stop Date

History
09/01/17 1809 - POM ORDER by NBALCETIS
09/01/17 1822 - VERIFIED by AADEGBAMIG
09/01/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

WRF6T - WARFARIN SOD 6 MG TAB - 6 MG

WRF3T - WARFARIN SOD 3 MG TAB - 3 MG

Dose 9 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 09/01/17 2100 DC: 09/01/17-2100
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541876

Discontinued Comments dc

History
09/01/17 1116 - ENTER by AMOLINARI
09/01/17 1809 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 09/01/17-2100 STOP: 09/04/17 2101 SOFT STOP: 0
DC COMMENTS:
TO:
START: 09/01/17-2100 STOP: 09/01/17-2100 SOFT STOP:
DC COMMENTS:
dc
09/01/17 1809 - DISCONTINUE by NBALCETIS Eff: 09/01/17 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
DC COMMENTS:
dc
09/01/17 1822 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by NBALCETIS Eff: 09/01/17 1809
Discontinue by NBALCETIS Eff: 09/01/17 1809
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

DULO20CA - DULOXETINE HCL 20 MG CPDR

Dose 60 MG (3 CAPSULE DELAYED RELEASES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859 CAN: 08/30/17-1200
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427354

History
08/30/17 1127 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538793
08/30/17 1200 - CANCEL by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 30MG CAP
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

GLPZ5T - GLIPIZIDE 5 MG TAB

Dose 20 MG (4 TABLETS)
Admin Route ORAL
Frequency 2144 (ONE)
Start Date 08/22/17-2144 Stop Date 08/22/17 2145 CAN: 08/22/17-2146
Ordering Doctor DOHLE,CAROLIN
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539155

History
08/22/17 2144 - ENTER by AMACCA
Items Dispensed: 4 Doses Dispensed: 1
For: 08/22/17 - 2144
08/22/17 2145 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 2145
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/22/17 2146 - CANCEL by AMACCA
Items Auto Credited: 4 Doses Auto Credited: 1
For: 08/22/17 - 2144
EDIT DOCTOR: DOHLE,CAROLIN
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
D/C
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

HARRIS,JOHN F W00001219209 (Continued)

WRF3T - WARFARIN SOD 3 MG TAB

Dose 9 MG (3 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 09/04/17 2101 CAN: 09/01/17-1115
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427920

History
09/01/17 1105 - POM ORDER by NBALCETIS
09/01/17 1115 - CANCEL by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
changed to split med
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient HERBERT,ROBERT A Responsible Doctor BRIONES,MARIA M.D.

Account Number W00001219625 Location B1EA Unit Number M000209418
Age/Sex 90/M Room 115 Registered Date 09/01/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 7.99 in 172.7 cm Body Surface Area 1.84 m2

Weight 156 lb 11.2 oz 71.078 kg
Hem-Onc No

Drug Allergies NSAIDS (Non-Steroidal Anti-Inflamma, naproxen

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

BISM262O - BISMUTH SUBSALICYLATE BTL (KAOPECTATE)

Dose 30 ML (0.1271186 MLS)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: DIARRHEA - FOR DIARRHEA
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542077

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG

IPR06NA15 - IPRATROPIUM BR 0.06% NA SPR 15 ML BTL

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Admin Route NASAL
Frequency DAILY (PRN) PRN REASON: rinithis
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $111.57
Rx Number 01542082

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1710 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1645
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542067

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542074

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01542066

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1708 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

ALLP300T - ALLOPURINOL 300 MG TAB

Dose 300 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $1.43
Rx Number 01542079

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542069

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 10 MG (2 TABLET, ENTERIC COATEDS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542075

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 2,000 UNIT (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $0.50
Rx Number 01542081

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1710 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 1,000 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.16
Rx Number 01542080

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542065

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1708 - VERIFIED by AADEGBAMIG

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.60
Rx Number 01542073

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

IRON45TA - IRON,CARBONYL (FERRO SEQUELS) TAB

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $1.00
Rx Number 01542071

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

LSNP20T - LISINOPRIL 20 MG TAB

Dose 40 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $1.20
Rx Number 01542083

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1710 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency AFTER MEALS & BEDTIM (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542070

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542068

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 09/02/17-0800 Stop Date 10/02/17 0759
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $1.76
Rx Number 01542106

History
09/01/17 1809 - POM ORDER by MBRIONES
09/01/17 1817 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0800
For: 09/03/17 - 0800
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/01/17-1645 Stop Date 10/01/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.20
Rx Number 01542076

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 09/01/17 - 1645

THM100T - THIAMINE HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.10
Rx Number 01542084

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1710 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/01/17-1645 Stop Date 09/08/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542085

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1710 - VERIFIED by AADEGBAMIG

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
MDD = 400MG/DAY
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/01/17-1645 Stop Date 09/08/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01542086

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1710 - VERIFIED by AADEGBAMIG

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleep
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 09/01/17-1645 Stop Date 09/08/17 1644
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542072

History
09/01/17 1653 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/01/17-2100 Stop Date 09/01/17 2101 DC: 09/01/17-2101
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542078

Warnings
Type: BURKE
Range: WARFARIN SOD
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.5 MG/DAY - 15 MG/DAY. Ordered dose of 0 MG/DAY is
below the Low Daily Dose.

Discontinued Comments Reached Stop Date

History
09/01/17 1654 - POM ORDER by MBRIONES
09/01/17 1709 - VERIFIED by AADEGBAMIG
09/01/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

HERBERT,ROBERT A W00001219625 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 09/02/17 2100 DC: 09/02/17-2100
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542240

History
09/02/17 1608 - POM ORDER by HAZIZI
09/02/17 1609 - EDIT by HAZIZI
EDIT DOCTOR: AZIZI,HANA MD
FROM:
START: 09/02/17-2100 STOP: 09/04/17 2059 SOFT STOP:
TO:
START: 09/02/17-2100 STOP: 09/02/17-2100 SOFT STOP:
09/02/17 1609 - VERIFIED by SYSTEM
Verified in order to DC
09/02/17 1609 - DISCONTINUE by HAZIZI Eff: 09/02/17 2100
EDIT DOCTOR: AZIZI,HANA MD
09/02/17 1615 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by HAZIZI Eff: 09/02/17 1609
Edit by SYSTEM Eff: 09/02/17 1609
Discontinue by HAZIZI Eff: 09/02/17 1609

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/02/17-2100 Stop Date 09/02/17 2101 DC: 09/02/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542241

Discontinued Comments Reached Stop Date

History
09/02/17 1609 - POM ORDER by HAZIZI
09/02/17 1614 - VERIFIED by MHAIMOWITZ
09/02/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient HUGHES,PAUL Responsible Doctor PECHMAN,KAREN MD.

Account Number W00001219372 Location B1EA Unit Number M000209252
Age/Sex 50/M Room 105 Registered Date 08/23/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 5 in 165.1 cm Body Surface Area 1.81 m2

Weight 162 lb 4.8 oz 73.618 kg
Hem-Onc No

Drug Allergies [pencillin], Penicillins

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: REMOVAL OF INST, TG-L3, DECOMP L3-L5
Secondary Diagnosis:

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Clinical Indication OTHER
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541864

History
09/01/17 0952 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540532
09/01/17 1017 - EDIT by AMOLINARI
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
DISPENSE: 1
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP: 0
DISPENSE: 0
09/01/17 1017 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 975 MG (3 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/23/17-1615 Stop Date 09/22/17 1614
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539363

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1624 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/23/17-2000 Stop Date 09/22/17 1959
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01539365

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1625 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2000
For: 08/29/17 - 2000
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2000
For: 08/31/17 - 2000
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2000
For: 09/02/17 - 2000
For: 09/03/17 - 2000
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2000
For: 09/05/17 - 2000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY BEDTIME (PRN) PRN REASON: Insomnia
Start Date 08/23/17-1615 Stop Date 09/22/17 1614
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539366

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1625 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/23/17-1700 Stop Date 09/22/17 1659
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $8.00
Rx Number 01539364

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1625 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/23/17-2100 Stop Date 09/22/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 27 Total Costs $0.00 Total Charges $4.40
Rx Number 01539372

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1628 - VERIFIED by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

For: 09/04/17 - 0900

For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

GMFB600T - GEMFIBROZIL 600 MG TAB

Dose 600 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/23/17-1700 Stop Date 09/22/17 1659
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 27 Total Costs $0.00 Total Charges $14.96
Rx Number 01539382

History
08/23/17 1642 - ENTER by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

LRT10T - LORATADINE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 13 Total Costs $0.00 Total Charges $11.33
Rx Number 01539373

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1628 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/23/17-1615 Stop Date 09/22/17 1614
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539367

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1625 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/23/17-1615 Stop Date 09/22/17 1614
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539368

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1625 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

MTH500T - METHOCARBAMOL 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: Muscle spasm
Start Date 08/23/17-1615 Stop Date 09/22/17 1614
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $0.53
Rx Number 01539376

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1631 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 08/23/17 - 1615
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/23/17-1615 Stop Date 09/22/17 1614
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 01539379

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1637 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/23/17 - 1615
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 7.5 MG (1.5 TABLETS)

Dose Instructions PRN MILD PAIN (PAIN SCALE 1-3)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/01/17-1000 Stop Date 09/08/17 0959
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541865

Alternating Links: Rx Num 01540535

History
09/01/17 0952 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540533
09/01/17 1017 - EDIT by AMOLINARI
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1000 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1000 STOP: 09/08/17-0959 SOFT STOP: 0
09/01/17 1017 - VERIFIED by AMOLINARI

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/01/17-1000 Stop Date 09/08/17 0959
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01541866

Alternating Links: Rx Num 01540535

History
09/01/17 0952 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540534
09/01/17 1017 - EDIT by AMOLINARI
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1000 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1000 STOP: 09/08/17-0959 SOFT STOP: 0
09/01/17 1017 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 12.5 MG (2.5 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/01/17-1000 Stop Date 09/08/17 0959
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541867

Alternating Links: Rx Num 01540534

History
09/01/17 0952 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540535
09/01/17 1018 - EDIT by AMOLINARI
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1000 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1000 STOP: 09/08/17-0959 SOFT STOP: 0
09/01/17 1018 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 13 Total Costs $0.00 Total Charges $229.68
Rx Number 01539374

History
08/23/17 1623 - POM ORDER by HMOHAMED
08/23/17 1629 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions CONSTIPATION
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/24/17 1614
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01539910

History
08/25/17 1124 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01539370
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/24/17 - 2052
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/25/17 - 1122
New Order Start: 08/26/17 - 0900
New Order Stop: 09/24/17 - 1614
08/25/17 1220 - EDIT by EBALILO
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
PRN CONSTIPATION
TO:
DOSE INSTRUCTIONS:
CONSTIPATION
08/25/17 1220 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by HMOHAMED Eff: 08/25/17 1124
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/24/17 - 2052
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/25/17 - 1122
New Order Start: 08/26/17 - 0900
New Order Stop: 09/24/17 - 1614
08/25/17 1220 - VERIFIED by EBALILO
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 09/04/17 - 0900
For: 09/05/17 - 0900

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 08/24/17-1200 Stop Date 09/23/17 1159
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 26 Total Costs $0.00 Total Charges $2.00
Rx Number 01539369

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1626 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/24/17 - 1200
For: 08/25/17 - 1200
For: 08/26/17 - 1200
For: 08/27/17 - 1200
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1200
For: 08/29/17 - 1200
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1200
For: 08/31/17 - 1200
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1200
For: 09/05/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/23/17-2100 Stop Date 08/30/17 2059 DC: 08/28/17-0728
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Clinical Indication OTHER
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01539371

History
08/23/17 1623 - POM ORDER by HMOHAMED
08/23/17 1628 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 2100
08/28/17 0728 - DISCONTINUE by HMOHAMED Eff: 08/28/17 0728
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/28/17 0728 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01426666
08/28/17 0734 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by HMOHAMED Eff: 08/28/17 0728
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-0900 Stop Date 09/04/17 0859 DC: 09/01/17-0952
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Clinical Indication OTHER
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540532

History
08/28/17 0728 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01539371
08/28/17 0733 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0900 STOP: 09/04/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/28/17-0900 STOP: 09/04/17-0859 SOFT STOP: 0
DISPENSE: 0
08/28/17 0733 - VERIFIED by AMOLINARI
09/01/17 0952 - DISCONTINUE by JRUSSO Eff: 09/01/17 0952
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/01/17 0952 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01427904
09/01/17 1018 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency ONETIME (ONE)
Start Date 08/25/17-1130 Stop Date 08/25/17 1131 DC: 08/25/17-1131
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539905

Discontinued Comments Reached Stop Date

History
08/25/17 1124 - POM ORDER by HMOHAMED
08/25/17 1219 - VERIFIED by EBALILO
08/25/17 1219 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 1131
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 30 GM (120 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/24/17-1415 Stop Date 08/24/17 1416 DC: 08/24/17-1416
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01539623

Discontinued Comments Reached Stop Date

History
08/24/17 1413 - POM ORDER by RSHARMA
08/24/17 1415 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 1415
08/24/17 1416 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 1416
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/23/17-1615 Stop Date 08/30/17 1614 DC: 08/28/17-0728
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01539451

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1748 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0728 - DISCONTINUE by HMOHAMED Eff: 08/28/17 0728
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/28/17 0728 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01426668
08/28/17 0734 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by HMOHAMED Eff: 08/28/17 0728
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 12.5 MG (2.5 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/23/17-1615 Stop Date 08/30/17 1614 DC: 08/28/17-0728
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01539452

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1749 - EDIT by EBALILO
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
DOSE INSTRUCTIONS:
PRN MODERATE PAIN (PAIN SCALE 4-6)
TO:
PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
DOSE INSTRUCTIONS:
PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
08/23/17 1749 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0728 - DISCONTINUE by HMOHAMED Eff: 08/28/17 0728
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/28/17 0728 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01426669
08/28/17 0734 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by HMOHAMED Eff: 08/28/17 0728
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 7.5 MG (1.5 TABLETS)

Dose Instructions PRN MILD PAIN (PAIN SCALE 1-3)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/23/17-1615 Stop Date 08/30/17 1614 DC: 08/28/17-0728
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539450

History
08/23/17 1623 - POM ORDER by HMOHAMED
08/23/17 1747 - EDIT by EBALILO
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
DOSE INSTRUCTIONS:
PRN MODERATE PAIN (PAIN SCALE 4-6)
TO:
PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
DOSE INSTRUCTIONS:
PRN MILD PAIN (PAIN SCALE 1-3)
08/23/17 1747 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0728 - DISCONTINUE by HMOHAMED Eff: 08/28/17 0728
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/28/17 0728 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01426667
08/28/17 0734 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by HMOHAMED Eff: 08/28/17 0728
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 7.5 MG (1.5 TABLETS)

Dose Instructions PRN MILD PAIN (PAIN SCALE 1-3)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/28/17-0730 Stop Date 09/04/17 0729 DC: 09/01/17-0952
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540533

History
08/28/17 0728 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01539450
08/28/17 0733 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0730 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-0730 STOP: 09/04/17-0729 SOFT STOP: 0
08/28/17 0733 - VERIFIED by AMOLINARI
08/28/17 0734 - LINK by AMOLINARI
FROM:
TO: Alternating: 01540534, 01540535
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0952 - DISCONTINUE by JRUSSO Eff: 09/01/17 0952
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/01/17 0952 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01427905
09/01/17 1018 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/28/17-0730 Stop Date 09/04/17 0729 DC: 09/01/17-0952
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01540534

History
08/28/17 0728 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01539451
08/28/17 0733 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0730 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-0730 STOP: 09/04/17-0729 SOFT STOP: 0
08/28/17 0733 - VERIFIED by AMOLINARI
08/28/17 0734 - LINK by AMOLINARI
FROM:
TO: Alternating: 01540533, 01540535
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0952 - DISCONTINUE by JRUSSO Eff: 09/01/17 0952
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/01/17 0952 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01427906
09/01/17 1018 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 12.5 MG (2.5 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/28/17-0730 Stop Date 09/04/17 0729 DC: 09/01/17-0952
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01540535

History
08/28/17 0728 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01539452
08/28/17 0734 - EDIT by AMOLINARI
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0730 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-0730 STOP: 09/04/17-0729 SOFT STOP: 0
08/28/17 0734 - VERIFIED by AMOLINARI
08/28/17 0734 - LINK by AMOLINARI
FROM:
TO: Alternating: 01540533, 01540534
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0952 - DISCONTINUE by JRUSSO Eff: 09/01/17 0952
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/01/17 0952 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01427907
09/01/17 1018 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/23/17-1615 Stop Date 08/25/17 1122 DC: 08/25/17-1122
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539370

History
08/23/17 1623 - POM ORDER by HMOHAMED
08/23/17 1626 - VERIFIED by EBALILO
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 1124 - DISCONTINUE by HMOHAMED Eff: 08/25/17 1122
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/25/17 1124 - EDIT by HMOHAMED
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
FROM:
START: 08/23/17-1615 STOP: 09/24/17 1614 SOFT STOP: 0
TO:
START: 08/23/17-1615 STOP: 08/25/17-1122 SOFT STOP:
08/25/17 1124 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01426162
08/25/17 1220 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by HMOHAMED Eff: 08/25/17 1124
Discontinue by HMOHAMED Eff: 08/25/17 1124
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

HUGHES,PAUL W00001219372 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Gemfibrozil 600mg

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/23/17-1700 Stop Date 09/22/17 1659 CAN: 08/23/17-1638
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01425544

History
08/23/17 1622 - POM ORDER by HMOHAMED
08/23/17 1638 - CANCEL by EBALILO
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO NF ENTRY

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Dose Instructions PRN NAUSEA
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/23/17-1615 Stop Date 09/22/17 1614 CAN: 08/23/17-1637
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01425552

History
08/23/17 1623 - POM ORDER by HMOHAMED
08/23/17 1637 - CANCEL by EBALILO
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
DUPLICATE ORDER
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient JACKSON,ALGY A Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219385 Location B1WE Unit Number M000098296
Age/Sex 81/F Room 149 Registered Date 08/22/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 5 in 165.1 cm Body Surface Area 1.58 m2

Weight 117 lb 11.2 oz 53.388 kg
Hem-Onc No

Drug Allergies iodine, phenytoin, levothyroxine sodium, nitrofurantoin

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

BISM262O4 - BISMUTH SUBSALICYLATE (KAOPECTATE) BTL

Dose 15 ML (0.0635593 BOTTLES)

Dose Instructions PRN DIARRHEA
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: DIARRHEA - FOR DIARRHEA
Start Date 08/25/17-1315 Stop Date 09/24/17 1314
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $0.25
Rx Number 01540088

History
08/25/17 1303 - POM ORDER by NBALCETIS
08/25/17 1439 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 1315

ECN1C30 - ECONAZOLE NITRATE 1% CR 30 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions L hand
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $117.60
Rx Number 01540751

History
08/28/17 1517 - POM ORDER by NBALCETIS
08/28/17 1525 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

FLT05NA16 - FLUTICASONE PROPIONATE 0.05% NA SPR 16 GM BTL

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Admin Route NASAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541861

History
09/01/17 0956 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540561
09/01/17 1016 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
09/01/17 1016 - CREDIT by AMOLINARI
ITEMS: 1

SLFL50250 - SALMETEROL XINAF/FLUTICASONE 50-250 MCG/DOSE DISKUS

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $557.34
Rx Number 01539018

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1534 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 2100
08/29/17 1255 - DEBIT by AADEGBAMIG
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

TR1C15 - TRIAMCINOLONE ACET 0.1% CR 15 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions L hand
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541862

History
09/01/17 0956 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540752
09/01/17 1016 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
09/01/17 1016 - CREDIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

ACPCT - ACIDOPHILUS/PECTIN TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/22/17-1700 Stop Date 09/21/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 58 Total Costs $0.00 Total Charges $3.76
Rx Number 01539022

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1535 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 10
For: 08/22/17 - 1700
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 12
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

For: 08/30/17 - 2100

For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 3 TIMES A DAY (SCH)
Start Date 08/22/17-1700 Stop Date 09/21/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $9.00
Rx Number 01539047

History
08/22/17 1624 - POM ORDER by NBALCETIS
08/22/17 1638 - VERIFIED by MHAIMOWITZ
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

For: 09/04/17 - 0900

For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Dose Instructions PRN WHEEZING
Admin Route NEBULIZER
Frequency EVERY 4 HOURS (PRN) PRN REASON: WHEEZE - for Wheezing
Start Date 08/22/17-1630 Stop Date 09/21/17 1629
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539048

History
08/22/17 1624 - POM ORDER by NBALCETIS
08/22/17 1638 - VERIFIED by MHAIMOWITZ
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $0.36
Rx Number 01539010

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1533 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 30 Total Costs $0.00 Total Charges $819.60
Rx Number 01539012

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1533 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

BETA1TAB19 - BETA-CAROTENE(A) W-C & E/ZN/CU (OCUVITE PRESERVISON)

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $2.76
Rx Number 01539036

History
08/22/17 1621 - ENTER by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

CRV6.25T - CARVEDILOL 6.25 MG TAB

Dose 12.5 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 90 AND/OR PULSE < 50
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 58 Total Costs $0.00 Total Charges $15.60
Rx Number 01539013

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1533 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

For: 09/05/17 - 2100

CTRZ5T - CETIRIZINE HCL 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 30 Total Costs $0.00 Total Charges $7.80
Rx Number 01539033

History
08/22/17 1540 - ENTER by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 1,000 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $0.96
Rx Number 01539014

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1534 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01539016

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1534 - VERIFIED by AMACCA
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

FOSF3PAC3 - FOSFOMYCIN TROMETHAMINE 3 GM PACKET

Dose 3 GM (1 PACKET)
Admin Route ORAL
Frequency Th@0900 (SCH)
Start Date 08/24/17-0900 Stop Date 09/27/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $0.00
Rx Number 01539049

History
08/22/17 1624 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01539031
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/28/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: Mo@0900 (SCH)
New Freq/Sch: Th@0900 (SCH)
Old Order Stop: 08/28/17 - 0900
New Order Start: 08/24/17 - 0900
New Order Stop: 09/27/17 - 0859
08/22/17 1642 - EDIT by MHAIMOWITZ
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
TO:
CHARGE TYPE: PSM - PATIENT'S SELF MEDS
CHARGE: $0.00
08/22/17 1642 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by NBALCETIS Eff: 08/22/17 1624
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/28/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: Mo@0900 (SCH)
New Freq/Sch: Th@0900 (SCH)
Old Order Stop: 08/28/17 - 0900
New Order Start: 08/24/17 - 0900
New Order Stop: 09/27/17 - 0859
08/22/17 1642 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

FRSM20T - FUROSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $5.16
Rx Number 01539019

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1535 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

GLPZ5T - GLIPIZIDE 5 MG TAB

Dose 2.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $1.20
Rx Number 01539020

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1535 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: SBP > 180
Start Date 08/24/17-0900 Stop Date 09/21/17 1459
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01539249

History
08/23/17 1200 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01539021
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 6 HOURS (PRN)
New Freq/Sch: DAILY (PRN)
Old Order Stop: 08/23/17 - 1158
New Order Start: 08/24/17 - 0900
New Order Stop: 09/21/17 - 1459
08/23/17 1218 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by NBALCETIS Eff: 08/23/17 1200
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 6 HOURS (PRN)
New Freq/Sch: DAILY (PRN)
Old Order Stop: 08/23/17 - 1158
New Order Start: 08/24/17 - 0900
New Order Stop: 09/21/17 - 1459
08/23/17 1218 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 1
For: 08/24/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 30 MG (1.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 28 Total Costs $0.00 Total Charges $4.80
Rx Number 01539023

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1535 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/22/17-1700 Stop Date 09/21/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 29 Total Costs $0.00 Total Charges $42.00
Rx Number 01539024

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1535 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/22/17 - 1700
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

MRTZ15T - MIRTAZAPINE 15 MG TAB

Dose 30 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 30 Total Costs $0.00 Total Charges $13.80
Rx Number 01539046

History
08/22/17 1624 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01539025
08/22/17 1637 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/23/17-0800 Stop Date 09/22/17 0759
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $10.56
Rx Number 01539026

History
08/22/17 1521 - POM ORDER by NBALCETIS
08/22/17 1535 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0800
For: 08/24/17 - 0800
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Dose Instructions PRN NAUSEA
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/28/17-1145 Stop Date 09/27/17 1144
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $3.30
Rx Number 01540614

History
08/28/17 1135 - POM ORDER by NBALCETIS
08/28/17 1201 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/28/17 - 1145
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

KCL10TCR - POTASSIUM CHLORIDE 10 MEQ TABCR

Dose 10 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $9.96
Rx Number 01539027

Warnings
Type: BURKE
Range: POTASSIUM CHLORIDE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 40 MEQ/DAY - 100 MEQ/DAY. Ordered dose of 10 MEQ/DAY
is below the Low Daily Dose.

History
08/22/17 1521 - POM ORDER by NBALCETIS
08/22/17 1536 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

THR30T - THYROID 30 MG TAB

Dose 60 MG (2 TABLETS)
Admin Route ORAL
Frequency SuMoTuThFr@0900 (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 20 Total Costs $0.00 Total Charges $8.40
Rx Number 01539028

History
08/22/17 1521 - POM ORDER by NBALCETIS
08/22/17 1536 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/25/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/01/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

FLT05NA16 - FLUTICASONE PROPIONATE 0.05% NA SPR 16 GM BTL

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Admin Route NASAL
Frequency NIGHTLY (SCH)
Start Date 08/22/17-2100 Stop Date 08/29/17 2059 DC: 08/28/17-1027
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $255.78
Rx Number 01539017

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1534 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 2100
08/28/17 1028 - DISCONTINUE by NBALCETIS Eff: 08/28/17 1027
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/28/17 1028 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01426742
08/28/17 1045 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by NBALCETIS Eff: 08/28/17 1028
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

FLT05NA16 - FLUTICASONE PROPIONATE 0.05% NA SPR 16 GM BTL

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Admin Route NASAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-0954
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $255.78
Rx Number 01540561

History
08/28/17 1028 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01539017
08/28/17 1045 - VERIFIED by JDIMARCO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
08/29/17 1424 - EDIT by AMACCA
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/04/17-2059 SOFT STOP:
09/01/17 0956 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0954
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0956 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427911
09/01/17 1016 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0956
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

MINE120C - MINERAL OIL/PETROLATUM,WHITE 120 GM JAR

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions dry skin
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/22/17-2100 Stop Date 08/29/17 2059 DC: 08/29/17-2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $15.30
Rx Number 01539053

Discontinued Comments Reached Stop Date

History
08/22/17 1639 - POM ORDER by NBALCETIS
08/22/17 1646 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 2100
08/29/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

TR1C15 - TRIAMCINOLONE ACET 0.1% CR 15 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions L hand
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-0954
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $16.71
Rx Number 01540752

History
08/28/17 1517 - POM ORDER by NBALCETIS
08/28/17 1526 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
09/01/17 0956 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0954
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0956 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427912
09/01/17 1016 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0956
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859 DC: 08/29/17-1428
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 7 Total Costs $0.00 Total Charges $71.00
Rx Number 01539009

Discontinued Comments low BP

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1533 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/29/17 1432 - DISCONTINUE by NBALCETIS Eff: 08/29/17 1428
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
low BP
08/30/17 1431 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by NBALCETIS Eff: 08/29/17 1432
low BP
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859 DC: 08/25/17-1301
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01539015

Discontinued Comments dc

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1534 - VERIFIED by AMACCA
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/25/17 1303 - DISCONTINUE by NBALCETIS Eff: 08/25/17 1301
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/25/17 1439 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by NBALCETIS Eff: 08/25/17 1303
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

FOSF3PAC3 - FOSFOMYCIN TROMETHAMINE 3 GM PACKET

Dose 3 GM (1 PACKET)
Admin Route ORAL
Frequency Mo@0900 (SCH)
Start Date 08/28/17-0900 Stop Date 09/27/17 0859 DC: 08/28/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539031

History
08/22/17 1537 - ENTER by AMACCA
08/22/17 1624 - DISCONTINUE by NBALCETIS Eff: 08/28/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/22/17 1624 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425238
08/22/17 1642 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by NBALCETIS Eff: 08/22/17 1624
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 50 MG (2 TABLETS)
Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: SBP > 180
Start Date 08/22/17-1500 Stop Date 08/23/17 1158 DC: 08/23/17-1158
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 6 Total Costs $ Total Charges $
Rx Number 01539021

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1535 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 08/22/17 - 1500
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 1200 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/22/17-1500 STOP: 09/21/17 1459 SOFT STOP: 0
DISPENSE: 0
TO:
START: 08/22/17-1500 STOP: 08/23/17-1158 SOFT STOP:
DISPENSE: 6
08/23/17 1200 - DISCONTINUE by NBALCETIS Eff: 08/23/17 1158
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/23/17 1200 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425426
08/23/17 1218 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by NBALCETIS Eff: 08/23/17 1200
Discontinue by NBALCETIS Eff: 08/23/17 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

LVF500T - LEVOFLOXACIN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 08/30/17 0859 DC: 08/30/17-0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication PNEUMONIA
Total Dispensed 7 Total Costs $0.00 Total Charges $478.31
Rx Number 01539029

Discontinued Comments Reached Stop Date

History
08/22/17 1521 - POM ORDER by NBALCETIS
08/22/17 1536 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/30/17 0900 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 0859
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

MRTZ15T - MIRTAZAPINE 15 MG TAB

Dose 15 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059 DC: 08/22/17-2100
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539025

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1535 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/22/17 1624 - DISCONTINUE by NBALCETIS Eff: 08/22/17 2100
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/22/17 1624 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425239
08/22/17 1642 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by NBALCETIS Eff: 08/22/17 1624
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Flurazepam 15mg HS prn insomnia

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: insomnia
Start Date 08/22/17-1500 Stop Date 09/21/17 1459 DC: 08/22/17-1617
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539045

Discontinued Comments dc

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1624 - DISCONTINUE by NBALCETIS Eff: 08/22/17 1617
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/22/17 1624 - VERIFIED by SYSTEM
Verified in order to DC
08/23/17 1218 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 08/22/17 1624
Discontinue by NBALCETIS Eff: 08/22/17 1624
dc

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Fosfomycin 3gram po weekly

Admin Route ORAL
Frequency Mo@0900 (SCH)
Start Date 08/28/17-0900 Stop Date 09/27/17 0859 DC: 08/28/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539030

History
08/22/17 1520 - POM ORDER by NBALCETIS
08/22/17 1536 - DISCONTINUE by AMACCA Eff: 08/28/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/22/17 1536 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Preservition AREDS Softgel 1 daily po

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859 DC: 08/23/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539035

Discontinued Comments WE STOCK OCUVITE PRESERVISION ARED

History
08/22/17 1521 - POM ORDER by NBALCETIS
08/22/17 1620 - DISCONTINUE by AMACCA Eff: 08/23/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
WE STOCK OCUVITE PRESERVISION ARED
08/22/17 1620 - VERIFIED by SYSTEM
Verified in order to DC

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Zyrtec 10mg HS po

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059 DC: 08/22/17-2100
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539032

History
08/22/17 1530 - POM ORDER by NBALCETIS
08/22/17 1539 - DISCONTINUE by AMACCA Eff: 08/22/17 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/22/17 1539 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

THR15T - THYROID 15 MG TAB

Dose 15 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/23/17-0700 Stop Date 08/23/17 0700 DC: 08/23/17-0700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539008

Discontinued Comments dup

History
08/22/17 1521 - POM ORDER by NBALCETIS
08/22/17 1530 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/23/17-0700 STOP: 09/22/17 0659 SOFT STOP: 0
DISPENSE: 3
DC COMMENTS:
TO:
START: 08/23/17-0700 STOP: 08/23/17-0700 SOFT STOP:
DISPENSE: 0
DC COMMENTS:
dup
08/22/17 1530 - VERIFIED by SYSTEM
Verified in order to DC
08/22/17 1530 - DISCONTINUE by NBALCETIS Eff: 08/23/17 0700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
DC COMMENTS:
dup
08/22/17 1536 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by NBALCETIS Eff: 08/22/17 1530
Edit by SYSTEM Eff: 08/22/17 1530
Discontinue by NBALCETIS Eff: 08/22/17 1530
dup
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

JACKSON,ALGY A W00001219385 (Continued)

BETA1TAB19 - BETA-CAROTENE(A) W-C & E/ZN/CU (OCUVITE PRESERVISON)

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859 CAN: 08/22/17-1648
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed Total Costs $ Total Charges $
Rx Number U01425240

History
08/22/17 1624 - POM ORDER by NBALCETIS
08/22/17 1648 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
DUPLICATE ORDER
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient JANOS,CLARE M Responsible Doctor GITLER, ELLEN M.D.

Account Number W00001219376 Location B1EA Unit Number M000209243
Age/Sex 93/F Room 117 Registered Date 08/24/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.99 in 172.7 cm Body Surface Area 1.90 m2

Weight 168 lb 9.6 oz 76.476 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/24/17-1220 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: L IT FX
Secondary Diagnosis:

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions To back
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 09/04/17-0900 Stop Date 10/04/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01542298

History
09/03/17 1126 - POM ORDER by JRUSSO
09/03/17 1242 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 1
For: 09/04/17 - 0900

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1145 Stop Date 09/23/17 1144
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539557

History
08/24/17 1156 - POM ORDER by DSPUNBERG
08/24/17 1211 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/24/17-1145 Stop Date 09/23/17 1144
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $4.50
Rx Number 01539555

History
08/24/17 1156 - POM ORDER by DSPUNBERG
08/24/17 1211 - VERIFIED by MHAIMOWITZ
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 12 Total Costs $0.00 Total Charges $1.00
Rx Number 01539546

History
08/24/17 1201 - POM ORDER by DSPUNBERG
08/24/17 1207 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1145 Stop Date 09/23/17 1144
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539548

History
08/24/17 1156 - POM ORDER by DSPUNBERG
08/24/17 1208 - VERIFIED by MHAIMOWITZ
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1145 Stop Date 09/23/17 1144
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $2.00
Rx Number 01539547

History
08/24/17 1156 - POM ORDER by DSPUNBERG
08/24/17 1208 - VERIFIED by MHAIMOWITZ
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 12 Total Costs $0.00 Total Charges $852.30
Rx Number 01539551

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.52
MG/KG/DAY is below the Low Daily Dose.

History
08/24/17 1201 - POM ORDER by DSPUNBERG
08/24/17 1210 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $3.00
Rx Number 01539561

History
08/24/17 1218 - POM ORDER by EGITLER
08/24/17 1224 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

IRON45TA - IRON,CARBONYL (FERRO SEQUELS) TAB

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 12 Total Costs $0.00 Total Charges $5.00
Rx Number 01539549

History
08/24/17 1156 - POM ORDER by DSPUNBERG
08/24/17 1208 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE: 50 EACH (50 TABLETS)
DISPENSE: 150
CHARGE: $25.00
TO:
DOSE: 1 EACH (1 TABLET)
DISPENSE: 3
CHARGE: $0.50
08/24/17 1208 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency AFTER MEALS & BEDTIM (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/24/17-1145 Stop Date 09/23/17 1144
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539552

History
08/24/17 1156 - POM ORDER by DSPUNBERG
08/24/17 1210 - VERIFIED by MHAIMOWITZ
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1145 Stop Date 09/23/17 1144
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01539556

History
08/24/17 1156 - POM ORDER by DSPUNBERG
08/24/17 1211 - VERIFIED by MHAIMOWITZ
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 100 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 25 Total Costs $0.00 Total Charges $5.00
Rx Number 01539553

History
08/24/17 1201 - POM ORDER by DSPUNBERG
08/24/17 1210 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01539554

History
08/24/17 1201 - POM ORDER by DSPUNBERG
08/24/17 1211 - VERIFIED by MHAIMOWITZ
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1145 Stop Date 09/23/17 1144
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01539550

History
08/24/17 1156 - POM ORDER by DSPUNBERG
08/24/17 1208 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE: 374 EACH (374 TABLETS)
CHARGE: $37.40
DOSE INSTRUCTIONS:
374 MG = 2 tablets
TO:
DOSE: 2 EACH (2 TABLETS)
CHARGE: $0.20
DOSE INSTRUCTIONS:
08/24/17 1208 - VERIFIED by MHAIMOWITZ
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

JANOS,CLARE M W00001219376 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/24/17-1145 Stop Date 08/31/17 1144 DC: 08/24/17-1217
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539558

History
08/24/17 1156 - POM ORDER by DSPUNBERG
08/24/17 1212 - VERIFIED by MHAIMOWITZ
08/24/17 1219 - DISCONTINUE by EGITLER Eff: 08/24/17 1217
EDIT DOCTOR: GITLER, ELLEN M.D.
08/24/17 1237 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EGITLER Eff: 08/24/17 1219

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (SCH)
Start Date 08/24/17-1300 Stop Date 09/23/17 1259 CAN: 08/24/17-1215
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01425727

History
08/24/17 1201 - POM ORDER by DSPUNBERG
08/24/17 1215 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
D/C OK DR. SPUNBERG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient JOHNSON,EFFIE M Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219741 Location B1WE Unit Number M000139471
Age/Sex 71/F Room 155 Registered Date 09/01/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 5 in 165.1 cm Body Surface Area 1.96 m2

Weight 196 lb 4.8 oz 89.04 kg
Hem-Onc No

Drug Allergies simvastatin

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
09/01/17-1320 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

GLAT40SY - GLATIRAMER ACETATE 40 MG/ML ML

Dose 40 MG (1 ML)
Admin Route SUBCUTAN.
Frequency MoWeFr@0900 (SCH)
Start Date 09/04/17-0900 Stop Date 10/06/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541950

History
09/01/17 1320 - ENTER by AADEGBAMIG

LEVA0.63 - LEVALBUTEROL HCL 0.63 MG/3 ML VIAL

Dose 0.63 MG (3 ML)

Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 09/01/17-1300 Stop Date 10/01/17 1259
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $222.48
Rx Number 01541947

History
09/01/17 1309 - POM ORDER by NBALCETIS
09/01/17 1316 - VERIFIED by AADEGBAMIG
Items Dispensed: 12 Doses Dispensed: 1
For: 09/01/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

SLFL50250 - SALMETEROL XINAF/FLUTICASONE 50-250 MCG/DOSE DISKUS

Dose 1 ACTUATION (1 DISKUS ACTUATION)

Admin Route INHALATION
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $278.67
Rx Number 01541914

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1258 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.06
Rx Number 01541910

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1258 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $34.15
Rx Number 01541948

History
09/01/17 1318 - ENTER by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BCL10T - BACLOFEN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 9 Total Costs $0.00 Total Charges $3.00
Rx Number 01541911

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1258 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $32.26
Rx Number 01541912

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1258 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01541913

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1258 - VERIFIED by AADEGBAMIG

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541916

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1259 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@0900,1300,2100 (SCH)
Start Date 09/01/17-1300 Stop Date 10/01/17 1259
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $1.40
Rx Number 01541915

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1258 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 09/01/17 - 1300
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 2100
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 2100

LRZ1T - LORAZEPAM 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: anxiety
Start Date 09/01/17-1215 Stop Date 09/08/17 1214
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541917

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1259 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

MTP25TSR - METOPROLOL SUCCINATE XL 25 MG TABCR

Dose 25 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $3.76
Rx Number 01541918

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1259 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 09/03/17-0800 Stop Date 10/03/17 0759
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $0.00 Total Charges $0.88
Rx Number 01542287

History
09/02/17 2212 - POM ORDER by HAZIZI
09/03/17 1025 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by JHART Eff: 09/03/17 0812
09/03/17 1025 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0800
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/04/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541919

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1259 - VERIFIED by AADEGBAMIG

PRD5T - PREDNISONE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 09/05/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 6 Total Costs $0.00 Total Charges $2.00
Rx Number 01541920

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1259 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900

PRD5T - PREDNISONE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/05/17-0900 Stop Date 09/07/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01541921

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1259 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059 DC: 09/02/17-2100
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541928

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1309 - DISCONTINUE by NBALCETIS Eff: 09/02/17 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 1309 - VERIFIED by SYSTEM
Verified in order to DC
09/01/17 1309 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427982
09/01/17 1316 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Conflict with New Allergy by PHABKGJOB Eff: 09/01/17 1256
Edit by SYSTEM Eff: 09/01/17 1309
Discontinue by NBALCETIS Eff: 09/01/17 1309

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 20 MG (0.25 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 10/02/17 2059 DC: 09/02/17-2100
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541949

History
09/01/17 1309 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01541928
09/01/17 1318 - DISCONTINUE by AADEGBAMIG Eff: 09/02/17 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
09/01/17 1318 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

GLAT40SY - GLATIRAMER ACETATE 40 MG/ML ML

Dose 40 MG (1 ML)
Admin Route SUBCUTAN.
Frequency ONETIME (ONE)
Start Date 09/02/17-1030 Stop Date 09/02/17 1031 DC: 09/02/17-1031
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $0.00
Rx Number 01542159

Discontinued Comments Reached Stop Date

History
09/02/17 1021 - ENTER by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 1030
09/02/17 1031 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 1031
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Copaxone 20mg subcut daily

(Own medication)
Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859 DC: 09/02/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541929

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1309 - DISCONTINUE by NBALCETIS Eff: 09/02/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 1309 - VERIFIED by SYSTEM
Verified in order to DC
09/01/17 1309 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427983
09/01/17 1316 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by SYSTEM Eff: 09/01/17 1309
Discontinue by NBALCETIS Eff: 09/01/17 1309
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Copaxone 40mg subcut mowefr

(Own medication)
Admin Route SUBCUTAN.
Frequency MoWeFr (SCH)
Start Date 09/04/17-0900 Stop Date 10/02/17 0859 DC: 09/04/17-0900
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541951

History
09/01/17 1309 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01541929
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 09/02/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: MoWeFr (SCH)
Old Order Stop: 09/02/17 - 0900
New Order Start: 09/04/17 - 0900
New Order Stop: 10/02/17 - 0859
09/01/17 1320 - DISCONTINUE by AADEGBAMIG Eff: 09/04/17 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
09/01/17 1320 - REVIEW PROVIDER ACTIVITY by SYSTEM
Freq/Sch Edit by NBALCETIS Eff: 09/01/17 1309
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 09/02/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: MoWeFr (SCH)
Old Order Stop: 09/02/17 - 0900
New Order Start: 09/04/17 - 0900
New Order Stop: 10/02/17 - 0859
09/01/17 1320 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

JOHNSON,EFFIE M W00001219741 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 40 MG (2 CAPSULE DELAYED RELEASES)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 09/02/17-0800 Stop Date 10/02/17 0759 DC: 09/02/17-0800
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542102

Discontinued Comments DC PER DR. BALCETIS

History
09/01/17 1219 - POM ORDER by NBALCETIS
09/01/17 1724 - DISCONTINUE by AADEGBAMIG Eff: 09/02/17 0800
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC PER DR. BALCETIS
09/01/17 1724 - VERIFIED by SYSTEM
Verified in order to DC

GLTR20V - GLATIRAMER ACETATE FOR INJ 20 MG VIAL

Dose 40 MG (2 VIALS)
Admin Route SUBCUTAN.
Frequency 0900 (ONE)
Start Date 09/02/17-0900 Stop Date 09/02/17 0901 CAN: 09/02/17-1022
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01428191

History
09/01/17 2227 - POM ORDER by RMINASSIAN
09/02/17 1022 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO NF MED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient JOHNSON,VERONICA A Responsible Doctor ELASHVILI, MERY

Account Number W00001219468 Location B2EA Unit Number M000209363
Age/Sex 70/F Room 205 Registered Date 08/29/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 2.01 in 157.5 cm Body Surface Area 1.79 m2

Weight 171 lb 14.4 oz 77.973 kg
Hem-Onc No

Drug Allergies morphine, hydromorphone (From Dilaudid)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions water 3oz

Admin Route ORAL
Frequency 3 X DAILY & BEDTIME (SCH)
Start Date 08/30/17-2100 Stop Date 09/30/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541480

History
08/30/17 2016 - POM COPY AND EDIT by YCHO
FROM: Rx #01541476
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/31/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: AFTER MEALS (SCH)
New Freq/Sch: 3 X DAILY & BEDTIME (SCH)
Old Order Stop: 08/30/17 - 2200
New Order Start: 08/30/17 - 2100
New Order Stop: 09/30/17 - 0859
08/30/17 2020 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
TO:
ORDER TYPE: BULK - BULK ORDER
08/30/17 2020 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by YCHO Eff: 08/30/17 2016
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/31/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: AFTER MEALS (SCH)
New Freq/Sch: 3 X DAILY & BEDTIME (SCH)
Old Order Stop: 08/30/17 - 2200
New Order Start: 08/30/17 - 2100
New Order Stop: 09/30/17 - 0859
08/30/17 2020 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 09/09/17 0859
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01541897

History
09/01/17 1154 - POM ORDER by EALEXEEV
09/01/17 1207 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 0900

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/29/17-1245 Stop Date 09/28/17 1244
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540949

History
08/29/17 1249 - POM ORDER by YCHO
08/29/17 1253 - VERIFIED by AMACCA
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $80.90
Rx Number 01540972

History
08/29/17 1325 - ENTER by AADEGBAMIG
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $3.75
Rx Number 01540956

History
08/29/17 1319 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1245 Stop Date 09/28/17 1244
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540950

History
08/29/17 1249 - POM ORDER by YCHO
08/29/17 1253 - VERIFIED by AMACCA
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 2,000 UNIT (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $0.75
Rx Number 01541640

History
08/31/17 1457 - POM ORDER by YCHO
08/31/17 1500 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 7 Total Costs $0.00 Total Charges $1.75
Rx Number 01541212

History
08/29/17 1818 - POM ORDER by MELASHVI
08/29/17 1842 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/30/17-0900 Stop Date 09/29/17 0859
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 7 Total Costs $0.00 Total Charges $1.50
Rx Number 01540955

History
08/29/17 1314 - POM ORDER by YCHO
08/29/17 1318 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/29/17-1245 Stop Date 09/28/17 1244
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540952

History
08/29/17 1249 - POM ORDER by YCHO
08/29/17 1253 - VERIFIED by AMACCA
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1245 Stop Date 09/28/17 1244
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540951

History
08/29/17 1249 - POM ORDER by YCHO
08/29/17 1253 - VERIFIED by AMACCA
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 1244
Ordering Doctor ELASHVILI, MERY
Total Dispensed 16 Total Costs $0.00 Total Charges $1.00
Rx Number 01541214

History
08/29/17 1818 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01540953
Result of Frequency/Schedule Edit
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: NIGHTLY (PRN)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/29/17 - 1814
New Order Start: 08/29/17 - 2100
New Order Stop: 09/28/17 - 1244
08/29/17 1842 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by MELASHVI Eff: 08/29/17 1818
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: NIGHTLY (PRN)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/29/17 - 1814
New Order Start: 08/29/17 - 2100
New Order Stop: 09/28/17 - 1244
08/29/17 1842 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 3 EA (0 EACHS)
Admin Route ORAL
Frequency 7 TIMES A DAY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059 DC: 08/30/17-1819
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541213

History
08/29/17 1824 - POM ORDER by MELASHVI
08/29/17 1842 - EDIT by MHAIMOWITZ
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
TO:
ORDER TYPE: BULK - BULK ORDER
08/29/17 1842 - VERIFIED by MHAIMOWITZ
08/30/17 1821 - DISCONTINUE by YCHO Eff: 08/30/17 1819
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/30/17 2008 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 08/30/17 1821
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions water 3oz

Admin Route ORAL
Frequency AFTER MEALS (SCH)
Start Date 08/31/17-0900 Stop Date 08/30/17 2200 DC: 08/31/17-0900
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541476

Discontinued Comments NEW ORDER ON FILE

History
08/30/17 2006 - POM ORDER by YCHO
08/30/17 2008 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
TO:
ORDER TYPE: BULK - BULK ORDER
08/30/17 2008 - VERIFIED by MHAIMOWITZ
08/30/17 2016 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/31/17-0900 STOP: 09/30/17 0859 SOFT STOP: 0
TO:
START: 08/31/17-0900 STOP: 08/30/17-2200 SOFT STOP:
08/30/17 2016 - POM COPY AND EDIT by YCHO
TO: Rx #U01427556
08/30/17 2021 - DISCONTINUE by MHAIMOWITZ Eff: 08/31/17 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
NEW ORDER ON FILE
08/30/17 2022 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by YCHO Eff: 08/30/17 2016
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route ORAL
Frequency NOW (ONE)
Start Date 09/01/17-1208 Stop Date 09/01/17 1209 DC: 09/01/17-1209
Ordering Doctor ELASHVILI, MERY
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01541898

Discontinued Comments Reached Stop Date

History
09/01/17 1147 - POM ORDER by MELASHVI
09/01/17 1208 - EDIT by AMOLINARI
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
SIG: DAILY
SCHEDULE: SCH
START: 09/02/17-0900 STOP: 10/02/17 0859 SOFT STOP: 0
TO:
SIG: NOW
SCHEDULE: ONE
START: 09/01/17-1208 STOP: 09/01/17-1209 SOFT STOP:
09/01/17 1208 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1208
09/01/17 1209 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 1209
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 09/01/17-1700 Stop Date 10/01/17 1659 DC: 09/01/17-1700
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540973

History
08/29/17 1314 - POM ORDER by YCHO
08/29/17 1325 - DISCONTINUE by AADEGBAMIG Eff: 09/01/17 1700
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1325 - VERIFIED by SYSTEM
Verified in order to DC

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/28/17 1659 DC: 08/29/17-1700
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540974

History
08/29/17 1314 - POM ORDER by YCHO
08/29/17 1325 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 1700
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1325 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 08/31/17 1701 DC: 08/31/17-1009
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $129.40
Rx Number 01540971

History
08/29/17 1324 - ENTER by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 5
For: 08/29/17 - 1700
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/31/17 1009 - DISCONTINUE by YCHO Eff: 08/31/17 1009
Items Auto Credited: 2 Doses Auto Credited: 1
For: 08/31/17 - 1700
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/31/17 1009 - POM COPY AND EDIT by YCHO
TO: Rx #U01427603
08/31/17 1028 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by YCHO Eff: 08/31/17 1009
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/02/17 1659 DC: 08/31/17-1700
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541533

History
08/31/17 1009 - POM COPY AND EDIT by YCHO
FROM: Rx #01540971
08/31/17 1029 - EDIT by AMACCA
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-1700 STOP: 09/02/17 SOFT STOP:
DISPENSE: 6
TO:
START: 08/31/17-1700 STOP: 09/02/17-1659 SOFT STOP:
DISPENSE: 8
08/31/17 1029 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 4
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
08/31/17 1031 - DISCONTINUE by YCHO Eff: 08/31/17 1700
Items Auto Credited: 8 Doses Auto Credited: 4
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/31/17 1031 - POM COPY AND EDIT by YCHO
TO: Rx #U01427612
08/31/17 1032 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by YCHO Eff: 08/31/17 1031
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

APIX5TAB2 - APIXABAN 5 MG TABLET

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 08/31/17 1700 DC: 08/31/17-1700
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541534

Discontinued Comments Reached Stop Date

History
08/31/17 1031 - POM COPY AND EDIT by YCHO
FROM: Rx #01541533
08/31/17 1032 - VERIFIED by AMACCA
08/31/17 1700 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059 DC: 08/29/17-2100
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540957

History
08/29/17 1314 - POM ORDER by YCHO
08/29/17 1319 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 2100
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1319 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

JOHNSON,VERONICA A W00001219468 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/29/17-1245 Stop Date 08/29/17 1814 DC: 08/29/17-1814
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01540953

History
08/29/17 1249 - POM ORDER by YCHO
08/29/17 1253 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 08/29/17 - 1245
08/29/17 1818 - EDIT by MELASHVI
EDIT DOCTOR: ELASHVILI, MERY
FROM:
START: 08/29/17-1245 STOP: 09/28/17 1244 SOFT STOP: 0
DISPENSE: 2
TO:
START: 08/29/17-1245 STOP: 08/29/17-1814 SOFT STOP:
DISPENSE: 0
08/29/17 1818 - DISCONTINUE by MELASHVI Eff: 08/29/17 1814
EDIT DOCTOR: ELASHVILI, MERY
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/29/17 1818 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01427291
08/29/17 1843 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by MELASHVI Eff: 08/29/17 1818
Discontinue by MELASHVI Eff: 08/29/17 1818
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient KEIDAN,DAVID B Responsible Doctor GITLER, ELLEN M.D.

Account Number W00001219370 Location B1EA Unit Number M000148575
Age/Sex 73/M Room 109 Registered Date 08/23/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 1.81 m2

Weight 154 lb 12.8 oz 70.216 kg
Hem-Onc No

Drug Allergies Penicillins, Sulfa (Sulfonamide Antibiotics), aspirin

ADRS [tyleno], acetaminophen (From Tylenol)

Med Allergies:
Food Allergies:
Primary Diagnosis: BILAT TKR
Secondary Diagnosis:

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 09/22/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01539496

History
08/23/17 2044 - POM ORDER by HMOHAMED
08/23/17 2045 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 08/23/17 - 2100
08/31/17 0748 - DEBIT by AMOLINARI
ITEMS: 1

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/23/17-1500 Stop Date 09/22/17 1459
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539305

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

PROP10DR - PROPYLENE GLYCOL/PEG 400 1 DROP DROP.APPLI

Dose 1 DROP (0.1 DROP APPLICATIONS)

Admin Route OPHTHALMIC
Frequency 3 TIMES A DAY (SCH)
Start Date 08/25/17-1300 Stop Date 09/22/17 1659
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $0.00
Rx Number 01539879

History
08/25/17 1005 - COPY AND EDIT by AMOLINARI
FROM: Rx #01539352
08/25/17 1005 - ENTER by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/25/17 - 1300
08/25/17 1005 - SYSTEM COPY AND EDIT by AMOLINARI
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
START: 08/23/17-1700 STOP: 09/22/17 1659 SOFT STOP: 0
DISPENSE: 6
TO:
ORDER TYPE: BULK - BULK ORDER
START: 08/25/17-1300 STOP: 09/22/17-1659 SOFT STOP: 0
DISPENSE: 8
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

ALFU10TA - ALFUZOSIN HCL 10 MG TABSR

Dose 10 MG (1 TAB SUSTAINED RELEASE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 09/22/17 2059
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $526.90
Rx Number 01539314

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/23/17 - 2100
For: 08/24/17 - 2100
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

ALLP100T - ALLOPURINOL 100 MG TAB

Dose 100 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $7.70
Rx Number 01539315

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions Constipation
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/23/17-1500 Stop Date 09/22/17 1459
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01539307

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

CLC1250T - CALCIUM CARBONATE 1250 MG (=500MG ELEM. CA++)

Dose 1,250 MG (1 TABLET)

Dose Instructions 1250MG CALCIUM CARB. = 500MG ELEM. CALCIUM
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/23/17-1700 Stop Date 09/22/17 1659
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 27 Total Costs $0.00 Total Charges $1.76
Rx Number 01539325

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1521 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/23/17-1500 Stop Date 09/22/17 1459
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.75
Rx Number 01539302

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

EZET10TA - EZETIMIBE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $287.65
Rx Number 01539318

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1521 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

FNST5T - FINASTERIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $34.65
Rx Number 01539317

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1521 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

FLX20C - FLUOXETINE HCL 20 MG CAP

Dose 40 MG (2 CAPSULES)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 26 Total Costs $0.00 Total Charges $11.00
Rx Number 01539326

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1521 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $3.30
Rx Number 01539313

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 4 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/29/17-0830 Stop Date 09/05/17 0829
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01540901

History
08/29/17 0822 - POM ORDER by MBRIONES
08/29/17 0837 - VERIFIED by AMACCA
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

HYDR4TAB8 - HYDROMORPHONE HCL 4 MG TAB

Dose 8 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/29/17-0830 Stop Date 09/05/17 0829
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540902

History
08/29/17 0822 - POM ORDER by MBRIONES
08/29/17 0838 - VERIFIED by AMACCA
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

HDR2T1 - HYDROMORPHONE HCL 2 MG TAB

Dose 6 MG (3 TABLETS)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/29/17-1352 Stop Date 09/05/17 1351
Ordering Doctor BRIONES,MARIA DOLORES
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01540990

History
08/29/17 1352 - ENTER by AMACCA
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

IRON45TA - IRON,CARBONYL (FERRO SEQUELS) TAB

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $5.50
Rx Number 01539311

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Dose Instructions Dyspepsia/Abdominal Discomfort
Admin Route ORAL
Frequency AFTER MEALS & BEDTIM (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/23/17-1500 Stop Date 09/22/17 1459
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539308

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/23/17-1500 Stop Date 09/22/17 1459
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01539306

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

MLX7.5T - MELOXICAM 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Dose Instructions take with food in stomach
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/18/17 2300
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $3.85
Rx Number 01539319

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1521 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

RIVA10TA - RIVAROXABAN 10 MG TABLET

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 09/09/17 2300
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $355.63
Rx Number 01539323

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1521 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/23/17 - 2100
For: 08/24/17 - 2100
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

ROSU10TA - ROSUVASTATIN CALCIUM 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY OTHER NIGHT (SCH)
Start Date 08/23/17-2100 Stop Date 09/22/17 2059
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 7 Total Costs $0.00 Total Charges $130.50
Rx Number 01539316

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/23/17 - 2100
For: 08/25/17 - 2100
For: 08/27/17 - 2100
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 2100
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 2100
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/02/17 - 2100
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions 374 MG = 2 tablets
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/23/17-1500 Stop Date 09/22/17 1459
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $1.40
Rx Number 01539312

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 1
For: 08/23/17 - 1500
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

VITA1CAP19 - VITAMIN B COMPLEX W/VIT B-12 1 EA TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $0.88
Rx Number 01539324

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1521 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 0900
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/31/17-1630 Stop Date 09/07/17 1629
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541806

History
08/31/17 1620 - POM COPY AND EDIT by MBRIONES
FROM: Rx #01539899
08/31/17 1701 - EDIT by AMACCA
EDIT DOCTOR: BRIONES,MARIA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-1630 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/31/17-1630 STOP: 09/07/17-1629 SOFT STOP:
08/31/17 1701 - VERIFIED by AMACCA
09/01/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions Mild pain/Fever
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/23/17-1500 Stop Date 09/22/17 1459 DC: 08/23/17-1634
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539303

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
08/23/17 1635 - DISCONTINUE by EGITLER Eff: 08/23/17 1634
EDIT DOCTOR: GITLER, ELLEN M.D.
08/23/17 2045 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by EGITLER Eff: 08/23/17 1635
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

DIAZ5TAB34 - DIAZEPAM 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/28/17-1315 Stop Date 08/28/17 1316 DC: 08/28/17-1316
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540674

Discontinued Comments Reached Stop Date

History
08/28/17 1307 - POM ORDER by MBRIONES
08/28/17 1311 - VERIFIED by AADEGBAMIG
08/28/17 1316 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 1316
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

HYDR4TAB8 - HYDROMORPHONE HCL 4 MG TAB

Dose 6 MG (1.5 TABLETS)

Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/29/17-0830 Stop Date 09/05/17 0829 DC: 08/29/17-1351
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540903

History
08/29/17 0822 - POM ORDER by MBRIONES
08/29/17 0838 - VERIFIED by AMACCA
08/29/17 1351 - DISCONTINUE by AMACCA Eff: 08/29/17 1351
EDIT DOCTOR: BRIONES,MARIA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MILD PAIN (PAIN SCALE 1-3)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/23/17-1500 Stop Date 08/30/17 1459 DC: 08/25/17-0957
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539320

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1519 - EDIT by AADEGBAMIG
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
TO:
DOSE INSTRUCTIONS:
FOR MILD PAIN (PAIN SCALE 1-3)
08/23/17 1519 - EDIT by AADEGBAMIG
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE INSTRUCTIONS:
FOR MILD PAIN (PAIN SCALE 1-3)
TO:
DOSE INSTRUCTIONS:
PRN MILD PAIN (PAIN SCALE 1-3)
08/23/17 1521 - VERIFIED by AADEGBAMIG
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0958 - DISCONTINUE by EGITLER Eff: 08/25/17 0957
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0958 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426106
08/25/17 1150 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EGITLER Eff: 08/25/17 0958
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/23/17-1500 Stop Date 08/30/17 1459 DC: 08/25/17-0957
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01539321

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1521 - VERIFIED by AADEGBAMIG
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0958 - DISCONTINUE by EGITLER Eff: 08/25/17 0957
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0958 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426107
08/25/17 1150 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EGITLER Eff: 08/25/17 0958

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 15 MG (3 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/23/17-1500 Stop Date 08/30/17 1459 DC: 08/25/17-0957
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01539322

History
08/23/17 1509 - POM ORDER by EGITLER
08/23/17 1521 - VERIFIED by AADEGBAMIG
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0958 - DISCONTINUE by EGITLER Eff: 08/25/17 0957
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0958 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426108
08/25/17 1150 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EGITLER Eff: 08/25/17 0958
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MILD PAIN (PAIN SCALE 1-3)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/25/17-1000 Stop Date 09/01/17 0959 DC: 08/29/17-0819
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539896

History
08/25/17 0958 - POM COPY AND EDIT by EGITLER
FROM: Rx #01539320
08/25/17 1149 - EDIT by MHAIMOWITZ
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1000 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1000 STOP: 09/01/17-0959 SOFT STOP: 0
08/25/17 1149 - VERIFIED by MHAIMOWITZ
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/29/17 0822 - DISCONTINUE by MBRIONES Eff: 08/29/17 0819
EDIT DOCTOR: BRIONES,MARIA M.D.
08/29/17 0837 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MBRIONES Eff: 08/29/17 0822
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/25/17-1000 Stop Date 09/01/17 0959 DC: 08/29/17-0819
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539897

History
08/25/17 0958 - POM COPY AND EDIT by EGITLER
FROM: Rx #01539321
08/25/17 1150 - EDIT by MHAIMOWITZ
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1000 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1000 STOP: 09/01/17-0959 SOFT STOP: 0
08/25/17 1150 - VERIFIED by MHAIMOWITZ
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/29/17 0822 - DISCONTINUE by MBRIONES Eff: 08/29/17 0819
EDIT DOCTOR: BRIONES,MARIA M.D.
08/29/17 0837 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MBRIONES Eff: 08/29/17 0822
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 15 MG (3 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/25/17-1000 Stop Date 09/01/17 0959 DC: 08/29/17-0819
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $5.75
Rx Number 01539898

History
08/25/17 0958 - POM COPY AND EDIT by EGITLER
FROM: Rx #01539322
08/25/17 1150 - EDIT by MHAIMOWITZ
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1000 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1000 STOP: 09/01/17-0959 SOFT STOP: 0
08/25/17 1150 - VERIFIED by MHAIMOWITZ
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/29/17 0822 - DISCONTINUE by MBRIONES Eff: 08/29/17 0819
EDIT DOCTOR: BRIONES,MARIA M.D.
08/29/17 0837 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MBRIONES Eff: 08/29/17 0822
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

PROP10DR - PROPYLENE GLYCOL/PEG 400 1 DROP DROP.APPLI

Dose 1 DROP (0.1 DROP APPLICATIONS)

Admin Route OPHTHALMIC
Frequency 3 TIMES A DAY (SCH)
Start Date 08/23/17-1700 Stop Date 09/22/17 1659 DC: 08/25/17-1005
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $0.00
Rx Number 01539352

History
08/23/17 1601 - ENTER by AADEGBAMIG
Items Dispensed: 13 Doses Dispensed: 13
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/25/17 1005 - COPY AND EDIT by AMOLINARI
TO: Rx #01539879
08/25/17 1005 - DISCONTINUE by AMOLINARI Eff: 08/25/17 1005
Items Auto Credited: 14 Doses Auto Credited: 14
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
EDIT DOCTOR: GITLER, ELLEN M.D.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

EDIT SOURCE: PHARMACY WRITTEN CHANGE

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/23/17-1500 Stop Date 08/30/17 1459 DC: 08/25/17-0957
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539310

History
08/23/17 1508 - POM ORDER by EGITLER
08/23/17 1520 - VERIFIED by AADEGBAMIG
08/25/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0958 - DISCONTINUE by EGITLER Eff: 08/25/17 0957
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0958 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426109
08/25/17 1151 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EGITLER Eff: 08/25/17 0958
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/25/17-1000 Stop Date 09/01/17 0959 DC: 08/31/17-1619
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.28
Rx Number 01539899

History
08/25/17 0958 - POM COPY AND EDIT by EGITLER
FROM: Rx #01539310
08/25/17 1150 - EDIT by MHAIMOWITZ
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1000 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1000 STOP: 09/01/17-0959 SOFT STOP: 0
08/25/17 1150 - VERIFIED by MHAIMOWITZ
08/28/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/31/17 1620 - DISCONTINUE by MBRIONES Eff: 08/31/17 1619
EDIT DOCTOR: BRIONES,MARIA M.D.
08/31/17 1620 - POM COPY AND EDIT by MBRIONES
TO: Rx #U01427806
08/31/17 1701 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MBRIONES Eff: 08/31/17 1620
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

KEIDAN,DAVID B W00001219370 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (0 EACHS)
Dose Instructions pt may use own
Admin Route OPHTHALMIC
Frequency 3 TIMES A DAY (SCH)
Start Date 08/23/17-1700 Stop Date 09/22/17 1659 DC: 08/23/17-1700
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539353

History
08/23/17 1526 - POM ORDER by EGITLER
08/23/17 1602 - VERIFIED by SYSTEM
Verified in order to DC
08/23/17 1602 - DISCONTINUE by AADEGBAMIG Eff: 08/23/17 1700
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient KINNIE,JAMES Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219439 Location B2WEII Unit Number M000209267
Age/Sex 81/M Room 241 Registered Date 08/24/17
Status ADM IN Bed 02 Discharged Date

Height 6 ft 0.99 in 185.4 cm Body Surface Area 1.75 m2

Weight 122 lb 11.2 oz 55.656 kg
Hem-Onc No

Drug Allergies No Known Allergies (NKA)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CRANIOTOMY W/ EVAC OF SDH
Secondary Diagnosis:

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 4 GM (4 GEL APPLICATIONS)

Dose Instructions to R-ankle
Admin Route TOPICALLY
Frequency 4 TIMES A DAY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $108.60
Rx Number 01542150

History
09/01/17 2101 - POM ORDER by RMINASSIAN
09/01/17 2103 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

LEVE100S4 - LEVETIRACETAM 100MG/ML 473 ML ML

Dose 15 ML (15 MLS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 380 Total Costs $0.00 Total Charges $1719.90
Rx Number 01539878

History
08/25/17 0858 - POM ORDER by SDAS
08/25/17 1003 - EDIT by AMOLINARI
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
BULK: Y
DISPENSE: 1
CHARGE: $2085.93
TO:
BULK: N
DISPENSE: 90
CHARGE: $66.15
08/25/17 1003 - VERIFIED by AMOLINARI
Items Dispensed: 90 Doses Dispensed: 6
For: 08/25/17 - 0900
08/27/17 1250 - DEBIT by AADEGBAMIG
ITEMS: 200 DOSES: 14
09/02/17 1428 - DEBIT by MHAIMOWITZ
ITEMS: 90 DOSES: 6

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-1700 Stop Date 09/05/17 1659
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01540931

History
08/29/17 1056 - POM ORDER by YOLEE
08/29/17 1100 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/24/17-1500 Stop Date 09/23/17 1459
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01539632

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1502 - VERIFIED by EBALILO
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $127.80
Rx Number 01539641

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1507 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1500 Stop Date 09/23/17 1459
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539633

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1504 - VERIFIED by EBALILO
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/24/17-1700 Stop Date 09/23/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $6.00
Rx Number 01539634

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1504 - VERIFIED by EBALILO
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

GLBR1.25T - GLYBURIDE 1.25 MG TAB

Dose 1.25 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $0.54
Rx Number 01541557

History
08/31/17 1108 - ENTER by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/24/17-2200 Stop Date 09/23/17 2159
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 38 Total Costs $0.00 Total Charges $278.40
Rx Number 01539642

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1507 - VERIFIED by EBALILO
Items Dispensed: 11 Doses Dispensed: 11
For: 08/24/17 - 2200
For: 08/25/17 - 0600
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0822 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/24/17-1500 Stop Date 09/23/17 1459
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539636

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1506 - VERIFIED by EBALILO
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1500 Stop Date 09/23/17 1459
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539635

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1506 - VERIFIED by EBALILO
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

PANT40SU2 - PANTOPRAZOLE SODIUM 40 MG PKT

Dose 40 MG (1 PACKET)
Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/25/17-0800 Stop Date 09/24/17 0759
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $327.80
Rx Number 01539644

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1508 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

PHN100C - PHENYTOIN SODIUM EXT. RELEASE 100 MG CAP

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 50 Total Costs $0.00 Total Charges $125.00
Rx Number 01539651

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1511 - VERIFIED by EBALILO
Items Dispensed: 14 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1500 Stop Date 09/25/17 1459
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539639

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1506 - VERIFIED by EBALILO
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1500 Stop Date 09/23/17 1459
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539640

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1507 - VERIFIED by EBALILO
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/24/17-1700 Stop Date 09/23/17 1659 DC: 08/30/17-0914
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01539643

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1508 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 1700
08/30/17 0915 - DISCONTINUE by YOLEE Eff: 08/30/17 0914
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/30/17 1108 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by YOLEE Eff: 08/30/17 0915
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

ZINC454O - ZINC OXIDE 454 GM JAR

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions Apply to decub area
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/29/17-1200 Stop Date 08/29/17 1200 DC: 08/29/17-1200
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $101.40
Rx Number 01540922

History
08/29/17 1051 - POM ORDER by YOLEE
08/29/17 1051 - NOW DOSE by YOLEE
Now Dose: 08/29/17 1200
08/29/17 1051 - KEEP NEXT DOSE by System
Keep Next Dose: 08/30/17 0900
08/29/17 1053 - REVIEW PROVIDER ACTIVITY by AMACCA
Now Dose by YOLEE Eff: 08/29/17 1051
Now Dose 08/29/17 - 1200
Keep Next Dose 08/30/17 - 0900
08/29/17 1053 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1200
08/29/17 1056 - EDIT by YOLEE
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
FROM:
START: 08/29/17-1200 STOP: 09/28/17 1159 SOFT STOP: 0
TO:
START: 08/29/17-1200 STOP: 08/29/17-1200 SOFT STOP:
08/29/17 1056 - DISCONTINUE by YOLEE Eff: 08/29/17 1200
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/29/17 1100 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by YOLEE Eff: 08/29/17 1056
Discontinue by YOLEE Eff: 08/29/17 1056
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

GLYB2.5T12 - GLYBURIDE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859 DC: 08/31/17-1104
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $4.55
Rx Number 01539652

History
08/24/17 1519 - ENTER by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 1104 - DISCONTINUE by YOLEE Eff: 08/31/17 1104
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
08/31/17 1105 - POM COPY AND EDIT by YOLEE
TO: Rx #U01427628
08/31/17 1106 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by YOLEE Eff: 08/31/17 1104
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

GLYB2.5T12 - GLYBURIDE 2.5 MG TAB

Dose 1.25 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859 DC: 09/01/17-0900
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541556

History
08/31/17 1105 - POM COPY AND EDIT by YOLEE
FROM: Rx #01539652
08/31/17 1107 - DISCONTINUE by AMACCA Eff: 09/01/17 0900
EDIT DOCTOR: LEE,YOUNGHOON MD, PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/31/17 1107 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

LEVE750T - LEVETIRACETAM 750 MG TAB

Dose 1,500 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059 DC: 08/25/17-0857
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $51.75
Rx Number 01539650

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1509 - VERIFIED by EBALILO
Items Dispensed: 14 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/25/17 0858 - DISCONTINUE by SDAS Eff: 08/25/17 0857
Items Auto Credited: 20 Doses Auto Credited: 10
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/25/17 1003 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SDAS Eff: 08/25/17 0858
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

KINNIE,JAMES W00001219439 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 2.5 EA (0 EACHS)

Admin Route PO
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859 CAN: 08/24/17-1513
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01425814

History
08/24/17 1459 - POM ORDER by SDAS
08/24/17 1513 - CANCEL by EBALILO
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO NF ENTRY
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient KOLOSKY,KEVIN Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001219212 Location B2EA Unit Number M000208802
Age/Sex 57/M Room 216 Registered Date 08/16/17
Status ADM IN Bed 01 Discharged Date

Height 6 ft 5.99 in 198.1 cm Body Surface Area 2.74 m2

Weight 316 lb oz 143.335 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

CRB6OT15 - CARBAMIDE PEROXIDE 6.5% OT SOLN 15 ML BTL

Dose 10 DROP (10 DROP APPLICATIONS)

Dose Instructions 5-10 DROPS bilateral ears
Admin Route OTIC
Frequency 2 TIMES A DAY (SCH)
Start Date 09/03/17-0900 Stop Date 09/05/17 0901
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01542292

History
09/03/17 0835 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01541930
09/03/17 1043 - EDIT by MHAIMOWITZ
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/03/17-0900 STOP: 09/05/17 SOFT STOP:
TO:
START: 09/03/17-0900 STOP: 09/05/17-0901 SOFT STOP: 0
09/03/17 1043 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by JDWARKA Eff: 09/03/17 0903
09/03/17 1043 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 09/03/17 - 0900
09/03/17 1049 - CREDIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions left shoulder
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01540728

History
08/28/17 1338 - POM ORDER by TKOUTZEVA
08/28/17 1431 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 1
For: 08/29/17 - 0900
08/31/17 1117 - DEBIT by AMACCA
ITEMS: 1
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 3 TIMES A DAY (PRN) PRN REASON: irritation of skin
Start Date 09/01/17-1230 Stop Date 09/08/17 1229
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541933

History
09/01/17 1231 - POM COPY AND EDIT by SDAS
FROM: Rx #01540570
09/01/17 1309 - EDIT by AADEGBAMIG
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1230 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1230 STOP: 09/08/17-1229 SOFT STOP:
09/01/17 1310 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1230
09/01/17 1310 - CREDIT by AADEGBAMIG
ITEMS: 1
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/16/17-1715 Stop Date 09/15/17 1714
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $8.00
Rx Number 01537380

History
08/16/17 1707 - POM ORDER by RMINASSIAN
08/16/17 1712 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/16/17-2100 Stop Date 09/15/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 42 Total Costs $0.00 Total Charges $1229.40
Rx Number 01537260

History
08/16/17 1520 - POM ORDER by TKOUTZEVA
08/16/17 1524 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 08/16/17 - 2100
For: 08/17/17 - 2100
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
Items Auto Credited: 10 Doses Auto Credited: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

For: 09/03/17 - 2100

For: 09/04/17 - 2100
For: 09/05/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Items Auto Debited: 10 Doses Auto Debited: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@1900 (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1900 Stop Date 09/15/17 1714
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541503

History
08/31/17 0812 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01537381
Result of Frequency/Schedule Edit
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY@1900 (PRN)
Old Order Stop: 08/31/17 - 0811
New Order Start: 08/31/17 - 1900
New Order Stop: 09/15/17 - 1714
08/31/17 0831 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by TKOUTZEVA Eff: 08/31/17 0812
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY@1900 (PRN)
Old Order Stop: 08/31/17 - 0811
New Order Start: 08/31/17 - 1900
New Order Stop: 09/15/17 - 1714
08/31/17 0831 - VERIFIED by AMOLINARI
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0001 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

HCT25T - HYDROCHLOROTHIAZIDE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 20 Total Costs $0.00 Total Charges $1.80
Rx Number 01537261

History
08/16/17 1520 - POM ORDER by TKOUTZEVA
08/16/17 1524 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
Items Auto Credited: 4 Doses Auto Credited: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

For: 09/05/17 - 0900

FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Items Auto Debited: 4 Doses Auto Debited: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/16/17-1715 Stop Date 09/15/17 1714
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537383

History
08/16/17 1707 - POM ORDER by RMINASSIAN
08/16/17 1712 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1715 Stop Date 09/15/17 1714
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537382

History
08/16/17 1707 - POM ORDER by RMINASSIAN
08/16/17 1712 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/17/17-0900 Stop Date 09/16/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 20 Total Costs $0.00 Total Charges $375.84
Rx Number 01537262

History
08/16/17 1520 - POM ORDER by TKOUTZEVA
08/16/17 1524 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
Items Auto Credited: 4 Doses Auto Credited: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

For: 09/05/17 - 0900

FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Items Auto Debited: 4 Doses Auto Debited: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 09/15/17 1714
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 28 Total Costs $0.00 Total Charges $1.20
Rx Number 01539242

History
08/23/17 0901 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01537384
Result of Frequency/Schedule Edit
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/20/17 - 2125
Old Freq/Sch: NIGHTLY (PRN)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/23/17 - 0859
New Order Start: 08/23/17 - 2100
New Order Stop: 09/15/17 - 1714
08/23/17 1215 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by TKOUTZEVA Eff: 08/23/17 0901
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/20/17 - 2125
Old Freq/Sch: NIGHTLY (PRN)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/23/17 - 0859
New Order Start: 08/23/17 - 2100
New Order Stop: 09/15/17 - 1714
08/23/17 1215 - VERIFIED by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 5
For: 08/23/17 - 2100
For: 08/24/17 - 2100
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

Items Dispensed: 4 Doses Dispensed: 2

For: 09/04/17 - 2100
For: 09/05/17 - 2100
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
Items Auto Credited: 10 Doses Auto Credited: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Items Auto Debited: 10 Doses Auto Debited: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/22/17-1615 Stop Date 09/21/17 1614
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $2.53
Rx Number 01539034

History
08/22/17 1614 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01538744
08/22/17 1615 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 1615
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1430
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

BALS30OI - BALSAM PERU/ZINC OXIDE 113 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (PRN) PRN REASON: skin irritation / rash
Start Date 08/03/17-1845 Stop Date 09/02/17 1844 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01534086

Discontinued Comments DC'd by Discharge

History
08/03/17 1847 - POM ORDER by RMINASSIAN
08/03/17 1855 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/03/17 - 1845
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
08/08/17 1459 - CREDIT by EBALILO
ITEMS: 1

CRB6OT15 - CARBAMIDE PEROXIDE 6.5% OT SOLN 15 ML BTL

Dose 10 DROP (10 DROP APPLICATIONS)

Dose Instructions 5-10 DROPS
Admin Route OTIC
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-1700 Stop Date 09/03/17 1659 DC: 08/31/17-0807
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $12.21
Rx Number 01541411

History
08/30/17 1701 - POM ORDER by TKOUTZEVA
08/30/17 1702 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 1700
08/31/17 0810 - DISCONTINUE by TKOUTZEVA Eff: 08/31/17 0807
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/31/17 0810 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427573
08/31/17 1009 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/31/17 0810
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

CRB6OT15 - CARBAMIDE PEROXIDE 6.5% OT SOLN 15 ML BTL

Dose 10 DROP (10 DROP APPLICATIONS)

Dose Instructions 5-10 DROPS bilateral ears
Admin Route OTIC
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-0900 Stop Date 09/02/17 0901 DC: 09/01/17-1230
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541526

History
08/31/17 0810 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01541411
08/31/17 1009 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-0900 STOP: 09/30/17 0859 SOFT STOP: 0
DISPENSE: 1
TO:
START: 08/31/17-0900 STOP: 09/02/17-0901 SOFT STOP: 0
DISPENSE: 0
08/31/17 1009 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by SANTONY Eff: 08/31/17 0937
08/31/17 1009 - VERIFIED by AMOLINARI
09/01/17 1231 - DISCONTINUE by SDAS Eff: 09/01/17 1230
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
09/01/17 1231 - POM COPY AND EDIT by SDAS
TO: Rx #U01427966
09/01/17 1310 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 09/01/17 1231
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

CRB6OT15 - CARBAMIDE PEROXIDE 6.5% OT SOLN 15 ML BTL

Dose 10 DROP (10 DROP APPLICATIONS)

Dose Instructions 5-10 DROPS bilateral ears
Admin Route OTIC
Frequency 2 TIMES A DAY (SCH)
Start Date 09/01/17-1700 Stop Date 09/03/17 1659 DC: 09/03/17-0834
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541930

History
09/01/17 1231 - POM COPY AND EDIT by SDAS
FROM: Rx #01541526
09/01/17 1309 - EDIT by AADEGBAMIG
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1700 STOP: 09/03/17 SOFT STOP:
TO:
START: 09/01/17-1700 STOP: 09/03/17-1659 SOFT STOP:
09/01/17 1310 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 1700
09/01/17 1310 - CREDIT by AADEGBAMIG
ITEMS: 1
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0000 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
09/03/17 0835 - DISCONTINUE by JRUSSO Eff: 09/03/17 0834
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/03/17 0835 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01428326
09/03/17 1043 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by JRUSSO Eff: 09/03/17 0835
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

TR5C15 - TRIAMCINOLONE ACET 0.5% CR 15 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions rt upper back around the scapula
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/17/17-1700 Stop Date 08/24/17 1659 DC: 08/21/17-0831
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $33.30
Rx Number 01537534

History
08/17/17 1049 - POM ORDER by TKOUTZEVA
08/17/17 1052 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 1700
08/21/17 0832 - DISCONTINUE by TKOUTZEVA Eff: 08/21/17 0831
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/21/17 0832 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01424694
08/21/17 0853 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/21/17 0832

TR5C15 - TRIAMCINOLONE ACET 0.5% CR 15 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions rt upper back around the scapula,itching
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (PRN) PRN REASON: ITCH - Itching
Start Date 08/21/17-0845 Stop Date 08/28/17 0844 DC: 08/28/17-0844
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538478

Discontinued Comments Reached Stop Date

History
08/21/17 0832 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01537534
08/21/17 0853 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 0845
08/21/17 0853 - CREDIT by AMOLINARI
ITEMS: 1
08/28/17 0844 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 0844
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

ZINC454O - ZINC OXIDE 454 GM JAR

Dose 1 APPLIC (1 OINT. APPLICATION)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (PRN) PRN REASON: RASH - Rash
Start Date 08/16/17-1530 Stop Date 09/15/17 1529 DC: 08/26/17-1015
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $101.40
Rx Number 01537264

History
08/16/17 1520 - POM ORDER by TKOUTZEVA
08/16/17 1525 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 1530
08/26/17 1015 - DISCONTINUE by AADEGBAMIG Eff: 08/26/17 1015
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 3 TIMES A DAY (PRN) PRN REASON: irritation of skin
Start Date 08/26/17-1015 Stop Date 09/02/17 1014 DC: 08/28/17-0919
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01540304

History
08/26/17 1010 - POM ORDER by HAZIZI
08/26/17 1015 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/26/17 - 1015
08/28/17 0919 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0919
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0920 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426695
08/28/17 1052 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by TKOUTZEVA Eff: 08/28/17 0919
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 3 TIMES A DAY (PRN) PRN REASON: irritation of skin
Start Date 08/28/17-0930 Stop Date 09/04/17 0929 DC: 09/01/17-1230
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01540570

History
08/28/17 0920 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540304
08/28/17 1052 - VERIFIED by JDIMARCO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 0930
08/28/17 1454 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0930 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-0930 STOP: 09/04/17-0929 SOFT STOP: 0
09/01/17 1231 - DISCONTINUE by SDAS Eff: 09/01/17 1230
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
09/01/17 1231 - POM COPY AND EDIT by SDAS
TO: Rx #U01427968
09/01/17 1310 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 09/01/17 1231
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/03/17-1845 Stop Date 09/02/17 1844 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534077

Discontinued Comments DC'd by Discharge

History
08/03/17 1837 - POM ORDER by RMINASSIAN
08/03/17 1839 - VERIFIED by EBALILO
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

ASPI325T5 - ASPIRIN 325 MG TABEC

Dose 325 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/04/17-0900 Stop Date 09/03/17 0859 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $0.15
Rx Number 01534082

Discontinued Comments DC'd by Discharge

History
08/03/17 1847 - POM ORDER by RMINASSIAN
08/03/17 1852 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/03/17-2100 Stop Date 09/02/17 2059 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $62.40
Rx Number 01534083

Discontinued Comments DC'd by Discharge

History
08/03/17 1847 - POM ORDER by RMINASSIAN
08/03/17 1853 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/03/17 - 2100
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
Items Auto Credited: 10 Doses Auto Credited: 5
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/03/17-1845 Stop Date 09/02/17 1844 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534078

Discontinued Comments DC'd by Discharge

History
08/03/17 1837 - POM ORDER by RMINASSIAN
08/03/17 1839 - VERIFIED by EBALILO
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1715 Stop Date 08/31/17 0811 DC: 08/31/17-0811
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537381

History
08/16/17 1707 - POM ORDER by RMINASSIAN
08/16/17 1712 - VERIFIED by AMACCA
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/31/17 0812 - DISCONTINUE by TKOUTZEVA Eff: 08/31/17 0811
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/31/17 0812 - EDIT by TKOUTZEVA
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
START: 08/16/17-1715 STOP: 09/15/17 1714 SOFT STOP: 0
TO:
START: 08/16/17-1715 STOP: 08/31/17-0811 SOFT STOP:
08/31/17 0812 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427576
08/31/17 0832 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by TKOUTZEVA Eff: 08/31/17 0812
Discontinue by TKOUTZEVA Eff: 08/31/17 0812
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/04/17-0900 Stop Date 09/03/17 0859 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534084

Discontinued Comments DC'd by Discharge

History
08/03/17 1847 - POM ORDER by RMINASSIAN
08/03/17 1853 - VERIFIED by EBALILO
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/03/17-2200 Stop Date 09/02/17 2159 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $18.56
Rx Number 01534108

Discontinued Comments DC'd by Discharge

History
08/03/17 2009 - POM ORDER by RMINASSIAN
08/03/17 2012 - VERIFIED by EBALILO
Items Dispensed: 11 Doses Dispensed: 11
For: 08/03/17 - 2200
For: 08/04/17 - 0600
For: 08/04/17 - 1400
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
For: 08/09/17 - 0600
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
Items Auto Credited: 15 Doses Auto Credited: 15
For: 08/04/17 - 1400
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
For: 08/09/17 - 0600
FROM:
DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

TO:
DC COMMENTS:
DC'd by Discharge

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/03/17-1845 Stop Date 09/02/17 1844 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534079

Discontinued Comments DC'd by Discharge

History
08/03/17 1837 - POM ORDER by RMINASSIAN
08/03/17 1840 - VERIFIED by EBALILO
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/03/17-1845 Stop Date 09/02/17 1844 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534080

Discontinued Comments DC'd by Discharge

History
08/03/17 1837 - POM ORDER by RMINASSIAN
08/03/17 1840 - VERIFIED by EBALILO
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/01/17 2059 DC: 08/27/17-1908
Ordering Doctor Koutzeva,Totka MD PGY-4
Clinical Indication OTHER
Total Dispensed 4 Total Costs $0.00 Total Charges $32.12
Rx Number 01540011

Discontinued Comments UTI Proteus mirabilis resistant to Macrobid

History
08/25/17 1131 - POM ORDER by TKOUTZEVA
08/25/17 1247 - VERIFIED by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/27/17 1914 - DISCONTINUE by YIVANOV Eff: 08/27/17 1908
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
EDIT DOCTOR: IVANOV,YURIY MD PGY-3
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
UTI Proteus mirabilis resistant to Macrobid
08/28/17 0727 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by YIVANOV Eff: 08/27/17 1914
UTI Proteus mirabilis resistant to Macrobid
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY@0800 (SCH)
Start Date 08/04/17-0800 Stop Date 09/03/17 0759 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $20.88
Rx Number 01534085

Discontinued Comments DC'd by Discharge

History
08/03/17 1847 - POM ORDER by RMINASSIAN
08/03/17 1853 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0800
For: 08/05/17 - 0800
For: 08/06/17 - 0800
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0800
For: 08/08/17 - 0800
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0800
For: 08/06/17 - 0800
For: 08/07/17 - 0800
For: 08/08/17 - 0800
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/03/17-1845 Stop Date 09/02/17 1844 DC: 08/04/17-1130
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01534081

Discontinued Comments DC'd by Discharge

History
08/03/17 1837 - POM ORDER by RMINASSIAN
08/03/17 1840 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 1
For: 08/03/17 - 1845
08/04/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 2348 - DISCONTINUE by DISCHARGE Eff: 08/04/17 1130
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/16/17-1715 Stop Date 08/23/17 0859 DC: 08/23/17-0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 4 Total Costs $0.00 Total Charges $0.20
Rx Number 01537384

History
08/16/17 1707 - POM ORDER by RMINASSIAN
08/16/17 1713 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 1715
08/18/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0901 - EDIT by TKOUTZEVA
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
START: 08/16/17-1715 STOP: 09/15/17 1714 SOFT STOP: 0
DISPENSE: 0
TO:
START: 08/16/17-1715 STOP: 08/23/17-0859 SOFT STOP:
DISPENSE: 14
08/23/17 0901 - DISCONTINUE by TKOUTZEVA Eff: 08/23/17 0859
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/23/17 0901 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01425403
08/23/17 1215 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by TKOUTZEVA Eff: 08/23/17 0901
Discontinue by TKOUTZEVA Eff: 08/23/17 0901
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 25 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/21/17-1800 Stop Date 09/20/17 1759 DC: 08/22/17-1613
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.23
Rx Number 01538744

History
08/21/17 1802 - POM ORDER by CDOHLE
08/21/17 1806 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 1800
08/22/17 1614 - DISCONTINUE by RMINASSIAN Eff: 08/22/17 1613
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/22/17 1614 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01425229
08/22/17 1615 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RMINASSIAN Eff: 08/22/17 1614
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

TS160800 - TRIMETHOPRIM/SULFAMETHOXAZOLE 160-800 MG TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/27/17-2100 Stop Date 08/30/17 2059 DC: 08/30/17-2059
Ordering Doctor IVANOV,YURIY MD PGY-3
Clinical Indication COMPLICATED UTI
Total Dispensed 6 Total Costs $0.00 Total Charges $2.88
Rx Number 01540513

Discontinued Comments Reached Stop Date

History
08/27/17 1914 - POM ORDER by YIVANOV
08/28/17 0727 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by MAGEORGE Eff: 08/27/17 2306
08/28/17 0727 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
08/30/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF7.5T - WARFARIN SOD 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/16/17-2100 Stop Date 08/17/17 2059 DC: 08/17/17-0818
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537263

History
08/16/17 1520 - POM ORDER by TKOUTZEVA
08/16/17 1525 - VERIFIED by AMACCA
08/17/17 0818 - DISCONTINUE by TKOUTZEVA Eff: 08/17/17 0818
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/17/17 0818 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01423759
08/17/17 0822 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/17/17 0818

WRF7.5T - WARFARIN SOD 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/17/17-2100 Stop Date 08/17/17 2101 DC: 08/17/17-2101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537507

Discontinued Comments Reached Stop Date

History
08/17/17 0818 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01537263
08/17/17 0822 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/17/17-2100 STOP: 08/18/17 SOFT STOP:
TO:
START: 08/17/17-2100 STOP: 08/17/17-2101 SOFT STOP: 0
08/17/17 0822 - VERIFIED by AMOLINARI
08/17/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF6T - WARFARIN SOD 6 MG TAB

Dose 6 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 08/19/17 2059 DC: 08/18/17-2100
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538033

History
08/18/17 1308 - POM ORDER by TKOUTZEVA
08/18/17 1311 - VERIFIED by AADEGBAMIG
08/18/17 1318 - DISCONTINUE by TKOUTZEVA Eff: 08/18/17 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/18/17 1318 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01424281
08/18/17 1325 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by TKOUTZEVA Eff: 08/18/17 1318

WRF6T - WARFARIN SOD 6 MG TAB

Dose 6.5 MG (1.08333 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 08/19/17 2059 DC: 08/18/17-2100
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538039

History
08/18/17 1318 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538033
08/18/17 1330 - DISCONTINUE by AMACCA Eff: 08/18/17 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/18/17 1330 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/19/17-2100 Stop Date 08/19/17 2101 DC: 08/19/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538318

Discontinued Comments Reached Stop Date

History
08/19/17 1451 - POM ORDER by HAZIZI
08/19/17 1459 - VERIFIED by AADEGBAMIG
08/19/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF1T - WARFARIN SOD 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/20/17-2200 Stop Date 08/20/17 2201 DC: 08/20/17-2201
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538453

Discontinued Comments Reached Stop Date

History
08/20/17 2130 - POM ORDER by RSHARMA
08/21/17 0742 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by SKOSHY Eff: 08/20/17 2151
08/21/17 0742 - VERIFIED by AMOLINARI
08/21/17 0742 - DISCONTINUE by PHABKGJOB Eff: 08/20/17 2201
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 08/21/17 2101 DC: 08/21/17-2101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538546

Discontinued Comments Reached Stop Date

History
08/21/17 1246 - POM ORDER by TKOUTZEVA
08/21/17 1253 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/21/17-2100 STOP: 08/22/17 2059 SOFT STOP: 0
TO:
START: 08/21/17-2100 STOP: 08/21/17-2101 SOFT STOP: 0
08/21/17 1253 - VERIFIED by MHAIMOWITZ
08/21/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/21/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF6T - WARFARIN SOD 6 MG TAB

Dose 6 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/22/17-2100 Stop Date 08/22/17 2101 DC: 08/22/17-2101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538912

Discontinued Comments Reached Stop Date

History
08/22/17 1021 - POM ORDER by TKOUTZEVA
08/22/17 1025 - EDIT by EBALILO
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/22/17-2100 STOP: 08/23/17 2059 SOFT STOP: 0
TO:
START: 08/22/17-2100 STOP: 08/22/17-2101 SOFT STOP: 0
08/22/17 1025 - VERIFIED by EBALILO
08/22/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF7.5T - WARFARIN SOD 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 08/23/17 2101 DC: 08/23/17-2101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539256

Discontinued Comments Reached Stop Date

History
08/23/17 1254 - POM ORDER by TKOUTZEVA
08/23/17 1303 - EDIT by EBALILO
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/23/17-2100 STOP: 08/24/17 2059 SOFT STOP: 0
TO:
START: 08/23/17-2100 STOP: 08/23/17-2101 SOFT STOP: 0
08/23/17 1303 - VERIFIED by EBALILO
08/23/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF7.5T - WARFARIN SOD 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 08/25/17 2059 DC: 08/25/17-1247
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539560

History
08/24/17 1217 - POM ORDER by TKOUTZEVA
08/24/17 1217 - VERIFIED by AMACCA
08/25/17 1247 - DISCONTINUE by AMOLINARI Eff: 08/25/17 1247
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF7.5T - WARFARIN SOD 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 08/26/17 2059 DC: 08/25/17-2100
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539991

History
08/25/17 1105 - POM ORDER by TKOUTZEVA
08/25/17 1238 - DISCONTINUE by TKOUTZEVA Eff: 08/25/17 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/25/17 1238 - VERIFIED by SYSTEM
Verified in order to DC
08/25/17 1239 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426181
08/25/17 1248 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 08/25/17 1238
Discontinue by TKOUTZEVA Eff: 08/25/17 1238

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 08/25/17 2101 DC: 08/25/17-2101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540012

Discontinued Comments Reached Stop Date

History
08/25/17 1248 - ENTER by AMOLINARI
08/25/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/26/17-2100 Stop Date 08/26/17 2101 DC: 08/26/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540393

Discontinued Comments Reached Stop Date

History
08/26/17 1621 - POM ORDER by HAZIZI
08/26/17 1651 - VERIFIED by AADEGBAMIG
08/26/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/26/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/27/17-2100 Stop Date 08/27/17 2101 DC: 08/27/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540514

Discontinued Comments Reached Stop Date

History
08/27/17 1832 - POM ORDER by RMINASSIAN
08/28/17 0727 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by MAGEORGE Eff: 08/27/17 2213
08/28/17 0727 - VERIFIED by AMOLINARI
08/28/17 0728 - DISCONTINUE by PHABKGJOB Eff: 08/27/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF6T - WARFARIN SOD 6 MG TAB

Dose 6 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 08/29/17 2059 DC: 08/28/17-2100
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540656

History
08/28/17 1222 - POM ORDER by TKOUTZEVA
08/28/17 1303 - VERIFIED by YLEE
08/28/17 1520 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 1520 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426869
08/28/17 1557 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 1520

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 08/28/17 2101 DC: 08/28/17-2101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540785

Discontinued Comments Reached Stop Date

History
08/28/17 1557 - ENTER by MHAIMOWITZ
08/28/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 08/30/17 2101 DC: 08/30/17-2101
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541202

Discontinued Comments Reached Stop Date

History
08/29/17 1743 - POM ORDER by CDOHLE
08/29/17 1744 - VERIFIED by MHAIMOWITZ
08/30/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-2100 Stop Date 09/01/17 2059 DC: 09/01/17-1230
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541575

History
08/31/17 1216 - POM ORDER by TKOUTZEVA
08/31/17 1226 - VERIFIED by AMACCA
09/01/17 1231 - DISCONTINUE by SDAS Eff: 09/01/17 1230
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
09/01/17 1231 - POM COPY AND EDIT by SDAS
TO: Rx #U01427967
09/01/17 1310 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 09/01/17 1231
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 09/02/17 2059 DC: 09/02/17-2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541932

Discontinued Comments Reached Stop Date

History
09/01/17 1231 - POM COPY AND EDIT by SDAS
FROM: Rx #01541575
09/01/17 1309 - EDIT by AADEGBAMIG
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/02/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 09/02/17-2059 SOFT STOP:
09/01/17 1310 - VERIFIED by AADEGBAMIG
09/01/17 2027 - DISCONTINUE by DISCHARGE Eff: 09/01/17 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
09/02/17 0001 - FIX DISCONTINUE by PHABKGJOB
FROM:
FIX DC COMMENTS:
DC'd by Discharge
TO:
FIX DC COMMENTS:
09/02/17 2100 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/02/17-2100 Stop Date 09/02/17 2101 DC: 09/02/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542291

Discontinued Comments Reached Stop Date

History
09/02/17 1929 - POM ORDER by HAZIZI
09/03/17 1042 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by ACABELLO Eff: 09/02/17 2132
09/03/17 1042 - VERIFIED by MHAIMOWITZ
09/03/17 1042 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF6T - WARFARIN SOD 6 MG TAB - 6 MG

WRF1T - WARFARIN SOD 1 MG TAB - 0.5 MG

Dose 6.5 MG (1.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 08/19/17 2059 DC: 08/19/17-2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538040

Discontinued Comments Reached Stop Date

History
08/18/17 1331 - ENTER by AMACCA
08/19/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

KOLOSKY,KEVIN W00001219212 (Continued)

WRF7.5T - WARFARIN SOD 7.5 MG TAB

Dose 5 MG (0.6666667 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 08/26/17 2059 CAN: 08/25/17-1248
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01426181

History
08/25/17 1239 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01539991
08/25/17 1248 - CANCEL by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 5MG TAB

WRF6T - WARFARIN SOD 6 MG TAB

Dose 5 MG (0.83333 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 08/29/17 2059 CAN: 08/28/17-1556
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01426869

History
08/28/17 1520 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01540656
08/28/17 1556 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
NEW STRENGTH
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient KURCHE,ANTHONY T Responsible Doctor GITLER, ELLEN M.D.

Account Number W00001219394 Location B1EA Unit Number M000209287
Age/Sex 68/M Room 102 Registered Date 08/24/17
Status ADM IN Bed 02 Discharged Date

Height 6 ft 5.01 in 195.6 cm Body Surface Area 2.69 m2

Weight 308 lb 8 oz 139.933 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: POST DECOMP T10-11 L1-L3 L5-S
Secondary Diagnosis:

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1545 Stop Date 09/23/17 1544
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539695

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1600 - VERIFIED by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Dose Instructions FOR MILD PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/24/17-1545 Stop Date 09/23/17 1544
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539714

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1603 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HRS W/AWAKE (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6
Start Date 08/24/17-1545 Stop Date 09/23/17 1544
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01539715

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1603 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $5.67
Rx Number 01539702

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1601 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

ATRV10T - ATORVASTATIN 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $239.50
Rx Number 01539703

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1601 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions Constipation
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1545 Stop Date 09/23/17 1544
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539697

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1600 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

CRV25T - CARVEDILOL 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 25 Total Costs $0.00 Total Charges $6.27
Rx Number 01539704

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1601 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1545 Stop Date 09/23/17 1544
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01539694

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1600 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $3.00
Rx Number 01539701

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1601 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/24/17-1700 Stop Date 09/23/17 1659
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 25 Total Costs $0.00 Total Charges $5.32
Rx Number 01539706

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1601 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/24/17 - 1700
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

IRON45TA - IRON,CARBONYL (FERRO SEQUELS) TAB

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $5.00
Rx Number 01539699

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1600 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $2.70
Rx Number 01539709

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1602 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Dose Instructions Dyspepsia/Abdominal Discomfort
Admin Route ORAL
Frequency AFTER MEALS & BEDTIM (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/24/17-1545 Stop Date 09/23/17 1544
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539698

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1600 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1545 Stop Date 09/23/17 1544
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539696

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1600 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency DAILY@0800,1700 (SCH)
Start Date 08/24/17-1700 Stop Date 09/23/17 1659
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 50 Total Costs $0.00 Total Charges $70.00
Rx Number 01539710

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1602 - VERIFIED by AMACCA
Items Dispensed: 14 Doses Dispensed: 7
For: 08/24/17 - 1700
For: 08/25/17 - 0800
For: 08/25/17 - 1700
For: 08/26/17 - 0800
For: 08/26/17 - 1700
For: 08/27/17 - 0800
For: 08/27/17 - 1700
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0800
For: 08/28/17 - 1700
For: 08/29/17 - 0800
For: 08/29/17 - 1700
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0800
For: 08/30/17 - 1700
For: 08/31/17 - 0800
For: 08/31/17 - 1700
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0800
For: 09/01/17 - 1700
For: 09/02/17 - 0800
For: 09/02/17 - 1700
For: 09/03/17 - 0800
For: 09/03/17 - 1700
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0800
For: 09/04/17 - 1700
For: 09/05/17 - 0800
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.50
Rx Number 01539708

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1602 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/25/17-0800 Stop Date 09/24/17 0759
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 12 Total Costs $0.00 Total Charges $8.80
Rx Number 01539711

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1602 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0800
For: 08/26/17 - 0800
For: 08/27/17 - 0800
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1545 Stop Date 09/25/17 1544
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539712

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1602 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

RIVA10TA - RIVAROXABAN 10 MG TABLET

Dose 20 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $258.60
Rx Number 01539713

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1557 - NOW DOSE by EGITLER
Now Dose: 08/31/17 0900
08/24/17 1557 - KEEP NEXT DOSE by System
Keep Next Dose: 08/31/17 2100
08/24/17 1602 - REVIEW PROVIDER ACTIVITY by AMACCA
Now Dose by EGITLER Eff: 08/24/17 1557
Now Dose 08/31/17 - 0900
Keep Next Dose 08/31/17 - 2100
08/24/17 1602 - VERIFIED by AMACCA
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions 374 MG = 2 tablets
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1545 Stop Date 09/23/17 1544
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539700

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1601 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/01/17-1330 Stop Date 09/08/17 1329
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541954

History
09/01/17 1324 - POM ORDER by MBRIONES
09/01/17 1326 - VERIFIED by MHERMOSO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
MDD = 400MG/DAY
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/01/17-1330 Stop Date 09/08/17 1329
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01541955

History
09/01/17 1324 - POM ORDER by MBRIONES
09/01/17 1326 - VERIFIED by MHERMOSO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

ENXP100I - ENOXAPARIN INJ 100 MG/ML SYR

Dose 100 MG (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 08/24/17-2100 Stop Date 08/30/17 2300 DC: 08/30/17-2300
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $2640.95
Rx Number 01539705

Discontinued Comments Reached Stop Date

History
08/24/17 1556 - POM ORDER by EGITLER
08/24/17 1601 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/30/17 - 2100
08/30/17 2301 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2300
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859 DC: 08/25/17-0900
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539726

Discontinued Comments DUPLICATE

History
08/24/17 1608 - POM ORDER by EGITLER
08/24/17 1609 - VERIFIED by AMACCA
08/24/17 1628 - DISCONTINUE by AMACCA Eff: 08/25/17 0900
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DUPLICATE

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/24/17-1545 Stop Date 08/31/17 1544 DC: 08/25/17-0958
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539716

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1603 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0958 - DISCONTINUE by EGITLER Eff: 08/25/17 0958
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0958 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426110
08/25/17 1127 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EGITLER Eff: 08/25/17 0958
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
MDD = 400MG/DAY
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/24/17-1545 Stop Date 08/31/17 1544 DC: 08/25/17-0958
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539707

History
08/24/17 1557 - POM ORDER by EGITLER
08/24/17 1602 - VERIFIED by AMACCA
08/25/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0958 - DISCONTINUE by EGITLER Eff: 08/25/17 0958
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 0958 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426111
08/25/17 1127 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by EGITLER Eff: 08/25/17 0958
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/25/17-1000 Stop Date 09/01/17 0959 DC: 09/01/17-0959
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01539892

Discontinued Comments Reached Stop Date

History
08/25/17 0958 - POM COPY AND EDIT by EGITLER
FROM: Rx #01539716
08/25/17 1126 - EDIT by MHAIMOWITZ
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1000 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1000 STOP: 09/01/17-0959 SOFT STOP: 0
08/25/17 1126 - VERIFIED by MHAIMOWITZ
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0959 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 0959
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

KURCHE,ANTHONY T W00001219394 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
MDD = 400MG/DAY
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/25/17-1000 Stop Date 09/01/17 0959 DC: 09/01/17-0959
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.75
Rx Number 01539893

Discontinued Comments Reached Stop Date

History
08/25/17 0958 - POM COPY AND EDIT by EGITLER
FROM: Rx #01539707
08/25/17 1127 - EDIT by MHAIMOWITZ
EDIT DOCTOR: GITLER, ELLEN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1000 STOP: 09/01/17 SOFT STOP:
TO:
START: 08/25/17-1000 STOP: 09/01/17-0959 SOFT STOP: 0
08/25/17 1127 - VERIFIED by MHAIMOWITZ
08/28/17 0808 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0959 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 0959
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient LAING,RICHARD Responsible Doctor AMBROSE,ANNE MD

Account Number W00001219397 Location B2WEII Unit Number M000209253
Age/Sex 51/M Room 253 Registered Date 08/24/17
Status ADM IN Bed 01 Discharged Date

Height 6 ft 0.99 in 185.4 cm Body Surface Area 2.26 m2

Weight 224 lb 6.4 oz 101.786 kg
Hem-Onc No

Drug Allergies No Known Allergies (NKA)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

CLTR1C15 - CLOTRIMAZOLE 1% CR 15 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $25.50
Rx Number 01539820

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1925 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 0900

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 60 UNIT (0.6 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 09/29/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541270

History
08/30/17 0910 - POM COPY AND EDIT by SDAS
FROM: Rx #01539821
08/30/17 1202 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 2100
08/30/17 1202 - CREDIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/24/17-2200 Stop Date 09/23/17 2159
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01539822

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1926 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 2200

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/24/17-1915 Stop Date 09/23/17 1914
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01539824

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1927 - VERIFIED by EBALILO
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $142.00
Rx Number 01539830

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1929 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $0.30
Rx Number 01539827

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1928 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $7.50
Rx Number 01539828

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1928 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/24/17-1915 Stop Date 09/23/17 1914
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539825

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1927 - VERIFIED by EBALILO
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $6.75
Rx Number 01539823

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1927 - VERIFIED by EBALILO
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/24/17-2200 Stop Date 09/23/17 2159
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 38 Total Costs $0.00 Total Charges $278.40
Rx Number 01539837

History
08/24/17 2003 - POM ORDER by RSHARMA
08/24/17 2007 - VERIFIED by EBALILO
Items Dispensed: 11 Doses Dispensed: 11
For: 08/24/17 - 2200
For: 08/25/17 - 0600
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0824 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $3.00
Rx Number 01539829

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1928 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/24/17-1915 Stop Date 09/23/17 1914
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539826

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1927 - VERIFIED by EBALILO
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1700 Stop Date 10/02/17 1659
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542246

History
09/02/17 1659 - POM ORDER by HAZIZI
09/02/17 1704 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 09/02/17-1700 Stop Date 09/24/17 0759
Ordering Doctor AZIZI,HANA MD
Total Dispensed 7 Total Costs $0.00 Total Charges $3.50
Rx Number 01542204

History
09/02/17 1332 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01539831
Result of Frequency/Schedule Edit
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/02/17 - 1200
Last Actual Administration Time: 09/02/17 - 0816
Old Freq/Sch: 2XDAILY BRKFST/LUNCH (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 09/02/17 - 1331
New Order Start: 09/02/17 - 1700
New Order Stop: 09/24/17 - 0759
09/02/17 1341 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by HAZIZI Eff: 09/02/17 1332
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/02/17 - 1200
Last Actual Administration Time: 09/02/17 - 0816
Old Freq/Sch: 2XDAILY BRKFST/LUNCH (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 09/02/17 - 1331
New Order Start: 09/02/17 - 1700
New Order Stop: 09/24/17 - 0759
09/02/17 1341 - VERIFIED by MHAIMOWITZ
Items Dispensed: 7 Doses Dispensed: 7
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

PIOG30TA2 - PIOGLITAZONE HCL 30 MG TAB

Dose 30 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $494.80
Rx Number 01539833

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1930 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/31/17-1815 Stop Date 09/30/17 1814
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.20
Rx Number 01541825

History
08/31/17 1808 - POM ORDER by HMOHAMED
08/31/17 1810 - VERIFIED by AADEGBAMIG
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

SITA50TA10 - SITAGLIPTIN PHOSPHATE 50 MG TAB

Dose 100 MG (2 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 24 Total Costs $0.00 Total Charges $663.00
Rx Number 01539832

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1929 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 66 UNIT (0.66 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059 DC: 08/30/17-0909
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01539821

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1925 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 2100
08/30/17 0910 - DISCONTINUE by SDAS Eff: 08/30/17 0909
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/30/17 0910 - POM COPY AND EDIT by SDAS
TO: Rx #U01427322
08/30/17 1202 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SDAS Eff: 08/30/17 0910
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

MTF500T - METFORMIN HCL 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency 2XDAILY BRKFST/LUNCH (SCH)
Start Date 08/25/17-0800 Stop Date 09/02/17 1331 DC: 09/02/17-1331
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 24 Total Costs $0.00 Total Charges $29.75
Rx Number 01539831

History
08/24/17 1924 - POM ORDER by RSHARMA
08/24/17 1929 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0800
For: 08/25/17 - 1200
For: 08/26/17 - 0800
For: 08/26/17 - 1200
For: 08/27/17 - 0800
For: 08/27/17 - 1200
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0800
For: 08/28/17 - 1200
For: 08/29/17 - 0800
For: 08/29/17 - 1200
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0800
For: 08/30/17 - 1200
For: 08/31/17 - 0800
For: 08/31/17 - 1200
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0800
For: 09/01/17 - 1200
For: 09/02/17 - 0800
For: 09/02/17 - 1200
For: 09/03/17 - 0800
For: 09/03/17 - 1200
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0800
For: 09/04/17 - 1200
For: 09/05/17 - 0800
For: 09/05/17 - 1200
09/02/17 1332 - EDIT by HAZIZI
EDIT DOCTOR: AZIZI,HANA MD
FROM:
START: 08/25/17-0800 STOP: 09/24/17 0759 SOFT STOP: 0
DISPENSE: 4
TO:
START: 08/25/17-0800 STOP: 09/02/17-1331 SOFT STOP:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

LAING,RICHARD W00001219397 (Continued)

DISPENSE: 18
09/02/17 1332 - DISCONTINUE by HAZIZI Eff: 09/02/17 1331
EDIT DOCTOR: AZIZI,HANA MD
09/02/17 1332 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01428240
09/02/17 1342 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by HAZIZI Eff: 09/02/17 1332
Discontinue by HAZIZI Eff: 09/02/17 1332
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient LALUZ,NANCY Responsible Doctor VALLES,JENNIE MD

Account Number W00001219533 Location B1NN Unit Number M000209388
Age/Sex 59/F Room 133 Registered Date 08/30/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 2.99 in 160 cm Body Surface Area 1.92 m2

Weight 196 lb 8 oz 89.131 kg
Hem-Onc No

Drug Allergies [BETA-BLOCKERS], Beta-Blockers (Beta-Adrenergic Bloc, naproxen,

clarithromycin, diphenhydramine (From Benadryl)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: PARKINSONS DISEASE
Secondary Diagnosis:

ZINC454O - ZINC OXIDE 454 GM JAR

Dose 1 APPLIC (1 OINT. APPLICATION)

Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $101.40
Rx Number 01541454

History
08/30/17 1743 - POM ORDER by SMOHAMED
08/30/17 1822 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 0900

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/30/17-1745 Stop Date 09/29/17 1744
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01541440

History
08/30/17 1738 - POM ORDER by SMOHAMED
08/30/17 1756 - VERIFIED by MHAIMOWITZ
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

ALPR.5T - ALPRAZOLAM 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Dose Instructions PRN ANXIETY
Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/30/17-1800 Stop Date 09/06/17 1759
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01541455

History
08/30/17 1809 - POM ORDER by SMOHAMED
08/30/17 1823 - VERIFIED by MHAIMOWITZ
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $0.12
Rx Number 01541443

History
08/30/17 1743 - POM ORDER by SMOHAMED
08/30/17 1758 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/30/17-2000 Stop Date 09/29/17 1959
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541448

History
08/30/17 1738 - POM ORDER by SMOHAMED
08/30/17 1800 - VERIFIED by MHAIMOWITZ
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2000
For: 09/05/17 - 2000

DLT180CCR - DILTIAZEM HCL 180 MG (CARDIZEM CD) CR CAP 24HR

Dose 180 MG (1 CAPSULE CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $313.80
Rx Number 01541449

History
08/30/17 1743 - POM ORDER by SMOHAMED
08/30/17 1800 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $2.75
Rx Number 01541444

History
08/30/17 1743 - POM ORDER by SMOHAMED
08/30/17 1758 - VERIFIED by MHAIMOWITZ
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $340.92
Rx Number 01541445

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.45
MG/KG/DAY is below the Low Daily Dose.

History
08/30/17 1745 - POM ORDER by SMOHAMED
08/30/17 1759 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

LVCR25250 - LEVODOPA/CARBIDOPA 25-250 TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 12 Total Costs $0.00 Total Charges $6.65
Rx Number 01541446

History
08/30/17 1743 - POM ORDER by SMOHAMED
08/30/17 1759 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 8
For: 08/31/17 - 0900
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/30/17-1745 Stop Date 09/29/17 1744
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541450

History
08/30/17 1738 - POM ORDER by SMOHAMED
08/30/17 1800 - VERIFIED by MHAIMOWITZ
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/30/17-1745 Stop Date 09/29/17 1744
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541451

History
08/30/17 1739 - POM ORDER by SMOHAMED
08/30/17 1800 - VERIFIED by MHAIMOWITZ
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

PARO25TA - PAROXETINE HCL 25 MG TABSR

Dose 25 MG (1 TAB SUSTAINED RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $36.92
Rx Number 01541457

History
08/30/17 1748 - POM ORDER by SMOHAMED
08/30/17 1826 - EDIT by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DOSE: 20 MG (0.8 TAB SUSTAINED RELEASES)
TO:
DOSE: 25 MG (1 TAB SUSTAINED RELEASE)
08/30/17 1826 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 08/31/17-1200 Stop Date 09/30/17 1159
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 12 Total Costs $0.00 Total Charges $0.80
Rx Number 01541447

History
08/30/17 1738 - POM ORDER by SMOHAMED
08/30/17 1759 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 08/31/17 - 1200
For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
09/01/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1200
For: 09/05/17 - 1200

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN SLEEP
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/30/17-1745 Stop Date 09/06/17 1744
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.84
Rx Number 01541453

History
08/30/17 1743 - POM ORDER by SMOHAMED
08/30/17 1806 - VERIFIED by MHAIMOWITZ
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

LVCR25250 - LEVODOPA/CARBIDOPA 25-250 TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/30/17-1845 Stop Date 08/30/17 1846 DC: 08/30/17-1846
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.95
Rx Number 01541458

Discontinued Comments Reached Stop Date

History
08/30/17 1837 - POM ORDER by DSPUNBERG
08/30/17 1838 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 1845
08/30/17 1846 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 1846
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NOW (ONE)
Start Date 08/31/17-0515 Stop Date 08/31/17 0516 DC: 08/31/17-0516
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $0.20
Rx Number 01541498

Discontinued Comments Reached Stop Date

History
08/31/17 0511 - POM ORDER by YIVANOV
08/31/17 0733 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by RNEVIN Eff: 08/31/17 0521
08/31/17 0733 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 0515
08/31/17 0733 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 0516
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/31/17-0800 Stop Date 09/30/17 0759 DC: 09/01/17-1054
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01541452

History
08/30/17 1743 - POM ORDER by SMOHAMED
08/30/17 1806 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/31/17 - 0800
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
09/01/17 1056 - DISCONTINUE by JVALLES Eff: 09/01/17 1054
Items Auto Credited: 4 Doses Auto Credited: 4
For: 09/02/17 - 0800
For: 09/03/17 - 0800
For: 09/04/17 - 0800
For: 09/05/17 - 0800
EDIT DOCTOR: VALLES,JENNIE MD
09/01/17 1356 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by JVALLES Eff: 09/01/17 1056
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

LALUZ,NANCY W00001219533 (Continued)

PRX20T - PAROXETINE HCL 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 08/31/17 0900 DC: 08/31/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541436

History
08/30/17 1743 - POM ORDER by SMOHAMED
08/30/17 1748 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/31/17-0900 STOP: 09/30/17 0859 SOFT STOP: 0
DISPENSE: 4
TO:
START: 08/31/17-0900 STOP: 08/31/17-0900 SOFT STOP:
DISPENSE: 0
08/30/17 1748 - DISCONTINUE by SMOHAMED Eff: 08/31/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/30/17 1748 - VERIFIED by SYSTEM
Verified in order to DC
08/30/17 1806 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 08/30/17 1748
Edit by SYSTEM Eff: 08/30/17 1748
Discontinue by SMOHAMED Eff: 08/30/17 1748

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859 CAN: 08/30/17-1759
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01427508

History
08/30/17 1738 - POM ORDER by SMOHAMED
08/30/17 1759 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
DUPLICATE ORDER
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient LAVERY,BRIAN Responsible Doctor GITLER, ELLEN M.D.

Account Number W00001219460 Location B1EA Unit Number M000209313
Age/Sex 48/M Room 114 Registered Date 08/25/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 10 in 177.8 cm Body Surface Area 1.99 m2

Weight 179 lb 8 oz 81.42 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CONVERSION R UNI KNEE TO TKR, L TKR
Secondary Diagnosis:

MAGN300S - MAGNESIUM CITRATE 300 ML BTL

Dose 300 ML (1 BOTTLE)

Dose Instructions Constipation
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1545 Stop Date 09/24/17 1544
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540147

History
08/25/17 1606 - POM ORDER by DSPUNBERG
08/25/17 1615 - VERIFIED by EBALILO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions Mild pain/Fever
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/25/17-1545 Stop Date 09/24/17 1544
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540142

History
08/25/17 1606 - POM ORDER by DSPUNBERG
08/25/17 1612 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/19/17 2059
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $4.50
Rx Number 01540143

History
08/25/17 1611 - POM ORDER by DSPUNBERG
08/25/17 1612 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions Constipation
Admin Route RECTALLY
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1545 Stop Date 09/24/17 1544
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540146

History
08/25/17 1606 - POM ORDER by DSPUNBERG
08/25/17 1614 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions Constipation
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1545 Stop Date 09/24/17 1544
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540145

History
08/25/17 1606 - POM ORDER by DSPUNBERG
08/25/17 1614 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Dose Instructions Dyspepsia/Abdominal Discomfort
Admin Route ORAL
Frequency AFTER MEALS & BEDTIM (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/25/17-1545 Stop Date 09/24/17 1544
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540149

History
08/25/17 1606 - POM ORDER by DSPUNBERG
08/25/17 1615 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1545 Stop Date 09/24/17 1544
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540148

History
08/25/17 1606 - POM ORDER by DSPUNBERG
08/25/17 1615 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01540150

History
08/25/17 1611 - POM ORDER by DSPUNBERG
08/25/17 1615 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

OMEP10CA3 - OMEPRAZOLE 10 MG CPDR

Dose 10 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/26/17-0800 Stop Date 09/19/17 2300
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 11 Total Costs $0.00 Total Charges $20.97
Rx Number 01540212

History
08/25/17 1740 - POM COPY AND EDIT by EGITLER
FROM: Rx #01540157
08/25/17 1743 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0800
For: 08/27/17 - 0800
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/31/17-1630 Stop Date 09/07/17 1629
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541763

History
08/31/17 1624 - POM COPY AND EDIT by MBRIONES
FROM: Rx #01540151
08/31/17 1628 - EDIT by AMACCA
EDIT DOCTOR: BRIONES,MARIA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-1630 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/31/17-1630 STOP: 09/07/17-1629 SOFT STOP:
08/31/17 1628 - VERIFIED by AMACCA
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/31/17-1630 Stop Date 09/07/17 1629
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.50
Rx Number 01541764

History
08/31/17 1624 - POM COPY AND EDIT by MBRIONES
FROM: Rx #01540159
08/31/17 1628 - EDIT by AMACCA
EDIT DOCTOR: BRIONES,MARIA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-1630 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/31/17-1630 STOP: 09/07/17-1629 SOFT STOP:
08/31/17 1628 - VERIFIED by AMACCA
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

OXYC10TA2 - OXYCODONE HCL 10 MG TABCR

Dose 10 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/31/17-2100 Stop Date 09/07/17 2059
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01541765

History
08/31/17 1624 - POM COPY AND EDIT by MBRIONES
FROM: Rx #01540152
08/31/17 1628 - EDIT by AMACCA
EDIT DOCTOR: BRIONES,MARIA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-2100 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/31/17-2100 STOP: 09/07/17-2059 SOFT STOP:
08/31/17 1628 - VERIFIED by AMACCA
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions 374 MG = 2 tablets
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1545 Stop Date 09/24/17 1544
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01540155

History
08/25/17 1606 - POM ORDER by DSPUNBERG
08/25/17 1616 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 2
For: 08/25/17 - 1545
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/31/17-1630 Stop Date 09/07/17 1629
Ordering Doctor BRIONES,MARIA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541766

History
08/31/17 1624 - POM COPY AND EDIT by MBRIONES
FROM: Rx #01540154
08/31/17 1629 - EDIT by AMACCA
EDIT DOCTOR: BRIONES,MARIA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/31/17-1630 STOP: 09/07/17 SOFT STOP:
TO:
START: 08/31/17-1630 STOP: 09/07/17-1629 SOFT STOP:
08/31/17 1629 - VERIFIED by AMACCA
09/01/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

IRON45TA - IRON,CARBONYL (FERRO SEQUELS) TAB

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 08/26/17 0900 DC: 08/26/17-0900
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540144

Discontinued Comments dc

History
08/25/17 1606 - POM ORDER by DSPUNBERG
08/25/17 1614 - EDIT by DSPUNBERG
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
FROM:
START: 08/26/17-0900 STOP: 09/25/17 0859 SOFT STOP: 0
DISPENSE: 4
DC COMMENTS:
TO:
START: 08/26/17-0900 STOP: 08/26/17-0900 SOFT STOP:
DISPENSE: 0
DC COMMENTS:
dc
08/25/17 1614 - DISCONTINUE by DSPUNBERG Eff: 08/26/17 0900
EDIT DOCTOR: Spunberg,Daniel MD PGY-2
DC COMMENTS:
dc
08/25/17 1614 - VERIFIED by SYSTEM
Verified in order to DC
08/25/17 1617 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by DSPUNBERG Eff: 08/25/17 1614
Edit by SYSTEM Eff: 08/25/17 1614
Discontinue by DSPUNBERG Eff: 08/25/17 1614
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

OMEP10CA3 - OMEPRAZOLE 10 MG CPDR

Dose 10 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/26/17-0800 Stop Date 09/25/17 0759 DC: 08/26/17-0800
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540157

History
08/25/17 1611 - POM ORDER by DSPUNBERG
08/25/17 1617 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0800
For: 08/27/17 - 0800
For: 08/28/17 - 0800
For: 08/29/17 - 0800
08/25/17 1739 - DISCONTINUE by EGITLER Eff: 08/26/17 0800
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/26/17 - 0800
For: 08/27/17 - 0800
For: 08/28/17 - 0800
For: 08/29/17 - 0800
EDIT DOCTOR: GITLER, ELLEN M.D.
08/25/17 1740 - POM COPY AND EDIT by EGITLER
TO: Rx #U01426373
08/25/17 1743 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by EGITLER Eff: 08/25/17 1739
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (PAIN SCALE 4-6)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/25/17-1615 Stop Date 09/01/17 1614 DC: 08/31/17-1623
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540151

History
08/25/17 1611 - POM ORDER by DSPUNBERG
08/25/17 1616 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/31/17 1623 - DISCONTINUE by MBRIONES Eff: 08/31/17 1623
EDIT DOCTOR: BRIONES,MARIA M.D.
08/31/17 1624 - POM COPY AND EDIT by MBRIONES
TO: Rx #U01427819
08/31/17 1628 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MBRIONES Eff: 08/31/17 1623
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

OXYC10TA2 - OXYCODONE HCL 10 MG TABCR

Dose 10 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/01/17 2059 DC: 08/31/17-1623
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01540152

History
08/25/17 1614 - POM ORDER by DSPUNBERG
08/25/17 1616 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0900
08/31/17 1623 - DISCONTINUE by MBRIONES Eff: 08/31/17 1623
EDIT DOCTOR: BRIONES,MARIA M.D.
08/31/17 1624 - POM COPY AND EDIT by MBRIONES
TO: Rx #U01427821
08/31/17 1628 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MBRIONES Eff: 08/31/17 1623
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

LAVERY,BRIAN W00001219460 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 3 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/25/17-1615 Stop Date 09/01/17 1614 DC: 08/31/17-1623
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $7.75
Rx Number 01540159

History
08/25/17 1619 - POM ORDER by DSPUNBERG
08/25/17 1620 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/31/17 1623 - DISCONTINUE by MBRIONES Eff: 08/31/17 1623
EDIT DOCTOR: BRIONES,MARIA M.D.
08/31/17 1624 - POM COPY AND EDIT by MBRIONES
TO: Rx #U01427820
08/31/17 1628 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MBRIONES Eff: 08/31/17 1623

ZOLP5TAB63 - ZOLPIDEM TARTRATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions Sleeplessness
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: SLEEP - FOR SLEEP
Start Date 08/25/17-1545 Stop Date 09/01/17 1544 DC: 08/31/17-1623
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540154

History
08/25/17 1606 - POM ORDER by DSPUNBERG
08/25/17 1616 - VERIFIED by EBALILO
08/28/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/31/17 1623 - DISCONTINUE by MBRIONES Eff: 08/31/17 1623
EDIT DOCTOR: BRIONES,MARIA M.D.
08/31/17 1624 - POM COPY AND EDIT by MBRIONES
TO: Rx #U01427822
08/31/17 1628 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MBRIONES Eff: 08/31/17 1623
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient LERER,RICHARD Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219360 Location B1WE Unit Number M000200366
Age/Sex 84/M Room 153 Registered Date 08/21/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 10 in 177.8 cm Body Surface Area 1.86 m2

Weight 152 lb 12.8 oz 69.309 kg
Hem-Onc No

Drug Allergies ciprofloxacin (From Cipro), quinine, levofloxacin (From Levaquin)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CELLULITIS, SEPSIS OSTEOMYELITIS
Secondary Diagnosis:

NPH,100V14 - INSULIN HUMAN NPH 100 UNIT/ML 3ML VIAL

Dose 40 UNIT (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $133.83
Rx Number 01538654

History
08/21/17 1455 - POM ORDER by RNOVITCH
08/21/17 1509 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/28/17-2200 Stop Date 09/20/17 1659
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01540890

History
08/28/17 2058 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01538655
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/28/17 - 1700
Last Actual Administration Time: 08/28/17 - 1700 (Not Given)
Old Freq/Sch: BEFORE MEALS (SCH)
New Freq/Sch: BEFORE MEALS & BED (SCH)
Old Order Stop: 08/28/17 - 2056
New Order Start: 08/28/17 - 2200
New Order Stop: 09/20/17 - 1659
08/28/17 2100 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by JRUSSO Eff: 08/28/17 2058
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/28/17 - 1700
Last Actual Administration Time: 08/28/17 - 1700 (Not Given)
Old Freq/Sch: BEFORE MEALS (SCH)
New Freq/Sch: BEFORE MEALS & BED (SCH)
Old Order Stop: 08/28/17 - 2056
New Order Start: 08/28/17 - 2200
New Order Stop: 09/20/17 - 1659
08/28/17 2100 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

MPR2C30 - MUPIROCIN 2% CR 30 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication OTHER
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541860

History
09/01/17 0955 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540562
09/01/17 1015 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
DISPENSE: 1
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP: 0
DISPENSE: 0
09/01/17 1015 - VERIFIED by AMOLINARI

NST15PW - NYSTATIN 100,000 U/GM PWD 15 GM BTL

Dose 1 APPLIC (1 POWDER APPLICATION)

Dose Instructions To groin and scrotum
Admin Route TOPICALLY
Frequency 2 TIMES A DAY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $28.41
Rx Number 01540886

History
08/28/17 2053 - POM ORDER by JRUSSO
08/28/17 2054 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: Fever, pain
Start Date 09/01/17-1200 Stop Date 10/01/17 1159
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541891

History
09/01/17 1151 - POM ORDER by NBALCETIS
09/01/17 1205 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by JHART Eff: 09/01/17 1201
09/01/17 1205 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

C500T - ASCORBIC ACID 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01538630

History
08/21/17 1452 - POM ORDER by RNOVITCH
08/21/17 1504 - VERIFIED by EBALILO
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 15 Total Costs $0.00 Total Charges $0.39
Rx Number 01538641

History
08/21/17 1452 - POM ORDER by RNOVITCH
08/21/17 1504 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 1,000 UNIT (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 15 Total Costs $0.00 Total Charges $1.69
Rx Number 01538642

History
08/21/17 1452 - POM ORDER by RNOVITCH
08/21/17 1504 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

DOXY100C6 - DOXYCYCLINE HYCLATE 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/24/17-1700 Stop Date 09/23/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication DOCUMENTED INFECTION
Total Dispensed 13 Total Costs $0.00 Total Charges $15.00
Rx Number 01539425

History
08/23/17 1645 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538653
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/23/17 - 0900
Last Actual Administration Time: 08/23/17 - 0915
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: EVERY EVENING (SCH)
Old Order Stop: 08/23/17 - 1635
New Order Start: 08/24/17 - 1700
New Order Stop: 09/23/17 - 1659
08/23/17 1714 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by NBALCETIS Eff: 08/23/17 1645
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/23/17 - 0900
Last Actual Administration Time: 08/23/17 - 0915
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: EVERY EVENING (SCH)
Old Order Stop: 08/23/17 - 1635
New Order Start: 08/24/17 - 1700
New Order Stop: 09/23/17 - 1659
08/23/17 1714 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 1700
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 09/04/17 - 1700
For: 09/05/17 - 1700

FNST5T - FINASTERIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@2100 (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $37.80
Rx Number 01538857

History
08/21/17 2201 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01538847
08/21/17 2224 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 15 Total Costs $0.00 Total Charges $3.90
Rx Number 01538635

History
08/21/17 1456 - POM ORDER by RNOVITCH
08/21/17 1504 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

MTH4T - METHYLPREDNISOLONE 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 15 Total Costs $0.00 Total Charges $7.15
Rx Number 01538774

History
08/21/17 1943 - POM ORDER by RNOVITCH
08/21/17 1944 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

MTP50T - METOPROLOL TARTRATE 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions HOLD FOR SBP <90 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 23 Total Costs $0.00 Total Charges $1.80
Rx Number 01540018

History
08/25/17 1252 - ENTER by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

KCL10TCR - POTASSIUM CHLORIDE 10 MEQ TABCR

Dose 10 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY@1630 (SCH)
Start Date 08/30/17-1630 Stop Date 09/06/17 1629
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 7 Total Costs $0.00 Total Charges $0.83
Rx Number 01541266

Warnings
Type: BURKE
Range: POTASSIUM CHLORIDE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 40 MEQ/DAY - 100 MEQ/DAY. Ordered dose of 10 MEQ/DAY
is below the Low Daily Dose.

History
08/30/17 1119 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01539809
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/29/17 - 1700
Last Actual Administration Time: 08/29/17 - 1700 (Not Given)
Old Freq/Sch: EVERY EVENING (SCH)
New Freq/Sch: DAILY@1630 (SCH)
Old Order Stop: 08/30/17 - 1118
New Order Start: 08/30/17 - 1630
New Order Stop: 09/06/17 - 1629
08/30/17 1156 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by NBALCETIS Eff: 08/30/17 1119
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/29/17 - 1700
Last Actual Administration Time: 08/29/17 - 1700 (Not Given)
Old Freq/Sch: EVERY EVENING (SCH)
New Freq/Sch: DAILY@1630 (SCH)
Old Order Stop: 08/30/17 - 1118
New Order Start: 08/30/17 - 1630
New Order Stop: 09/06/17 - 1629
08/30/17 1156 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/30/17 - 1630
For: 08/31/17 - 1630
For: 09/01/17 - 1630
For: 09/02/17 - 1630
For: 09/03/17 - 1630
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1630
For: 09/05/17 - 1630
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

PRV20T - PRAVASTATIN SOD 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 32 Total Costs $0.00 Total Charges $44.20
Rx Number 01538646

History
08/21/17 1455 - POM ORDER by RNOVITCH
08/21/17 1506 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/21/17 - 2100
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

SILO8CAP2 - SILODOSIN 8 MG CAP

Dose 8 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY@2100 (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $227.76
Rx Number 01538858

History
08/21/17 2201 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01538848
08/21/17 2224 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

TRS20T - TORSEMIDE 20 MG TAB

Dose 10 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@1630 (SCH)
Start Date 08/30/17-1630 Stop Date 09/06/17 1629
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 7 Total Costs $0.00 Total Charges $2.05
Rx Number 01541265

History
08/30/17 1119 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01539808
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/29/17 - 1700
Last Actual Administration Time: 08/29/17 - 1700 (Not Given)
Old Freq/Sch: EVERY EVENING (SCH)
New Freq/Sch: DAILY@1630 (SCH)
Old Order Stop: 08/30/17 - 1117
New Order Start: 08/30/17 - 1630
New Order Stop: 09/06/17 - 1629
08/30/17 1155 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by NBALCETIS Eff: 08/30/17 1119
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/29/17 - 1700
Last Actual Administration Time: 08/29/17 - 1700 (Not Given)
Old Freq/Sch: EVERY EVENING (SCH)
New Freq/Sch: DAILY@1630 (SCH)
Old Order Stop: 08/30/17 - 1117
New Order Start: 08/30/17 - 1630
New Order Stop: 09/06/17 - 1629
08/30/17 1155 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/30/17 - 1630
For: 08/31/17 - 1630
For: 09/01/17 - 1630
For: 09/02/17 - 1630
For: 09/03/17 - 1630
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1630
For: 09/05/17 - 1630
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 16 Total Costs $0.00 Total Charges $2.99
Rx Number 01538648

History
08/21/17 1455 - POM ORDER by RNOVITCH
08/21/17 1506 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 2100
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 08/21/17-1700 Stop Date 08/28/17 2056 DC: 08/28/17-2056
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01538655

History
08/21/17 1456 - POM ORDER by RNOVITCH
08/21/17 1509 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 1700
08/28/17 2058 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 08/21/17-1700 STOP: 09/20/17 1659 SOFT STOP: 0
TO:
START: 08/21/17-1700 STOP: 08/28/17-2056 SOFT STOP:
08/28/17 2058 - DISCONTINUE by JRUSSO Eff: 08/28/17 2056
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/28/17 2058 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01426994
08/28/17 2101 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by JRUSSO Eff: 08/28/17 2058
Discontinue by JRUSSO Eff: 08/28/17 2058
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

MPR2C30 - MUPIROCIN 2% CR 30 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/22/17-0900 Stop Date 08/29/17 0859 DC: 08/28/17-1027
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Clinical Indication OTHER
Total Dispensed 1 Total Costs $0.00 Total Charges $288.93
Rx Number 01538856

History
08/21/17 2156 - POM ORDER by HMOHAMED
08/21/17 2223 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/22/17 - 0900
08/28/17 1027 - DISCONTINUE by NBALCETIS Eff: 08/28/17 1027
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/28/17 1027 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01426741
08/28/17 1045 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by NBALCETIS Eff: 08/28/17 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

MPR2C30 - MUPIROCIN 2% CR 30 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-0954
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication OTHER
Total Dispensed 1 Total Costs $0.00 Total Charges $288.93
Rx Number 01540562

History
08/28/17 1027 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538856
08/28/17 1045 - VERIFIED by JDIMARCO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
08/29/17 1425 - EDIT by AMACCA
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/04/17-2059 SOFT STOP:
09/01/17 0955 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0954
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0955 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427910
09/01/17 1015 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0955
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

DOXY100C6 - DOXYCYCLINE HYCLATE 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/23/17 1635 DC: 08/23/17-1635
Ordering Doctor NOVITCH, RICHARD MD.
Clinical Indication DOCUMENTED INFECTION
Total Dispensed 6 Total Costs $0.00 Total Charges $3.00
Rx Number 01538653

History
08/21/17 1452 - POM ORDER by RNOVITCH
08/21/17 1508 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/23/17 1645 - DISCONTINUE by NBALCETIS Eff: 08/23/17 1635
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/23/17 1645 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/22/17-0900 STOP: 08/29/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/22/17-0900 STOP: 08/23/17-1635 SOFT STOP:
DISPENSE: 2
08/23/17 1645 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425581
08/23/17 1714 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by NBALCETIS Eff: 08/23/17 1645
Discontinue by NBALCETIS Eff: 08/23/17 1645
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

FNST5T - FINASTERIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 DC: 08/22/17-0900
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538644

History
08/21/17 1452 - POM ORDER by RNOVITCH
08/21/17 1505 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/21/17 2158 - DISCONTINUE by HMOHAMED Eff: 08/22/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/21/17 2158 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01425046
08/21/17 2225 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HMOHAMED Eff: 08/21/17 2158
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

FNST5T - FINASTERIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@2100 (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 0859 DC: 08/22/17-2100
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538847

History
08/21/17 2158 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01538644
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@2100 (SCH)
Old Order Stop: 08/22/17 - 0900
New Order Start: 08/22/17 - 2100
New Order Stop: 09/21/17 - 0859
08/21/17 2201 - DISCONTINUE by HMOHAMED Eff: 08/22/17 2100
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/21/17 2201 - VERIFIED by SYSTEM
Verified in order to DC
08/21/17 2201 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01425049
08/21/17 2225 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by HMOHAMED Eff: 08/21/17 2158
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@2100 (SCH)
Old Order Stop: 08/22/17 - 0900
New Order Start: 08/22/17 - 2100
New Order Stop: 09/21/17 - 0859
Edit by SYSTEM Eff: 08/21/17 2201
Freq/Sch Edit by SYSTEM Eff: 08/21/17 2201
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@2100 (SCH)
Old Order Stop: 08/22/17 - 0900
New Order Start: 08/22/17 - 2100
New Order Stop: 09/21/17 - 0859
Discontinue by HMOHAMED Eff: 08/21/17 2201
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

FNST5T - FINASTERIDE 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency 2200 (ONE)
Start Date 08/21/17-2200 Stop Date 08/21/17 2201 DC: 08/21/17-2201
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $3.15
Rx Number 01538859

Discontinued Comments Reached Stop Date

History
08/21/17 2201 - POM ORDER by HMOHAMED
08/21/17 2224 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MPAULOSE Eff: 08/21/17 2203
08/21/17 2224 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 2200
08/21/17 2225 - DISCONTINUE by PHABKGJOB Eff: 08/21/17 2201
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP <90 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 DC: 08/25/17-1047
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 8 Total Costs $0.00 Total Charges $2.00
Rx Number 01538645

History
08/21/17 1456 - POM ORDER by RNOVITCH
08/21/17 1505 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/25/17 1049 - DISCONTINUE by NBALCETIS Eff: 08/25/17 1047
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/25/17 1049 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01426149
08/25/17 1252 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/25/17 1049
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

KCL10TCR - POTASSIUM CHLORIDE 10 MEQ TABCR

Dose 10 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/24/17 1832 DC: 08/24/17-1832
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 6 Total Costs $0.00 Total Charges $2.49
Rx Number 01538660

Warnings
Type: BURKE
Range: POTASSIUM CHLORIDE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 40 MEQ/DAY - 100 MEQ/DAY. Ordered dose of 10 MEQ/DAY
is below the Low Daily Dose.

History
08/21/17 1512 - ENTER by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/24/17 1834 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/22/17-0900 STOP: 09/21/17 0859 SOFT STOP: 0
TO:
START: 08/22/17-0900 STOP: 08/24/17-1832 SOFT STOP:
08/24/17 1834 - DISCONTINUE by NBALCETIS Eff: 08/24/17 1832
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/24/17 1834 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425972
08/24/17 1839 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by NBALCETIS Eff: 08/24/17 1834
Discontinue by NBALCETIS Eff: 08/24/17 1834
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

KCL10TCR - POTASSIUM CHLORIDE 10 MEQ TABCR

Dose 10 MEQ (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/24/17-1832 Stop Date 08/30/17 1118 DC: 08/30/17-1118
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $1.66
Rx Number 01539809

Warnings
Type: BURKE
Range: POTASSIUM CHLORIDE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 40 MEQ/DAY - 100 MEQ/DAY. Ordered dose of 10 MEQ/DAY
is below the Low Daily Dose.

History
08/24/17 1834 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538660
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/24/17 - 0900
Last Actual Administration Time: 08/24/17 - 0931
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: EVERY EVENING (SCH)
Old Order Stop: 08/24/17 - 1832
New Order Start: 08/24/17 - 1832
New Order Stop: 08/31/17 - 1831
08/24/17 1834 - NOW DOSE by NBALCETIS
Now Dose: 08/24/17 1832
08/24/17 1834 - KEEP NEXT DOSE by System
Keep Next Dose: 08/25/17 1700
08/24/17 1838 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by NBALCETIS Eff: 08/24/17 1834
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/24/17 - 0900
Last Actual Administration Time: 08/24/17 - 0931
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: EVERY EVENING (SCH)
Old Order Stop: 08/24/17 - 1832
New Order Start: 08/24/17 - 1832
New Order Stop: 08/31/17 - 1831
Now Dose by NBALCETIS Eff: 08/24/17 1834
Now Dose 08/24/17 - 1832
Keep Next Dose 08/25/17 - 1700
08/24/17 1838 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 1832
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

08/25/17 0835 - FILL by AMOLINARI

Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 1119 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/24/17-1832 STOP: 08/31/17 1831 SOFT STOP:
DISPENSE: 2
TO:
START: 08/24/17-1832 STOP: 08/30/17-1118 SOFT STOP:
DISPENSE: 6
08/30/17 1119 - DISCONTINUE by NBALCETIS Eff: 08/30/17 1118
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
08/30/17 1119 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427352
08/30/17 1156 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by NBALCETIS Eff: 08/30/17 1119
Discontinue by NBALCETIS Eff: 08/30/17 1119
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

SILO8CAP2 - SILODOSIN 8 MG CAP

Dose 8 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 DC: 08/22/17-0900
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538656

History
08/21/17 1455 - POM ORDER by RNOVITCH
08/21/17 1511 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/21/17 2158 - DISCONTINUE by HMOHAMED Eff: 08/22/17 0900
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/21/17 2158 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01425047
08/21/17 2225 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by HMOHAMED Eff: 08/21/17 2158
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

SILO8CAP2 - SILODOSIN 8 MG CAP

Dose 8 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY@2100 (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 0859 DC: 08/22/17-2100
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538848

History
08/21/17 2158 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01538656
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@2100 (SCH)
Old Order Stop: 08/22/17 - 0900
New Order Start: 08/22/17 - 2100
New Order Stop: 09/21/17 - 0859
08/21/17 2201 - DISCONTINUE by HMOHAMED Eff: 08/22/17 2100
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/21/17 2201 - VERIFIED by SYSTEM
Verified in order to DC
08/21/17 2201 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01425050
08/21/17 2225 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by HMOHAMED Eff: 08/21/17 2158
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@2100 (SCH)
Old Order Stop: 08/22/17 - 0900
New Order Start: 08/22/17 - 2100
New Order Stop: 09/21/17 - 0859
Edit by SYSTEM Eff: 08/21/17 2201
Freq/Sch Edit by SYSTEM Eff: 08/21/17 2201
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@2100 (SCH)
Old Order Stop: 08/22/17 - 0900
New Order Start: 08/22/17 - 2100
New Order Stop: 09/21/17 - 0859
Discontinue by HMOHAMED Eff: 08/21/17 2201
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

SILO8CAP2 - SILODOSIN 8 MG CAP

Dose 8 MG (1 CAPSULE)
Admin Route ORAL
Frequency 2200 (ONE)
Start Date 08/21/17-2200 Stop Date 08/21/17 2201 DC: 08/21/17-2201
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $18.98
Rx Number 01538860

Discontinued Comments Reached Stop Date

History
08/21/17 2201 - POM ORDER by HMOHAMED
08/21/17 2224 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Administration of Unverified Order by MPAULOSE Eff: 08/21/17 2203
08/21/17 2224 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 2200
08/21/17 2225 - DISCONTINUE by PHABKGJOB Eff: 08/21/17 2201
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

TRS20T - TORSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/22/17 1840 DC: 08/22/17-1840
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01538647

History
08/21/17 1455 - POM ORDER by RNOVITCH
08/21/17 1506 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/22/17 1840 - DISCONTINUE by NBALCETIS Eff: 08/22/17 1840
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/22/17 1840 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/22/17-0900 STOP: 09/21/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/22/17-0900 STOP: 08/22/17-1840 SOFT STOP:
DISPENSE: 1
08/22/17 1840 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425322
08/22/17 1927 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by NBALCETIS Eff: 08/22/17 1840
Discontinue by NBALCETIS Eff: 08/22/17 1840
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

TRS20T - TORSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: edema
Start Date 08/23/17-0900 Stop Date 08/24/17 1833 DC: 08/24/17-1833
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539137

History
08/22/17 1840 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538647
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time: 08/22/17 - 0900 (Not Given)
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY (PRN)
Old Order Stop: 08/22/17 - 1840
New Order Start: 08/23/17 - 0900
New Order Stop: 09/21/17 - 0859
08/22/17 1927 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by NBALCETIS Eff: 08/22/17 1840
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/22/17 - 0900
Last Actual Administration Time: 08/22/17 - 0900 (Not Given)
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY (PRN)
Old Order Stop: 08/22/17 - 1840
New Order Start: 08/23/17 - 0900
New Order Stop: 09/21/17 - 0859
08/22/17 1927 - VERIFIED by AMACCA
08/23/17 0822 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/24/17 1834 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/23/17-0900 STOP: 09/21/17 0859 SOFT STOP:
DISPENSE: 0
TO:
START: 08/23/17-0900 STOP: 08/24/17-1833 SOFT STOP:
DISPENSE: 2
08/24/17 1834 - DISCONTINUE by NBALCETIS Eff: 08/24/17 1833
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/24/17 1834 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425973
08/24/17 1839 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by NBALCETIS Eff: 08/24/17 1834
Discontinue by NBALCETIS Eff: 08/24/17 1834
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

TRS20T - TORSEMIDE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/25/17-1700 Stop Date 08/30/17 1117 DC: 08/30/17-1117
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 7 Total Costs $0.00 Total Charges $2.05
Rx Number 01539808

History
08/24/17 1834 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01539137
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: EVERY EVENING (SCH)
Old Order Stop: 08/24/17 - 1833
New Order Start: 08/25/17 - 1700
New Order Stop: 09/01/17 - 1659
08/24/17 1837 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by NBALCETIS Eff: 08/24/17 1834
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: EVERY EVENING (SCH)
Old Order Stop: 08/24/17 - 1833
New Order Start: 08/25/17 - 1700
New Order Stop: 09/01/17 - 1659
08/24/17 1837 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 1118 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/25/17-1700 STOP: 09/01/17 1659 SOFT STOP:
DISPENSE: 2
TO:
START: 08/25/17-1700 STOP: 08/30/17-1117 SOFT STOP:
DISPENSE: 5
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

08/30/17 1118 - DISCONTINUE by NBALCETIS Eff: 08/30/17 1117

EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/30/17 1119 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427351
08/30/17 1156 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by NBALCETIS Eff: 08/30/17 1118
Discontinue by NBALCETIS Eff: 08/30/17 1118

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 50 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP <90 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059 CAN: 08/25/17-1251
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed Total Costs $ Total Charges $
Rx Number U01426149

History
08/25/17 1049 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01538645
08/25/17 1251 - CANCEL by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 50MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

LERER,RICHARD W00001219360 (Continued)

POTA20TA82 - POTASSIUM CHLORIDE 20 MEQ TABCR (K-DUR)

Dose 10 MEQ (0.5 TABLET, CONTROLLED-RELEASES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 CAN: 08/21/17-1510
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424866

History
08/21/17 1456 - POM ORDER by RNOVITCH
08/21/17 1510 - CANCEL by EBALILO
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 10MEQ TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient LOCKER,LOIS Responsible Doctor NOVITCH, RICHARD MD.

Account Number W00001218982 Location B1WE Unit Number M000195650
Age/Sex 86/F Room 150 Registered Date 08/08/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 5 in 165.1 cm Body Surface Area 1.60 m2

Weight 120 lb 14.4 oz 54.839 kg
Hem-Onc No

Drug Allergies iodine, cortisone

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/08/17-1902 DRUG REGIMEN REVIEW COMPLETE
08/09/17-1343 DRUG REGIMEN REVIEW COMPLETE
08/13/17-1511 DRUG REGIMEN REVIEW COMPLETE
08/30/17-1501 DRUG REGIMEN REVIEW COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: COPD
Secondary Diagnosis:

BISM262O27 - BISMUTH SUBSALICYLATE 236 ML (PEPTO BISMOL) BTL

Dose 30 ML (0.1140684 BOTTLES)

Dose Instructions PRN DIARRHEA
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: DIARRHEA - FOR DIARRHEA
Start Date 08/25/17-1300 Stop Date 09/24/17 1259
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $12.66
Rx Number 01540022

History
08/25/17 1300 - POM ORDER by NBALCETIS
08/25/17 1302 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

BDS.5IN2 - BUDESONIDE INHA SUSP 0.5 MG/2 ML NEB

Dose 0.5 MG (2 ML)

Admin Route NEBULIZER
Frequency EVERY 12 HOURS (SCH)
Start Date 08/08/17-2100 Stop Date 09/07/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 45 Total Costs $0.00 Total Charges $1385.10
Rx Number 01535204

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1627 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 1
For: 08/08/17 - 2100
08/11/17 0727 - DEBIT by AMOLINARI
ITEMS: 2
08/20/17 1006 - DEBIT by AADEGBAMIG
ITEMS: 1
08/23/17 0737 - DEBIT by AMOLINARI
ITEMS: 2
08/28/17 1447 - DEBIT by AADEGBAMIG
ITEMS: 1
08/31/17 0737 - DEBIT by AMOLINARI
ITEMS: 2

NTR.4SL - NITROGLYCERIN 0.4 MG SUBL

Dose 0.4 MG (1 TABLET, SUBLINGUAL)

Admin Route SUBLINGUAL
Frequency EVERY 5 MINUTES X 3 (PRN) PRN REASON: Chest pain
Start Date 08/08/17-1615 Stop Date 09/07/17 1614
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 25 Total Costs $0.00 Total Charges $22.50
Rx Number 01535202

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1627 - VERIFIED by AMACCA
Items Dispensed: 25 Doses Dispensed: 1
For: 08/08/17 - 1615
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/08/17-1630 Stop Date 09/07/17 1629
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535219

History
08/08/17 1629 - POM ORDER by NBALCETIS
08/08/17 1633 - VERIFIED by AMACCA

NS.65NA45 - SODIUM CHLORIDE 0.65% NA SOLN 45 ML BTL

Dose 2 SPRAY (2 NASAL APPLICATIONS)

Admin Route NASAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $7.23
Rx Number 01535231

History
08/08/17 1720 - POM ORDER by NBALCETIS
08/08/17 1724 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Dose Instructions PRN Pain
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/08/17-1630 Stop Date 09/07/17 1629
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01535220

History
08/08/17 1629 - POM ORDER by NBALCETIS
08/08/17 1633 - VERIFIED by AMACCA
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $10.50
Rx Number 01535230

History
08/08/17 1720 - POM ORDER by NBALCETIS
08/08/17 1724 - VERIFIED by AMACCA
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

08/23/17 0821 - FILL by AMOLINARI

Items Dispensed: 12 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 08/15/17-1300 Stop Date 09/14/17 1259
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $19.25
Rx Number 01536894

History
08/15/17 1139 - POM ORDER by RNOVITCH
08/15/17 1145 - VERIFIED by AMOLINARI
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
For: 08/20/17 - 2100
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
For: 08/22/17 - 2100
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 12
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/25/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/26/17 - 0900

For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ALPR.5T - ALPRAZOLAM 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Dose Instructions PRN ANXIETY
Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/29/17-1500 Stop Date 09/05/17 1459
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541010

History
08/29/17 1450 - POM ORDER by RNOVITCH
08/29/17 1451 - VERIFIED by AMACCA
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 28 Total Costs $0.00 Total Charges $17.68
Rx Number 01535212

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1629 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/30/17 - 0900

For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

APIX2.5T - APIXABAN 2.5 MG TABLET

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/08/17-2100 Stop Date 09/07/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 57 Total Costs $0.00 Total Charges $841.36
Rx Number 01535195

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1626 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/08/17 - 2100
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

08/21/17 0829 - FILL by AMOLINARI

Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 28 Total Costs $0.00 Total Charges $0.78
Rx Number 01535211

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1628 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/30/17 - 0900

For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/08/17-2100 Stop Date 09/07/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 58 Total Costs $0.00 Total Charges $1570.90
Rx Number 01535207

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1628 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 08/08/17 - 2100
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

Items Dispensed: 4 Doses Dispensed: 2

For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 10 MG (2 TABLET, ENTERIC COATEDS)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/24/17-1700 Stop Date 09/23/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01539536

History
08/24/17 1108 - POM ORDER by NBALCETIS
08/24/17 1109 - VERIFIED by MHAIMOWITZ
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

CALC1TAB - CALCIUM CARBONATE/VITAMIN D2 (CALTRATE-600/VIT D.) TABLET

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY@1200 (SCH)
Start Date 08/10/17-1200 Stop Date 09/09/17 1159
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 27 Total Costs $0.00 Total Charges $5.00
Rx Number 01535416

History
08/09/17 1336 - POM ORDER by NBALCETIS
08/09/17 1342 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/10/17 - 1200
For: 08/11/17 - 1200
For: 08/12/17 - 1200
For: 08/13/17 - 1200
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1200
For: 08/15/17 - 1200
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 1200
For: 08/17/17 - 1200
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 1200
For: 08/19/17 - 1200
For: 08/20/17 - 1200
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 1200
For: 08/22/17 - 1200
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 1200
For: 08/24/17 - 1200
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1200
For: 08/26/17 - 1200
For: 08/27/17 - 1200
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1200
For: 08/29/17 - 1200
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1200
For: 08/31/17 - 1200
08/30/17 0816 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1200
For: 09/05/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

CYAN1TAB4 - CYANOCOBALAMIN/FA/PYRIDOXINE (FOLTX) TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/10/17-0900 Stop Date 09/09/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 27 Total Costs $0.00 Total Charges $68.54
Rx Number 01535478

History
08/09/17 1655 - POM ORDER by NBALCETIS
08/09/17 1700 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/10/17 - 0900
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

Items Dispensed: 3 Doses Dispensed: 3

For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

DGX.125T - DIGOXIN 0.125 MG TAB

Dose 0.125 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/02/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 4 Total Costs $0.00 Total Charges $62.10
Rx Number 01542101

History
09/01/17 1716 - POM ORDER by RNOVITCH
09/01/17 1723 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 300 MG (3 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/08/17-2100 Stop Date 09/07/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01535197

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1626 - VERIFIED by AMACCA
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

Items Dispensed: 9 Doses Dispensed: 3

For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

ERG50KC - ERGOCALCIFEROL 50,000 IUNITS CAP

Dose 50,000 IUNITS (1 CAPSULE)

Admin Route ORAL
Frequency We@1700 (SCH)
Start Date 08/09/17-1700 Stop Date 09/27/17 1701
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $12.12
Rx Number 01535414

History
08/09/17 1336 - POM ORDER by NBALCETIS
08/09/17 1341 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 1700
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/16/17 - 1700
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/16/17-0900 Stop Date 09/15/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $8.25
Rx Number 01537105

History
08/15/17 1909 - POM ORDER by RNOVITCH
08/15/17 1915 - VERIFIED by AADEGBAMIG
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

08/30/17 0816 - FILL by BGIRLING

Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 7 Total Costs $0.00 Total Charges $1.96
Rx Number 01537772

History
08/17/17 1749 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01535196
08/17/17 1813 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/21/17 1345 - HOLD by RNOVITCH Eff: 08/21/17 1344
EDIT DOCTOR: NOVITCH, RICHARD MD.
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/21/17 1356 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by RNOVITCH Eff: 08/21/17 1345
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

09/01/17 0820 - FILL by BGIRLING

Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/08/17-2100 Stop Date 09/07/17 2159
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 58 Total Costs $0.00 Total Charges $6.60
Rx Number 01535227

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 200 MG/DAY
is below the Low Daily Dose.

History
08/08/17 1720 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01535198
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/08/17 - 2200
Last Actual Administration Time:
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/08/17 - 2200
New Order Start: 08/08/17 - 2100
New Order Stop: 09/07/17 - 2159
08/08/17 1724 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by NBALCETIS Eff: 08/08/17 1720
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/08/17 - 2200
Last Actual Administration Time:
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: NIGHTLY (SCH)
Old Order Stop: 08/08/17 - 2200
New Order Start: 08/08/17 - 2100
New Order Stop: 09/07/17 - 2159
08/08/17 1724 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 08/08/17 - 2100
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/15/17 - 2100

08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

IPR02V2.5 - IPRATROPIUM BR 0.02% INH SOLN 2.5 ML NEB

Dose 2.5 ML (1 VIAL)

Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 08/15/17-1300 Stop Date 09/14/17 1259
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $338.80
Rx Number 01536895

History
08/15/17 1139 - POM ORDER by RNOVITCH
08/15/17 1145 - VERIFIED by AMOLINARI
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
For: 08/20/17 - 2100
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
For: 08/22/17 - 2100
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 12
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/25/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/26/17 - 0900

For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 2 TIMES A DAY (PRN) PRN REASON: SOB - For Shortness of Breath
Start Date 08/15/17-1145 Stop Date 09/14/17 1144
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01536896

History
08/15/17 1139 - POM ORDER by RNOVITCH
08/15/17 1145 - VERIFIED by AMOLINARI
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ISD40TCR - ISOSORBIDE DINITRATE 40 MG TABCR

Dose 20 MG (0.5 TABLET, CONTROLLED-RELEASES)

Dose Instructions HOLD FOR SBP < 95
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/25/17-2200 Stop Date 09/24/17 2159
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 35 Total Costs $0.00 Total Charges $53.25
Rx Number 01540153

History
08/25/17 1607 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01535209
08/25/17 1616 - VERIFIED by AMACCA
Items Dispensed: 14 Doses Dispensed: 14
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 09/05/17 - 0600

For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600

LACT10SY31 - LACTULOSE 20 GM/30 ML UDC

Dose 20 GM (30 ML)

Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/08/17-1730 Stop Date 09/07/17 1729
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $6.00
Rx Number 01535260

History
08/08/17 1720 - POM ORDER by NBALCETIS
08/08/17 1901 - EDIT by AMACCA
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
PRN REASON: SOB - For Shortness of Breath
TO:
PRN REASON: CONSTIP - FOR CONSTIPATION
08/08/17 1901 - VERIFIED by AMACCA
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

LVT.112T - LEVOTHYROXINE SODIUM 112 MCG (SYNTHROID) TAB

Dose 112 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/10/17-0700 Stop Date 09/09/17 0659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 28 Total Costs $0.00 Total Charges $70.00
Rx Number 01535480

History
08/09/17 1655 - POM ORDER by NBALCETIS
08/09/17 1701 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/10/17 - 0700
For: 08/11/17 - 0700
For: 08/12/17 - 0700
For: 08/13/17 - 0700
For: 08/14/17 - 0700
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/15/17 - 0700
For: 08/16/17 - 0700
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/17/17 - 0700
For: 08/18/17 - 0700
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/19/17 - 0700
For: 08/20/17 - 0700
For: 08/21/17 - 0700
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/22/17 - 0700
For: 08/23/17 - 0700
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/24/17 - 0700
For: 08/25/17 - 0700
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/26/17 - 0700
For: 08/27/17 - 0700
For: 08/28/17 - 0700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/29/17 - 0700
For: 08/30/17 - 0700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/31/17 - 0700
For: 09/01/17 - 0700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

08/30/17 0816 - FILL by BGIRLING

Items Dispensed: 3 Doses Dispensed: 3
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/05/17 - 0700
For: 09/06/17 - 0700

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions Constipation
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/08/17-1630 Stop Date 09/07/17 1629
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535217

History
08/08/17 1629 - POM ORDER by NBALCETIS
08/08/17 1633 - VERIFIED by AMACCA
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/08/17-2100 Stop Date 09/07/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 57 Total Costs $0.00 Total Charges $10.75
Rx Number 01535210

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1628 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/08/17 - 2100
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

08/21/17 0829 - FILL by AMOLINARI

Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-1700 Stop Date 09/07/17 1659
Ordering Doctor NOVITCH, RICHARD MD.
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 13 Total Costs $0.00 Total Charges $64.24
Rx Number 01541338

History
08/30/17 1428 - POM ORDER by RNOVITCH
08/30/17 1500 - VERIFIED by AMACCA
Items Dispensed: 9 Doses Dispensed: 9
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

SACU1TAB7 - SACUBITRIL/VALSARTAN 1 EACH TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 23 Total Costs $0.00 Total Charges $0.00
Rx Number 01540158

History
08/25/17 1618 - ENTER by AMACCA
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions Constipation
374mg=2 tablets
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/08/17-1630 Stop Date 09/07/17 1629
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01535218

History
08/08/17 1629 - POM ORDER by NBALCETIS
08/08/17 1633 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 08/08/17 - 1630
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

SMT80CT - SIMETHICONE 80 MG CHEW

Dose 80 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency WITH MEALS & BEDTIME (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/08/17-1730 Stop Date 09/07/17 1729
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $0.40
Rx Number 01535229

History
08/08/17 1720 - POM ORDER by NBALCETIS
08/08/17 1724 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/08/17 - 1730
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

BDS.5IN2 - BUDESONIDE INHA SUSP 0.5 MG/2 ML NEB

Dose 0.5 MG (2 ML)

Admin Route NEBULIZER
Frequency EVERY 12 HOURS (SCH)
Start Date 08/03/17-2100 Stop Date 09/02/17 2059 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 10 Total Costs $0.00 Total Charges $307.80
Rx Number 01534076

Discontinued Comments DC'd by Discharge

History
08/03/17 1816 - POM ORDER by RNOVITCH
08/03/17 1823 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 1
For: 08/03/17 - 2100
08/03/17 1824 - DEBIT by EBALILO
ITEMS: 1
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

GENT5DRO15 - GENTAMICIN SULFATE 0.3% OP SOL 5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Admin Route OPHTHALMIC
Frequency 4 TIMES A DAY (SCH)
Start Date 08/02/17-2100 Stop Date 08/09/17 2059 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Clinical Indication OTHER
Total Dispensed 1 Total Costs $0.00 Total Charges $6.60
Rx Number 01533789

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1835 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/02/17 - 2100
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

MOXI3DRO - MOXIFLOXACIN HCL 0.5% 3 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions Left eye
Admin Route OPHTHALMIC
Frequency EVERY 8 HOURS (SCH)
Start Date 08/11/17-1400 Stop Date 08/18/17 1359 DC: 08/17/17-1747
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication SEE PROGRESS NOTES
Total Dispensed 1 Total Costs $0.00 Total Charges $291.78
Rx Number 01535919

History
08/11/17 0740 - POM ORDER by NBALCETIS
08/11/17 0750 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 1400
08/17/17 1749 - DISCONTINUE by RNOVITCH Eff: 08/17/17 1747
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/17/17 1812 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/17/17 1749

MOXI3DRO - MOXIFLOXACIN HCL 0.5% 3 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions Left eye
Admin Route OPHTHALMIC
Frequency 0738 (ONE)
Start Date 08/11/17-0738 Stop Date 08/11/17 0739 DC: 08/11/17-0739
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication SEE PROGRESS NOTES
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01535920

Discontinued Comments Reached Stop Date

History
08/11/17 0740 - POM ORDER by NBALCETIS
08/11/17 0750 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 0738
08/11/17 0750 - DISCONTINUE by PHABKGJOB Eff: 08/11/17 0739
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/11/17 0751 - CREDIT by AMOLINARI
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

NTR.4SL - NITROGLYCERIN 0.4 MG SUBL

Dose 0.4 MG (1 TABLET, SUBLINGUAL)

Admin Route SUBLINGUAL
Frequency DAILY (PRN) PRN REASON: CP - Chest Pain
Start Date 08/02/17-1815 Stop Date 09/01/17 1814 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 25 Total Costs $0.00 Total Charges $22.50
Rx Number 01533792

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1837 - VERIFIED by MHAIMOWITZ
Items Dispensed: 25 Doses Dispensed: 1
For: 08/02/17 - 1815
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/02/17-1815 Stop Date 09/01/17 1814 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01533776

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1829 - VERIFIED by MHAIMOWITZ
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 500 MG (1 TABLET)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/11/17-0630 Stop Date 08/11/17 0631 DC: 08/11/17-0631
Ordering Doctor BARRY,STEVEN
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01535917

Discontinued Comments Reached Stop Date

History
08/11/17 0623 - POM ORDER by SBARRY
08/11/17 0725 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by MPAULOSE Eff: 08/11/17 0628
08/11/17 0725 - VERIFIED by AMOLINARI
08/11/17 0726 - DISCONTINUE by PHABKGJOB Eff: 08/11/17 0631
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency ONETIME (ONE)
Start Date 08/11/17-0630 Stop Date 08/11/17 0631 DC: 08/11/17-0631
Ordering Doctor BARRY,STEVEN
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01535918

Discontinued Comments Reached Stop Date

History
08/11/17 0624 - POM ORDER by SBARRY
08/11/17 0725 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by MPAULOSE Eff: 08/11/17 0628
08/11/17 0725 - VERIFIED by AMOLINARI
08/11/17 0726 - DISCONTINUE by PHABKGJOB Eff: 08/11/17 0631
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ALB083NB3 - ALBUTEROL SULF 0.083% NEBU SOL 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency ONETIME (ONE)
Start Date 08/29/17-0430 Stop Date 08/29/17 0431 DC: 08/29/17-0431
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540893

Discontinued Comments Reached Stop Date

History
08/29/17 0437 - POM ORDER by HMOHAMED
08/29/17 0722 - REVIEW PROVIDER ACTIVITY by AMACCA
Administration of Unverified Order by MPAULOSE Eff: 08/29/17 0445
08/29/17 0722 - VERIFIED by AMACCA
08/29/17 0723 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 0431
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ALPR.5T - ALPRAZOLAM 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Dose Instructions PRN ANXIETY
Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/02/17-1815 Stop Date 08/09/17 1814 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533777

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1829 - VERIFIED by MHAIMOWITZ
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ALPR.5T - ALPRAZOLAM 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Dose Instructions PRN ANXIETY
Admin Route ORAL
Frequency EVERY 12 HOURS (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/08/17-1615 Stop Date 08/15/17 1614 DC: 08/15/17-1415
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01535201

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1627 - VERIFIED by AMACCA
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/15/17 1415 - DISCONTINUE by RNOVITCH Eff: 08/15/17 1415
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/15/17 1415 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01423241
08/15/17 1416 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RNOVITCH Eff: 08/15/17 1415
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ALPR.5T - ALPRAZOLAM 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Dose Instructions PRN ANXIETY
Admin Route ORAL
Frequency EVERY 12 HOURS (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/15/17-1415 Stop Date 08/22/17 1414 DC: 08/22/17-1115
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01536952

History
08/15/17 1415 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01535201
08/15/17 1416 - EDIT by AADEGBAMIG
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/15/17-1415 STOP: 08/22/17 SOFT STOP:
TO:
START: 08/15/17-1415 STOP: 08/22/17-1414 SOFT STOP:
08/15/17 1416 - VERIFIED by AADEGBAMIG
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/22/17 1115 - DISCONTINUE by NBALCETIS Eff: 08/22/17 1115
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/22/17 1115 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425123
08/22/17 1126 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/22/17 1115
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ALPR.5T - ALPRAZOLAM 0.5 MG TAB

Dose 0.5 MG (1 TABLET)

Dose Instructions PRN ANXIETY
Admin Route ORAL
Frequency EVERY 12 HOURS (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/22/17-1115 Stop Date 08/29/17 1114 DC: 08/29/17-1114
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538941

Discontinued Comments Reached Stop Date

History
08/22/17 1115 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01536952
08/22/17 1126 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/22/17-1115 STOP: 08/29/17 SOFT STOP:
TO:
START: 08/22/17-1115 STOP: 08/29/17-1114 SOFT STOP: 0
08/22/17 1126 - VERIFIED by AMOLINARI
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/29/17 1114 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 1114
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/03/17-0900 Stop Date 09/02/17 0859 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 2 Total Costs $0.00 Total Charges $1.36
Rx Number 01533778

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1829 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/03/17 - 0900
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

APIX2.5T - APIXABAN 2.5 MG TABLET

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/02/17-2100 Stop Date 09/01/17 2059 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 4 Total Costs $0.00 Total Charges $64.72
Rx Number 01533779

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1829 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/03/17-0900 Stop Date 09/02/17 0859 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 2 Total Costs $0.00 Total Charges $0.06
Rx Number 01533780

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1830 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/03/17 - 0900
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/02/17-2100 Stop Date 09/01/17 2059 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 4 Total Costs $0.00 Total Charges $124.80
Rx Number 01533781

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1830 - VERIFIED by MHAIMOWITZ
Items Dispensed: 10 Doses Dispensed: 5
For: 08/02/17 - 2100
For: 08/03/17 - 2100
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 10 Doses Auto Credited: 5
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 5 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/02/17-1815 Stop Date 09/01/17 1814 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533782

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1830 - VERIFIED by MHAIMOWITZ
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/05/17 0004 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 1,000 UNIT (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@1200 (SCH)
Start Date 08/10/17-1200 Stop Date 09/09/17 1159 DC: 08/17/17-1747
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 8 Total Costs $0.00 Total Charges $0.91
Rx Number 01535415

History
08/09/17 1336 - POM ORDER by NBALCETIS
08/09/17 1342 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/10/17 - 1200
For: 08/11/17 - 1200
For: 08/12/17 - 1200
For: 08/13/17 - 1200
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1200
For: 08/15/17 - 1200
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 1200
For: 08/17/17 - 1200
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 1200
For: 08/19/17 - 1200
For: 08/20/17 - 1200
08/17/17 1749 - DISCONTINUE by RNOVITCH Eff: 08/17/17 1747
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/18/17 - 1200
For: 08/19/17 - 1200
For: 08/20/17 - 1200
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/17/17 1812 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/17/17 1749
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

DIAZ5TAB34 - DIAZEPAM 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: anxiety
Start Date 08/08/17-1730 Stop Date 08/15/17 1729 DC: 08/09/17-1333
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535259

Discontinued Comments sleepy today withot taking med

History
08/08/17 1720 - POM ORDER by NBALCETIS
08/08/17 1901 - VERIFIED by AMACCA
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 1336 - DISCONTINUE by NBALCETIS Eff: 08/09/17 1333
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
sleepy today withot taking med
08/09/17 1341 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/09/17 1336
sleepy today withot taking med
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

DGX.125T - DIGOXIN 0.125 MG TAB

Dose 0.125 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/03/17-0900 Stop Date 09/02/17 0859 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 2 Total Costs $0.00 Total Charges $52.20
Rx Number 01533783

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1831 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/03/17 - 0900
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/05/17 - 0900
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

DGX.125T - DIGOXIN 0.125 MG TAB

Dose 0.125 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 09/01/17-1723
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 22 Total Costs $0.00 Total Charges $643.50
Rx Number 01535199

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1627 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/30/17 - 0900

For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/30/17 1744 - HOLD by RNOVITCH Eff: 08/30/17 1743
EDIT DOCTOR: NOVITCH, RICHARD MD.
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/31/17 - 0900
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/31/17 0737 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by RNOVITCH Eff: 08/30/17 1744
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 1723 - DISCONTINUE by AADEGBAMIG Eff: 09/01/17 1723
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/02/17-1815 Stop Date 09/01/17 1814 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533785

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1831 - VERIFIED by MHAIMOWITZ
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/05/17 0004 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/10/17-0900 Stop Date 09/09/17 0859 DC: 08/17/17-1747
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01535479

History
08/09/17 1655 - POM ORDER by NBALCETIS
08/09/17 1701 - VERIFIED by AMACCA
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/17/17 1749 - DISCONTINUE by RNOVITCH Eff: 08/17/17 1747
For: 08/18/17 - 1200
For: 08/19/17 - 1200
For: 08/20/17 - 1200
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/17/17 1812 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/17/17 1749
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 5 MG (5 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/16/17-0900 Stop Date 09/15/17 0859 DC: 08/25/17-1722
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 50 Total Costs $0.00 Total Charges $13.50
Rx Number 01537106

Warnings
Type: BURKE
Range: FOLIC ACID
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.4 MG/DAY - 2 MG/DAY. Ordered dose of 5 MG/DAY is
above the Daily Dose range.

Type: BURKE
Range: FOLIC ACID
Condition: ALL COMMON INDICATIONS
Daily Dose Maximum Daily Dose is 2 MG/DOSE. Ordered dose of 5 MG/DOSE exceeds the
Maximum Daily Dose.

Discontinued Comments dup

History
08/15/17 1909 - POM ORDER by RNOVITCH
08/15/17 1915 - VERIFIED by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 15 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 10 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 15 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

08/25/17 1725 - DISCONTINUE by NBALCETIS Eff: 08/25/17 1722

Items Auto Credited: 20 Doses Auto Credited: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dup
08/29/17 0722 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/25/17 1725
dup
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 80 MG (2 TABLETS)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/03/17-0900 Stop Date 09/02/17 0859 DC: 08/04/17-1136
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 6 Total Costs $0.00 Total Charges $1.65
Rx Number 01533786

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1831 - VERIFIED by MHAIMOWITZ
Items Dispensed: 16 Doses Dispensed: 8
For: 08/03/17 - 0900
For: 08/03/17 - 1700
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/04/17 1138 - DISCONTINUE by RNOVITCH Eff: 08/04/17 1136
Items Auto Credited: 18 Doses Auto Credited: 9
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/04/17 1138 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01420577
08/04/17 1507 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RNOVITCH Eff: 08/04/17 1138
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 40 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/04/17-1700 Stop Date 09/03/17 1659 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01534166

Discontinued Comments DC'd by Discharge

History
08/04/17 1138 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01533786
08/04/17 1139 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 8 Doses Auto Credited: 8
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

FURO40TA14 - FUROSEMIDE 40 MG TAB

Dose 80 MG (2 TABLETS)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/08/17-1700 Stop Date 09/07/17 1659 DC: 08/17/17-1747
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 38 Total Costs $0.00 Total Charges $10.45
Rx Number 01535196

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1626 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 08/08/17 - 1700
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/17/17 1749 - DISCONTINUE by RNOVITCH Eff: 08/17/17 1747
Items Auto Credited: 12 Doses Auto Credited: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/20/17 - 0900

For: 08/20/17 - 1700
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/17/17 1749 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01424015
08/17/17 1812 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/17/17 1749
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/02/17-2200 Stop Date 09/01/17 2159 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 6 Total Costs $0.00 Total Charges $0.75
Rx Number 01533787

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1832 - VERIFIED by MHAIMOWITZ
Items Dispensed: 14 Doses Dispensed: 14
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
For: 08/04/17 - 1400
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
For: 08/09/17 - 0600
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 14 Doses Auto Credited: 14
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/06/17 - 2200

For: 08/07/17 - 0600
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
For: 08/09/17 - 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/08/17-2200 Stop Date 09/07/17 2159 DC: 08/08/17-2200
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535198

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1626 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 8
For: 08/08/17 - 2200
For: 08/09/17 - 0600
For: 08/09/17 - 1400
For: 08/09/17 - 2200
For: 08/10/17 - 0600
For: 08/10/17 - 1400
For: 08/10/17 - 2200
For: 08/11/17 - 0600
08/08/17 1720 - DISCONTINUE by NBALCETIS Eff: 08/08/17 2200
Items Auto Credited: 8 Doses Auto Credited: 8
For: 08/08/17 - 2200
For: 08/09/17 - 0600
For: 08/09/17 - 1400
For: 08/09/17 - 2200
For: 08/10/17 - 0600
For: 08/10/17 - 1400
For: 08/10/17 - 2200
For: 08/11/17 - 0600
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/08/17 1720 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01421568
08/08/17 1725 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/08/17 1720
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 100 MG (4 TABLETS)

Dose Instructions HOLD FOR SBP < 90
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/02/17-2200 Stop Date 09/01/17 2159 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 24 Total Costs $0.00 Total Charges $6.00
Rx Number 01533790

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1836 - VERIFIED by MHAIMOWITZ
Items Dispensed: 56 Doses Dispensed: 14
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
For: 08/04/17 - 1400
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 24 Doses Dispensed: 6
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
For: 08/09/17 - 0600
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 56 Doses Auto Credited: 14
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/09/17 - 0600

FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 100 MG (4 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/08/17-2200 Stop Date 09/07/17 2159 DC: 08/10/17-1452
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 24 Total Costs $0.00 Total Charges $3.60
Rx Number 01535203

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1627 - VERIFIED by AMACCA
Items Dispensed: 32 Doses Dispensed: 8
For: 08/08/17 - 2200
For: 08/09/17 - 0600
For: 08/09/17 - 1400
For: 08/09/17 - 2200
For: 08/10/17 - 0600
For: 08/10/17 - 1400
For: 08/10/17 - 2200
For: 08/11/17 - 0600
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 36 Doses Dispensed: 9
For: 08/11/17 - 1400
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
08/10/17 1453 - DISCONTINUE by NBALCETIS Eff: 08/10/17 1452
Items Auto Credited: 44 Doses Auto Credited: 11
For: 08/10/17 - 2200
For: 08/11/17 - 0600
For: 08/11/17 - 1400
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/10/17 1453 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01422033
08/10/17 1456 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/10/17 1453
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 50 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/10/17-2200 Stop Date 09/09/17 2159 DC: 08/24/17-1026
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 82 Total Costs $0.00 Total Charges $12.00
Rx Number 01535687

History
08/10/17 1453 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01535203
08/10/17 1455 - VERIFIED by AMOLINARI
Items Dispensed: 22 Doses Dispensed: 11
For: 08/10/17 - 2200
For: 08/11/17 - 0600
For: 08/11/17 - 1400
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 08/18/17 - 1400
For: 08/18/17 - 2200
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/21/17 - 0600

08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/21/17 - 1400
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 18 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/24/17 1027 - DISCONTINUE by NBALCETIS Eff: 08/24/17 1026
Items Auto Credited: 24 Doses Auto Credited: 12
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/24/17 1027 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425702
08/24/17 1038 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by NBALCETIS Eff: 08/24/17 1027
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 100
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/24/17-1400 Stop Date 09/23/17 1359 DC: 08/25/17-1604
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.30
Rx Number 01539532

Discontinued Comments dc

History
08/24/17 1027 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01535687
08/24/17 1037 - VERIFIED by MHAIMOWITZ
Items Dispensed: 12 Doses Dispensed: 12
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/25/17 1607 - DISCONTINUE by NBALCETIS Eff: 08/25/17 1604
Items Auto Credited: 14 Doses Auto Credited: 14
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

EDIT DOCTOR: BALCETIS,NOMEDA M.D.

FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/25/17 1610 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/25/17 1607
dc

IPR02V2.5 - IPRATROPIUM BR 0.02% INH SOLN 2.5 ML NEB

Dose 2.5 ML (1 VIAL)

Admin Route NEBULIZER
Frequency ONETIME (ONE)
Start Date 08/29/17-0430 Stop Date 08/29/17 0431 DC: 08/29/17-0431
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $4.40
Rx Number 01540894

Discontinued Comments Reached Stop Date

History
08/29/17 0437 - POM ORDER by HMOHAMED
08/29/17 0722 - REVIEW PROVIDER ACTIVITY by AMACCA
Administration of Unverified Order by MPAULOSE Eff: 08/29/17 0445
08/29/17 0722 - VERIFIED by AMACCA
08/29/17 0723 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 0431
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 08/02/17-2100 Stop Date 08/03/17 0754 DC: 08/03/17-0754
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01533775

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1829 - VERIFIED by MHAIMOWITZ
08/03/17 0755 - EDIT by RNOVITCH
EDIT DOCTOR: NOVITCH, RICHARD MD.
FROM:
START: 08/02/17-2100 STOP: 09/01/17 2059 SOFT STOP: 0
TO:
START: 08/02/17-2100 STOP: 08/03/17-0754 SOFT STOP:
08/03/17 0755 - DISCONTINUE by RNOVITCH Eff: 08/03/17 0754
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/03/17 0755 - POM COPY AND EDIT by RNOVITCH
TO: Rx #U01420220
08/03/17 0845 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by RNOVITCH Eff: 08/03/17 0755
Discontinue by RNOVITCH Eff: 08/03/17 0755
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency EVERY 4 HRS W/AWAKE (SCH)
Start Date 08/03/17-0900 Stop Date 09/01/17 2059 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01533843

Discontinued Comments DC'd by Discharge

History
08/03/17 0755 - POM COPY AND EDIT by RNOVITCH
FROM: Rx #01533775
Result of Frequency/Schedule Edit
Ordering Doctor: NOVITCH, RICHARD MD.
Last Scheduled Administration Time: 08/02/17 - 2100
Last Actual Administration Time: 08/03/17 - 0532
Old Freq/Sch: 4 TIMES A DAY (SCH)
New Freq/Sch: EVERY 4 HRS W/AWAKE (SCH)
Old Order Stop: 08/03/17 - 0754
New Order Start: 08/03/17 - 0900
New Order Stop: 09/01/17 - 2059
08/03/17 0845 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by RNOVITCH Eff: 08/03/17 0755
Ordering Doctor: NOVITCH, RICHARD MD.
Last Scheduled Administration Time: 08/02/17 - 2100
Last Actual Administration Time: 08/03/17 - 0532
Old Freq/Sch: 4 TIMES A DAY (SCH)
New Freq/Sch: EVERY 4 HRS W/AWAKE (SCH)
Old Order Stop: 08/03/17 - 0754
New Order Start: 08/03/17 - 0900
New Order Stop: 09/01/17 - 2059
08/03/17 0845 - VERIFIED by AMOLINARI
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
For: 08/08/17 - 2100
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/07/17 - 1700

For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (SCH)
Start Date 08/08/17-1700 Stop Date 09/07/17 1659 DC: 08/08/17-1716
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535208

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1628 - VERIFIED by AMACCA
08/08/17 1720 - DISCONTINUE by NBALCETIS Eff: 08/08/17 1716
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/08/17 1720 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01421569
08/08/17 1725 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/08/17 1720
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency 4 TIMES A DAY (PRN) PRN REASON: sob
Start Date 08/08/17-1730 Stop Date 09/07/17 1729 DC: 08/15/17-1138
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.75
Rx Number 01535228

History
08/08/17 1720 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01535208
08/08/17 1724 - VERIFIED by AMACCA
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/15/17 1139 - DISCONTINUE by RNOVITCH Eff: 08/15/17 1138
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/15/17 1145 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RNOVITCH Eff: 08/15/17 1139

IPRA3AMP11 - IPRATROPIUM/ALBUTEROL SULFATE 3 ML VIAL

Dose 3 ML (1 VIAL)
Admin Route NEBULIZER
Frequency NOW (ONE)
Start Date 08/14/17-0030 Stop Date 08/14/17 0031 DC: 08/14/17-0031
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536422

Discontinued Comments Reached Stop Date

History
08/14/17 0017 - POM ORDER by NCHANDEL
08/14/17 0738 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by SJOHNKUTTY Eff: 08/14/17 0036
08/14/17 0738 - VERIFIED by AMOLINARI
08/14/17 0738 - DISCONTINUE by PHABKGJOB Eff: 08/14/17 0031
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 83
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ISD10T - ISOSORBIDE DINITRATE 10 MG TAB

Dose 20 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 90
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/03/17-0900 Stop Date 09/02/17 0859 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 12 Total Costs $0.00 Total Charges $17.40
Rx Number 01533791

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1836 - VERIFIED by MHAIMOWITZ
Items Dispensed: 24 Doses Dispensed: 12
For: 08/03/17 - 0900
For: 08/03/17 - 1300
For: 08/03/17 - 1700
For: 08/04/17 - 0900
For: 08/04/17 - 1300
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 24 Doses Auto Credited: 12
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
FROM:
DC COMMENTS:
TO:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 84
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 85
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

ISD40TCR - ISOSORBIDE DINITRATE 40 MG TABCR

Dose 40 MG (1 TABLET, CONTROLLED-RELEASE)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/08/17-2200 Stop Date 09/07/17 2159 DC: 08/25/17-1604
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 51 Total Costs $0.00 Total Charges $63.90
Rx Number 01535209

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1628 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 8
For: 08/08/17 - 2200
For: 08/09/17 - 0600
For: 08/09/17 - 1400
For: 08/09/17 - 2200
For: 08/10/17 - 0600
For: 08/10/17 - 1400
For: 08/10/17 - 2200
For: 08/11/17 - 0600
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 1400
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 1400
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 86
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/18/17 - 2200

For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
For: 08/21/17 - 0600
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 1400
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
08/21/17 0829 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/25/17 1607 - DISCONTINUE by NBALCETIS Eff: 08/25/17 1604
Items Auto Credited: 14 Doses Auto Credited: 14
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
For: 08/28/17 - 1400
For: 08/28/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 87
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

For: 08/29/17 - 0600

For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/25/17 1607 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01426311
08/25/17 1610 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/25/17 1607

LACT10SY31 - LACTULOSE 20 GM/30 ML UDC

Dose 20 GM (30 ML)

Dose Instructions pt request lactulose for constipation
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/03/17-2130 Stop Date 08/03/17 2131 DC: 08/03/17-2131
Ordering Doctor UMAR,MOHAMMED DO
Total Dispensed 1 Total Costs $0.00 Total Charges $3.00
Rx Number 01534112

Discontinued Comments Reached Stop Date

History
08/03/17 2124 - POM ORDER by MUMAR
08/03/17 2154 - REVIEW PROVIDER ACTIVITY by EBALILO
Administration of Unverified Order by EMUNDACKAL Eff: 08/03/17 2139
08/03/17 2154 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/03/17 - 2130
08/03/17 2154 - DISCONTINUE by PHABKGJOB Eff: 08/03/17 2131
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 88
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

LVT.1T2 - LEVOTHYROXINE SODIUM 100 MCG (SYNTHROID) TAB

Dose 100 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/03/17-0700 Stop Date 08/03/17 0700 DC: 08/03/17-0700
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533814

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 2003 - DISCONTINUE by RNOVITCH Eff: 08/03/17 0700
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/02/17 2003 - EDIT by RNOVITCH
EDIT DOCTOR: NOVITCH, RICHARD MD.
FROM:
START: 08/03/17-0700 STOP: 09/02/17 0659 SOFT STOP: 0
DISPENSE: 5
TO:
START: 08/03/17-0700 STOP: 08/03/17-0700 SOFT STOP:
DISPENSE: 0
08/02/17 2003 - VERIFIED by SYSTEM
Verified in order to DC
08/02/17 2004 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by RNOVITCH Eff: 08/02/17 2003
Edit by SYSTEM Eff: 08/02/17 2003
Discontinue by RNOVITCH Eff: 08/02/17 2003
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 89
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

LVT.1T2 - LEVOTHYROXINE SODIUM 100 MCG (SYNTHROID) TAB

Dose 100 MCG (1 TABLET)

Admin Route ORAL
Frequency SuMoTuWeThSa@0700 (SCH)
Start Date 08/03/17-0700 Stop Date 09/02/17 0659 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $3.03
Rx Number 01533815

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 2004 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/03/17 - 0700
For: 08/05/17 - 0700
For: 08/06/17 - 0700
For: 08/07/17 - 0700
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/08/17 - 0700
For: 08/09/17 - 0700
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/05/17 - 0700
For: 08/06/17 - 0700
For: 08/07/17 - 0700
For: 08/08/17 - 0700
For: 08/09/17 - 0700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 90
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

LVT.1T2 - LEVOTHYROXINE SODIUM 100 MCG (SYNTHROID) TAB

Dose 200 MCG (2 TABLETS)

Admin Route ORAL
Frequency Fr@0700 (SCH)
Start Date 08/04/17-0700 Stop Date 09/03/17 0659 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 2 Total Costs $0.00 Total Charges $6.05
Rx Number 01533816

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 2004 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 1
For: 08/04/17 - 0700
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 91
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

LVT.1T2 - LEVOTHYROXINE SODIUM 100 MCG (SYNTHROID) TAB

Dose 100 MCG (1 TABLET)

Admin Route ORAL
Frequency Fr@0700 (SCH)
Start Date 08/11/17-0700 Stop Date 08/11/17 0700 DC: 08/11/17-0700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01535205

Discontinued Comments refused

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1627 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 0700
08/08/17 1720 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/11/17-0700 STOP: 09/10/17 0659 SOFT STOP: 0
DISPENSE: 1
DC COMMENTS:
TO:
START: 08/11/17-0700 STOP: 08/11/17-0700 SOFT STOP:
DISPENSE: 0
DC COMMENTS:
refused
08/08/17 1720 - DISCONTINUE by NBALCETIS Eff: 08/11/17 0700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
DC COMMENTS:
refused
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/08/17 1725 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by NBALCETIS Eff: 08/08/17 1720
Discontinue by NBALCETIS Eff: 08/08/17 1720
refused
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 92
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

LVT.1T2 - LEVOTHYROXINE SODIUM 100 MCG (SYNTHROID) TAB

Dose 100 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/09/17-0700 Stop Date 09/08/17 0659 DC: 08/09/17-1653
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $3.03
Rx Number 01535206

Discontinued Comments dc

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1628 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/09/17 - 0700
For: 08/10/17 - 0700
For: 08/11/17 - 0700
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/12/17 - 0700
For: 08/13/17 - 0700
For: 08/14/17 - 0700
08/09/17 1655 - DISCONTINUE by NBALCETIS Eff: 08/09/17 1653
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/10/17 - 0700
For: 08/11/17 - 0700
For: 08/12/17 - 0700
For: 08/13/17 - 0700
For: 08/14/17 - 0700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/09/17 1700 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/09/17 1655
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 93
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 90 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/02/17-2100 Stop Date 09/01/17 2059 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 4 Total Costs $0.00 Total Charges $1.00
Rx Number 01533784

Discontinued Comments DC'd by Discharge

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1831 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 94
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Entresto 97-103 mg po BID

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/08/17-1700 Stop Date 09/07/17 1659 DC: 08/08/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535215

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1630 - DISCONTINUE by AMACCA Eff: 08/08/17 1700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/08/17 1630 - VERIFIED by SYSTEM
Verified in order to DC

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (0 EACHS)
Dose Instructions Entresto 49/51 BID po
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659 DC: 08/25/17-1700
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540156

History
08/25/17 1607 - POM ORDER by NBALCETIS
08/25/17 1616 - DISCONTINUE by AMACCA Eff: 08/25/17 1700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/25/17 1616 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 95
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/03/17-0900 Stop Date 09/02/17 0859 DC: 08/03/17-1815
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01533788

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1832 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/03/17 - 0900
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/03/17 1816 - DISCONTINUE by RNOVITCH Eff: 08/03/17 1815
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/03/17 2157 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by RNOVITCH Eff: 08/03/17 1816
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 96
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

OMEP20CA - OMEPRAZOLE 20 MG CPDR

Dose 20 MG (1 CAPSULE DELAYED RELEASE)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/09/17-0800 Stop Date 09/08/17 0759 DC: 08/09/17-1013
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01535200

Discontinued Comments refused, does not work

History
08/08/17 1622 - POM ORDER by NBALCETIS
08/08/17 1627 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0800
For: 08/10/17 - 0800
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0800
For: 08/12/17 - 0800
For: 08/13/17 - 0800
08/09/17 1014 - DISCONTINUE by NBALCETIS Eff: 08/09/17 1013
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/10/17 - 0800
For: 08/11/17 - 0800
For: 08/12/17 - 0800
For: 08/13/17 - 0800
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
refused, does not work
08/09/17 1341 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/09/17 1014
refused, does not work
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 97
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

SACU1TAB4 - SACUBITRIL/VALSARTAN 1 EACH TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/03/17-1100 Stop Date 09/02/17 2059 DC: 08/04/17-2030
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.00
Rx Number 01533877

Discontinued Comments DC'd by Discharge

History
08/03/17 1044 - ENTER by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 8
For: 08/03/17 - 1100
For: 08/03/17 - 2100
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/03/17 1044 - NOW DOSE by AADEGBAMIG
Now Dose: 08/03/17 1100
08/03/17 1044 - KEEP NEXT DOSE by AADEGBAMIG
Keep Next Dose: 08/03/17 2100
08/04/17 0826 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/04/17 0849 - EDIT by AMOLINARI
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/03/17-1100 STOP: 09/02/17 1059 SOFT STOP: 0
DISPENSE: 4
TO:
START: 08/03/17-1100 STOP: 09/02/17-2059 SOFT STOP: 0
DISPENSE: 12
08/05/17 0005 - DISCONTINUE by DISCHARGE Eff: 08/04/17 2030
Items Auto Credited: 8 Doses Auto Credited: 8
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
FROM:
DC COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 98
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 99
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

SACU1TAB4 - SACUBITRIL/VALSARTAN 1 EACH TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/08/17-1700 Stop Date 09/07/17 1659 DC: 08/25/17-1604
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 34 Total Costs $0.00 Total Charges $0.00
Rx Number 01535216

Discontinued Comments dc

History
08/08/17 1631 - ENTER by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/08/17 - 1700
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0810 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 100
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

08/21/17 0829 - FILL by AMOLINARI

Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/25/17 1607 - DISCONTINUE by NBALCETIS Eff: 08/25/17 1604
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/25/17 1610 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/25/17 1607
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 101
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

TS160800 - TRIMETHOPRIM/SULFAMETHOXAZOLE 160-800 MG TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/13/17-1530 Stop Date 08/20/17 1529 DC: 08/17/17-1747
Ordering Doctor CHANDEL,NEEL MD
Clinical Indication COMPLICATED UTI
Total Dispensed 10 Total Costs $0.00 Total Charges $4.32
Rx Number 01536399

History
08/13/17 1506 - POM ORDER by NCHANDEL
08/13/17 1506 - NOW DOSE by NCHANDEL
Now Dose: 08/13/17 1530
08/13/17 1506 - KEEP NEXT DOSE by System
Keep Next Dose: 08/13/17 1700
08/13/17 1510 - REVIEW PROVIDER ACTIVITY by AMACCA
Now Dose by NCHANDEL Eff: 08/13/17 1506
Now Dose 08/13/17 - 1530
Keep Next Dose 08/13/17 - 1700
08/13/17 1510 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 6
For: 08/13/17 - 1530
For: 08/13/17 - 1700
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0810 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0825 - FILL by BGIRLING
Items Dispensed: 5 Doses Dispensed: 5
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
08/17/17 1749 - DISCONTINUE by RNOVITCH Eff: 08/17/17 1747
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
EDIT DOCTOR: NOVITCH, RICHARD MD.
08/17/17 1812 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RNOVITCH Eff: 08/17/17 1749
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 102
Run Time 1513 PHA Profile

LOCKER,LOIS W00001218982 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (0 EACHS)
Admin Route NF
Frequency EVERY 12 HOURS (SCH)
Start Date 08/02/17-2100 Stop Date 09/01/17 2059 DC: 08/03/17-1044
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01533878

History
08/02/17 1823 - POM ORDER by RNOVITCH
08/02/17 1934 - EDIT by MHAIMOWITZ
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
LABEL COMMENTS:
TO:
LABEL COMMENTS:
MED ON ORDER THUR. 8/3
DR. NOVITCH AWARE
08/03/17 1044 - DISCONTINUE by AADEGBAMIG Eff: 08/03/17 1044
EDIT DOCTOR: NOVITCH, RICHARD MD.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/03/17 1044 - REVIEW PROVIDER ACTIVITY by SYSTEM
Administration of Unverified Order by SJOHNKUTTY Eff: 08/02/17 2141
Administration of Unverified Order by EDENARO Eff: 08/03/17 0904
08/03/17 1044 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient LOUDON KING,GAY W Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219371 Location B2WEII Unit Number M000206734
Age/Sex 56/F Room 240 Registered Date 08/25/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 5 in 165.1 cm Body Surface Area 1.73 m2

Weight 146 lb 6.4 oz 66.406 kg
Hem-Onc No

Drug Allergies [SEASONAL ALLERGIES], Dust, gluten, wheat, mold

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

ALBU8HFA - ALBUTEROL SULFATE HFA 8 GM INH

Dose 1 ACTUATION (1 INHALER ACTUATION)

Admin Route INHALATION
Frequency EVERY 6 HOURS (PRN) PRN REASON: Shortness of breath
Start Date 08/25/17-1330 Stop Date 09/24/17 1329
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $57.24
Rx Number 01540051

History
08/25/17 1331 - POM ORDER by HMOHAMED
08/25/17 1338 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 1330

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions Apply to left chest
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01540084

History
08/25/17 1403 - POM ORDER by HMOHAMED
08/25/17 1407 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 08/25/17 - 2100
08/29/17 0719 - DEBIT by AMACCA
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 6 HOURS (SCH)
Start Date 08/28/17-1200 Stop Date 09/24/17 1329
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $6.00
Rx Number 01540624

History
08/28/17 0955 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540047
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/27/17 - 2300
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 6 HOURS (SCH)
Old Order Stop: 08/28/17 - 1200
New Order Start: 08/28/17 - 1200
New Order Stop: 09/24/17 - 1329
08/28/17 1217 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by JRUSSO Eff: 08/28/17 0955
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/27/17 - 2300
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 6 HOURS (SCH)
Old Order Stop: 08/28/17 - 1200
New Order Start: 08/28/17 - 1200
New Order Stop: 09/24/17 - 1329
08/28/17 1217 - VERIFIED by MHAIMOWITZ
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 24 Doses Dispensed: 12
For: 09/01/17 - 1200
For: 09/01/17 - 1800
For: 09/02/17 - 0000
For: 09/02/17 - 0600
For: 09/02/17 - 1200
For: 09/02/17 - 1800
For: 09/03/17 - 0000
For: 09/03/17 - 0600
For: 09/03/17 - 1200
For: 09/03/17 - 1800
For: 09/04/17 - 0000
For: 09/04/17 - 0600
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 16 Doses Dispensed: 8
For: 09/04/17 - 1200
For: 09/04/17 - 1800
For: 09/05/17 - 0000
For: 09/05/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

For: 09/05/17 - 1200

For: 09/05/17 - 1800
For: 09/06/17 - 0000
For: 09/06/17 - 0600

BCL10T - BACLOFEN 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-1300 Stop Date 09/30/17 1259
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 17 Total Costs $0.00 Total Charges $7.50
Rx Number 01541555

History
08/31/17 1059 - POM ORDER by JRUSSO
08/31/17 1100 - VERIFIED by AMACCA
Items Dispensed: 11 Doses Dispensed: 11
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1330 Stop Date 09/24/17 1329
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540050

History
08/25/17 1331 - POM ORDER by HMOHAMED
08/25/17 1338 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

BUPR150T4 - BUPROPION HCL 150 MG (WELLBUTRIN XL) TABSR

Dose 150 MG (1 TAB SUSTAINED RELEASE)

Dose Instructions ONCE A DAY DOSING
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $123.30
Rx Number 01540052

History
08/25/17 1331 - POM ORDER by HMOHAMED
08/25/17 1338 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/25/17-1700 Stop Date 09/24/17 1659
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $5.50
Rx Number 01540046

History
08/25/17 1331 - POM ORDER by HMOHAMED
08/25/17 1337 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 22 Total Costs $0.00 Total Charges $0.45
Rx Number 01540053

History
08/25/17 1331 - POM ORDER by HMOHAMED
08/25/17 1338 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/25/17-1330 Stop Date 09/24/17 1329
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540049

History
08/25/17 1331 - POM ORDER by HMOHAMED
08/25/17 1338 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/25/17-1330 Stop Date 09/24/17 1329
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540048

History
08/25/17 1331 - POM ORDER by HMOHAMED
08/25/17 1338 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 9 Total Costs $0.00 Total Charges $1.20
Rx Number 01540588

History
08/28/17 0955 - POM ORDER by JRUSSO
08/28/17 1134 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 09/02/17-1700 Stop Date 10/02/17 1659
Ordering Doctor AZIZI,HANA MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.40
Rx Number 01542245

History
09/02/17 1658 - POM ORDER by HAZIZI
09/02/17 1700 - VERIFIED by MHAIMOWITZ
Items Dispensed: 2 Doses Dispensed: 1
For: 09/02/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

VENL150C2 - VENLAFAXINE HCL 150 MG CAPCR

Dose 150 MG (1 CAPSULE CONTROLLED-RELEASE)

Dose Instructions ONCE A DAY DOSING
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/26/17-0900 Stop Date 09/25/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 11 Total Costs $0.00 Total Charges $315.27
Rx Number 01540054

History
08/25/17 1331 - POM ORDER by HMOHAMED
08/25/17 1338 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/25/17-1330 Stop Date 08/28/17 1200 DC: 08/28/17-1200
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540047

Discontinued Comments Reached Stop Date

History
08/25/17 1331 - POM ORDER by HMOHAMED
08/25/17 1337 - VERIFIED by AADEGBAMIG
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0955 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 08/25/17-1330 STOP: 09/24/17 1329 SOFT STOP: 0
TO:
START: 08/25/17-1330 STOP: 08/28/17-1200 SOFT STOP:
08/28/17 0955 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01426734
08/28/17 1200 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 1200
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/29/17 0719 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by JRUSSO Eff: 08/28/17 0955
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

LOUDON KING,GAY W W00001219371 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/28/17-0145 Stop Date 08/28/17 0146 DC: 08/28/17-0146
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540526

Discontinued Comments Reached Stop Date

History
08/28/17 0134 - POM ORDER by RMINASSIAN
08/28/17 0731 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by HKING Eff: 08/28/17 0147
08/28/17 0731 - VERIFIED by AMOLINARI
08/28/17 0731 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 0146
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SDCH1T - SODIUM CHLORIDE 1 GM TAB

Dose 1 GM (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/26/17-2100 Stop Date 08/27/17 0901 DC: 08/27/17-0901
Ordering Doctor AZIZI,HANA MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.60
Rx Number 01540428

Discontinued Comments Reached Stop Date

History
08/26/17 1908 - POM ORDER by HAZIZI
08/26/17 1909 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/26/17 - 2100
For: 08/27/17 - 0900
08/27/17 0901 - DISCONTINUE by PHABKGJOB Eff: 08/27/17 0901
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient LUCIA,DORA Responsible Doctor VALLES,JENNIE MD

Account Number W00001219369 Location B1NN Unit Number M000209207
Age/Sex 74/F Room 138 Registered Date 08/21/17
Status ADM IN Bed 02 Discharged Date

Height 4 ft 7.98 in 142.2 cm Body Surface Area 1.40 m2

Weight 113 lb 9.6 oz 51.528 kg
Hem-Onc No

Drug Allergies Sulfa (Sulfonamide Antibiotics), clavulanic acid (From Augmentin),

cefuroxime (From Ceftin), amoxicillin (From Augmentin)

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/22/17-0815 CHANGE DOSE/FREQUENCY COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

ART15OP - ARTIFICIAL TEARS OP SOLN 15 ML BTL

Dose 2 DROP (2 DROP APPLICATIONS)

Dose Instructions 2 DROPS
Admin Route OPHTHALMIC
Frequency 3 TIMES A DAY (SCH)
Start Date 08/28/17-1300 Stop Date 09/26/17 1044
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01540563

History
08/28/17 1045 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01540446
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: 2 TIMES A DAY (PRN)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/28/17 - 1300
New Order Start: 08/28/17 - 1300
New Order Stop: 09/26/17 - 1044
08/28/17 1046 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Freq/Sch Edit by SMOHAMED Eff: 08/28/17 1045
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: 2 TIMES A DAY (PRN)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/28/17 - 1300
New Order Start: 08/28/17 - 1300
New Order Stop: 09/26/17 - 1044
08/28/17 1046 - VERIFIED by JDIMARCO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1300
08/28/17 1239 - CREDIT by YLEE
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions please cut in half and apply to the back
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01539527

History
08/24/17 1004 - POM ORDER by SMOHAMED
08/24/17 1010 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 1
For: 08/25/17 - 0900
08/25/17 1823 - DEBIT by AADEGBAMIG
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/27/17-1200 Stop Date 09/20/17 2114
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01540450

History
08/27/17 1053 - POM COPY AND EDIT by YCHO
FROM: Rx #01538867
Result of Frequency/Schedule Edit
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/27/17 - 0600
Last Actual Administration Time: 08/27/17 - 0600 (Not Given)
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 6 HOURS (PRN)
Old Order Stop: 08/27/17 - 1051
New Order Start: 08/27/17 - 1200
New Order Stop: 09/20/17 - 2114
08/27/17 1132 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by YCHO Eff: 08/27/17 1053
Ordering Doctor: CHO,YUSIK MD PGY-2
Last Scheduled Administration Time: 08/27/17 - 0600
Last Actual Administration Time: 08/27/17 - 0600 (Not Given)
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 6 HOURS (PRN)
Old Order Stop: 08/27/17 - 1051
New Order Start: 08/27/17 - 1200
New Order Stop: 09/20/17 - 2114
08/27/17 1132 - VERIFIED by AADEGBAMIG
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

ACPCT - ACIDOPHILUS/PECTIN TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $1.04
Rx Number 01538843

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2153 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $184.60
Rx Number 01538837

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2153 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

ATRV10T - ATORVASTATIN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A WEEK (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 4 Total Costs $0.00 Total Charges $71.85
Rx Number 01538841

Warnings
Type: BURKE
Range: LIPITOR
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 5 MG/DAY - 80 MG/DAY. Ordered dose of 2.86 MG/DAY is
below the Low Daily Dose.

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2153 - VERIFIED by AADEGBAMIG
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/25/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@2200 (SCH)
Start Date 08/28/17-2200 Stop Date 09/24/17 2159
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 9 Total Costs $0.00 Total Charges $4.50
Rx Number 01540616

History
08/28/17 1144 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01540119
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/28/17 - 0600
Last Actual Administration Time: 08/28/17 - 0550
Old Freq/Sch: DAILY@0600,2200 (SCH)
New Freq/Sch: DAILY@2200 (SCH)
Old Order Stop: 08/28/17 - 1143
New Order Start: 08/28/17 - 2200
New Order Stop: 09/24/17 - 2159
08/28/17 1209 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SMOHAMED Eff: 08/28/17 1144
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/28/17 - 0600
Last Actual Administration Time: 08/28/17 - 0550
Old Freq/Sch: DAILY@0600,2200 (SCH)
New Freq/Sch: DAILY@2200 (SCH)
Old Order Stop: 08/28/17 - 1143
New Order Start: 08/28/17 - 2200
New Order Stop: 09/24/17 - 2159
08/28/17 1209 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2200
For: 08/29/17 - 2200
For: 08/30/17 - 2200
For: 08/31/17 - 2200
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2200
For: 09/02/17 - 2200
For: 09/03/17 - 2200
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2200
For: 09/05/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@0600,1400 (SCH)
Start Date 08/28/17-1400 Stop Date 09/20/17 2159
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $9.75
Rx Number 01540617

History
08/28/17 1144 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01540120
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/27/17 - 1400
Last Actual Administration Time: 08/27/17 - 1322
Old Freq/Sch: DAILY@1400 (SCH)
New Freq/Sch: DAILY@0600,1400 (SCH)
Old Order Stop: 08/28/17 - 1143
New Order Start: 08/28/17 - 1400
New Order Stop: 09/20/17 - 2159
08/28/17 1209 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SMOHAMED Eff: 08/28/17 1144
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/27/17 - 1400
Last Actual Administration Time: 08/27/17 - 1322
Old Freq/Sch: DAILY@1400 (SCH)
New Freq/Sch: DAILY@0600,1400 (SCH)
Old Order Stop: 08/28/17 - 1143
New Order Start: 08/28/17 - 1400
New Order Stop: 09/20/17 - 2159
08/28/17 1209 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 1400
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/30/17 - 0600
For: 08/30/17 - 1400
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 09/01/17 - 0600
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 1400
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/04/17 - 0600
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 1400
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

For: 09/05/17 - 0600

For: 09/05/17 - 1400
For: 09/06/17 - 0600

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY@20 (SCH)
Start Date 08/22/17-2000 Stop Date 09/21/17 1959
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538829

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2152 - VERIFIED by AADEGBAMIG
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2000
For: 08/26/17 - 2000
For: 08/27/17 - 2000
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2000
For: 08/29/17 - 2000
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2000
For: 08/31/17 - 2000
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2000
For: 09/02/17 - 2000
For: 09/03/17 - 2000
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2000
For: 09/05/17 - 2000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

BSP5T - BUSPIRONE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 08/22/17-2100 Stop Date 09/21/17 2059
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $23.40
Rx Number 01538844

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2154 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

CLC1250T - CALCIUM CARBONATE 1250 MG (=500MG ELEM. CA++)

Dose 1,250 MG (1 TABLET)

Dose Instructions 1250MG CALCIUM CARB. = 500MG ELEM. CALCIUM
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $1.04
Rx Number 01538836

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2153 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

CYAN500T - CYANOCOBALAMIN 500 MCG TAB

Dose 500 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 15 Total Costs $0.00 Total Charges $1.30
Rx Number 01538869

History
08/22/17 0815 - ENTER by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: ITCH - Itching
Start Date 08/21/17-2115 Stop Date 09/20/17 2114
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538833

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2152 - VERIFIED by AADEGBAMIG
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $8.75
Rx Number 01538826

History
08/21/17 2112 - POM ORDER by HMOHAMED
08/21/17 2152 - VERIFIED by AADEGBAMIG
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

For: 09/04/17 - 0900

For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $1107.99
Rx Number 01538838

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.78
MG/KG/DAY is below the Low Daily Dose.

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2153 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/21/17-2200 Stop Date 09/20/17 2159
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 47 Total Costs $0.00 Total Charges $5.85
Rx Number 01538839

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2153 - VERIFIED by AADEGBAMIG
Items Dispensed: 11 Doses Dispensed: 11
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0812 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

LVT.088T - LEVOTHYROXINE SODIUM 88 MCG (SYNTHROID) TAB

Dose 88 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/22/17-0700 Stop Date 09/21/17 0659
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $36.40
Rx Number 01538840

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2153 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/22/17 - 0700
For: 08/23/17 - 0700
For: 08/24/17 - 0700
For: 08/25/17 - 0700
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/26/17 - 0700
For: 08/27/17 - 0700
For: 08/28/17 - 0700
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/29/17 - 0700
For: 08/30/17 - 0700
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/31/17 - 0700
For: 09/01/17 - 0700
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/05/17 - 0700
For: 09/06/17 - 0700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/21/17-2115 Stop Date 09/20/17 2114
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538831

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2152 - VERIFIED by AADEGBAMIG
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-2115 Stop Date 09/20/17 2114
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538832

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2152 - VERIFIED by AADEGBAMIG
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/02/17-2100 Stop Date 09/06/17 1359
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01542172

History
09/02/17 1137 - POM COPY AND EDIT by HAZIZI
FROM: Rx #01541242
Result of Frequency/Schedule Edit
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/02/17 - 0600
Last Actual Administration Time: 09/02/17 - 0650
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 09/02/17 - 1136
New Order Start: 09/02/17 - 2100
New Order Stop: 09/06/17 - 1359
09/02/17 1145 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by HAZIZI Eff: 09/02/17 1137
Ordering Doctor: AZIZI,HANA MD
Last Scheduled Administration Time: 09/02/17 - 0600
Last Actual Administration Time: 09/02/17 - 0650
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: EVERY 12 HOURS (SCH)
Old Order Stop: 09/02/17 - 1136
New Order Start: 09/02/17 - 2100
New Order Stop: 09/06/17 - 1359
09/02/17 1145 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01538866

History
08/21/17 2307 - POM ORDER by HMOHAMED
08/22/17 0738 - VERIFIED by AMOLINARI
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/21/17-2115 Stop Date 09/20/17 2114
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 5 Total Costs $ Total Charges $
Rx Number 01538827

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2152 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 08/21/17 - 2115
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MILD PAIN (PAIN SCALE 1-3)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/01/17-1715 Stop Date 09/08/17 1714
Ordering Doctor VALLES,JENNIE MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542099

History
09/01/17 1713 - POM COPY AND EDIT by JVALLES
FROM: Rx #01540618
09/01/17 1719 - EDIT by AADEGBAMIG
EDIT DOCTOR: VALLES,JENNIE MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1715 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1715 STOP: 09/08/17-1714 SOFT STOP:
09/01/17 1720 - VERIFIED by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/01/17-1715 Stop Date 09/08/17 1714
Ordering Doctor VALLES,JENNIE MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542100

History
09/01/17 1713 - POM COPY AND EDIT by JVALLES
FROM: Rx #01540619
09/01/17 1720 - EDIT by AADEGBAMIG
EDIT DOCTOR: VALLES,JENNIE MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1715 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1715 STOP: 09/08/17-1714 SOFT STOP:
09/01/17 1720 - VERIFIED by AADEGBAMIG

PRD2.5T - PREDNISONE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 09/07/17 0859
Ordering Doctor VALLES,JENNIE MD
Total Dispensed 4 Total Costs $0.00 Total Charges $0.40
Rx Number 01542098

History
09/01/17 1712 - POM COPY AND EDIT by JVALLES
FROM: Rx #01540615
09/01/17 1720 - EDIT by AADEGBAMIG
EDIT DOCTOR: VALLES,JENNIE MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/02/17-0900 STOP: 09/07/17 SOFT STOP:
TO:
START: 09/02/17-0900 STOP: 09/07/17-0859 SOFT STOP:
09/01/17 1720 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

RABE20TA7 - RABEPRAZOLE SODIUM 20 MG TABCR

Dose 20 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $568.49
Rx Number 01538845

History
08/21/17 2158 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY@12 (SCH)
Start Date 08/22/17-1200 Stop Date 09/21/17 1159
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 30 Total Costs $0.00 Total Charges $2.60
Rx Number 01538828

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2152 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 08/22/17 - 1200
For: 08/23/17 - 1200
For: 08/24/17 - 1200
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1200
For: 08/26/17 - 1200
For: 08/27/17 - 1200
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1200
For: 08/29/17 - 1200
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1200
For: 08/31/17 - 1200
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1200
For: 09/02/17 - 1200
For: 09/03/17 - 1200
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 1200
For: 09/05/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

SMT80CT - SIMETHICONE 80 MG CHEW

Dose 80 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency EVERY 6 HOURS (SCH)
Start Date 08/22/17-0000 Stop Date 09/21/17 0000
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 62 Total Costs $0.00 Total Charges $2.55
Rx Number 01538835

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2153 - VERIFIED by AADEGBAMIG
Items Dispensed: 14 Doses Dispensed: 14
For: 08/22/17 - 0000
For: 08/22/17 - 0600
For: 08/22/17 - 1200
For: 08/22/17 - 1800
For: 08/23/17 - 0000
For: 08/23/17 - 0600
For: 08/23/17 - 1200
For: 08/23/17 - 1800
For: 08/24/17 - 0000
For: 08/24/17 - 0600
For: 08/24/17 - 1200
For: 08/24/17 - 1800
For: 08/25/17 - 0000
For: 08/25/17 - 0600
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 12
For: 08/25/17 - 1200
For: 08/25/17 - 1800
For: 08/26/17 - 0000
For: 08/26/17 - 0600
For: 08/26/17 - 1200
For: 08/26/17 - 1800
For: 08/27/17 - 0000
For: 08/27/17 - 0600
For: 08/27/17 - 1200
For: 08/27/17 - 1800
For: 08/28/17 - 0000
For: 08/28/17 - 0600
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 8
For: 08/28/17 - 1200
For: 08/28/17 - 1800
For: 08/29/17 - 0000
For: 08/29/17 - 0600
For: 08/29/17 - 1200
For: 08/29/17 - 1800
For: 08/30/17 - 0000
For: 08/30/17 - 0600
08/28/17 0812 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

Items Dispensed: 8 Doses Dispensed: 8

For: 08/30/17 - 1200
For: 08/30/17 - 1800
For: 08/31/17 - 0000
For: 08/31/17 - 0600
For: 08/31/17 - 1200
For: 08/31/17 - 1800
For: 09/01/17 - 0000
For: 09/01/17 - 0600
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 12
For: 09/01/17 - 1200
For: 09/01/17 - 1800
For: 09/02/17 - 0000
For: 09/02/17 - 0600
For: 09/02/17 - 1200
For: 09/02/17 - 1800
For: 09/03/17 - 0000
For: 09/03/17 - 0600
For: 09/03/17 - 1200
For: 09/03/17 - 1800
For: 09/04/17 - 0000
For: 09/04/17 - 0600
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 8
For: 09/04/17 - 1200
For: 09/04/17 - 1800
For: 09/05/17 - 0000
For: 09/05/17 - 0600
For: 09/05/17 - 1200
For: 09/05/17 - 1800
For: 09/06/17 - 0000
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

ART15OP - ARTIFICIAL TEARS OP SOLN 15 ML BTL

Dose 2 DROP (2 DROP APPLICATIONS)

Dose Instructions 2 DROPS
Admin Route OPHTHALMIC
Frequency 2 TIMES A DAY (PRN) PRN REASON: DRY.EYE - Dry Eyes
Start Date 08/27/17-1045 Stop Date 08/28/17 1300 DC: 08/28/17-1236
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $5.94
Rx Number 01540446

History
08/27/17 1042 - POM ORDER by YIVANOV
08/27/17 1051 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/27/17 - 1045
08/28/17 1045 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/27/17-1045 STOP: 09/26/17 1044 SOFT STOP: 0
TO:
START: 08/27/17-1045 STOP: 08/28/17-1300 SOFT STOP:
08/28/17 1045 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01426745
08/28/17 1046 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Edit by SMOHAMED Eff: 08/28/17 1045
08/28/17 1236 - DISCONTINUE by EALEXEEV Eff: 08/28/17 1236
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/28/17 1236 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01426803
08/28/17 1237 - REVIEW PROVIDER ACTIVITY by YLEE
Discontinue by EALEXEEV Eff: 08/28/17 1236
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

ART15OP - ARTIFICIAL TEARS OP SOLN 15 ML BTL

Dose 2 DROP (2 DROP APPLICATIONS)

Dose Instructions 2 DROPS
Admin Route OPHTHALMIC
Frequency 2 TIMES A DAY (PRN) PRN REASON: DRY.EYE - Dry Eyes
Start Date 08/28/17-1245 Stop Date 08/29/17 1245 DC: 08/29/17-0938
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $5.94
Rx Number 01540638

History
08/28/17 1236 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540446
08/28/17 1237 - EDIT by YLEE
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1245 STOP: 08/29/17 SOFT STOP:
TO:
START: 08/28/17-1245 STOP: 08/29/17-1245 SOFT STOP:
08/28/17 1238 - VERIFIED by YLEE
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 1245
08/29/17 0939 - DISCONTINUE by EALEXEEV Eff: 08/29/17 0938
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/29/17 0939 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427010
08/29/17 0940 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EALEXEEV Eff: 08/29/17 0939
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

ART15OP - ARTIFICIAL TEARS OP SOLN 15 ML BTL

Dose 2 DROP (2 DROP APPLICATIONS)

Dose Instructions 2 DROPS
Admin Route OPHTHALMIC
Frequency 2 TIMES A DAY (PRN) PRN REASON: DRY.EYE - Dry Eyes
Start Date 08/29/17-0945 Stop Date 08/30/17 0944 DC: 08/30/17-0944
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01540906

History
08/29/17 0939 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540638
08/29/17 0941 - EDIT by AMACCA
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0945 STOP: 08/30/17 SOFT STOP:
TO:
START: 08/29/17-0945 STOP: 08/30/17-0944 SOFT STOP:
08/29/17 0941 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 0945
08/29/17 0941 - CREDIT by AMACCA
ITEMS: 1
08/30/17 0944 - DISCONTINUE by EALEXEEV Eff: 08/30/17 0944
EDIT DOCTOR: Alexeev,Edward MD PGY-4
08/30/17 0944 - POM COPY AND EDIT by EALEXEEV
TO: Rx #U01427336
08/30/17 1045 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by EALEXEEV Eff: 08/30/17 0944
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

ART15OP - ARTIFICIAL TEARS OP SOLN 15 ML BTL

Dose 2 DROP (2 DROP APPLICATIONS)

Dose Instructions 2 DROPS
Admin Route OPHTHALMIC
Frequency 2 TIMES A DAY (PRN) PRN REASON: DRY.EYE - Dry Eyes
Start Date 08/30/17-0945 Stop Date 08/31/17 0944 DC: 08/31/17-0944
Ordering Doctor Alexeev,Edward MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541243

Discontinued Comments Reached Stop Date

History
08/30/17 0944 - POM COPY AND EDIT by EALEXEEV
FROM: Rx #01540906
08/30/17 1045 - EDIT by AMOLINARI
EDIT DOCTOR: Alexeev,Edward MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/30/17-0945 STOP: 08/31/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/30/17-0945 STOP: 08/31/17-0944 SOFT STOP: 0
DISPENSE: 0
08/30/17 1045 - VERIFIED by AMOLINARI
08/31/17 0944 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 0944
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions please cut in half and apply to the back
Admin Route TOPICALLY
Frequency 0950 (ONE)
Start Date 08/24/17-0950 Stop Date 08/24/17 0951 DC: 08/24/17-0951
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01539528

Discontinued Comments Reached Stop Date

History
08/24/17 1004 - POM ORDER by SMOHAMED
08/24/17 1010 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 1
For: 08/24/17 - 0950
08/24/17 1010 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 0951
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/21/17-2115 Stop Date 08/22/17 0600 DC: 08/22/17-0600
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538830

Discontinued Comments Reached Stop Date

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2152 - VERIFIED by AADEGBAMIG
08/21/17 2307 - EDIT by HMOHAMED
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
FROM:
START: 08/21/17-2115 STOP: 09/20/17 2114 SOFT STOP: 0
TO:
START: 08/21/17-2115 STOP: 08/22/17-0600 SOFT STOP:
08/21/17 2307 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01425057
08/22/17 0600 - DISCONTINUE by PHABKGJOB Eff: 08/22/17 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/22/17 0739 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by HMOHAMED Eff: 08/21/17 2307
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 975 MG (3 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/22/17-0600 Stop Date 08/27/17 1051 DC: 08/27/17-1051
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.75
Rx Number 01538867

History
08/21/17 2307 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01538830
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 08/22/17 - 0600
New Order Start: 08/22/17 - 0600
New Order Stop: 09/20/17 - 2114
08/22/17 0738 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by HMOHAMED Eff: 08/21/17 2307
Ordering Doctor: MOHAMED,HOSSAM ELDIN MD PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: EVERY 8 HOURS (SCH)
Old Order Stop: 08/22/17 - 0600
New Order Start: 08/22/17 - 0600
New Order Stop: 09/20/17 - 2114
Administration of Unverified Order by SHTHOMAS Eff: 08/22/17 0642
08/22/17 0738 - VERIFIED by AMOLINARI
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 27 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 18 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

08/27/17 1053 - EDIT by YCHO

EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/22/17-0600 STOP: 09/20/17 2114 SOFT STOP:
TO:
START: 08/22/17-0600 STOP: 08/27/17-1051 SOFT STOP:
08/27/17 1053 - DISCONTINUE by YCHO Eff: 08/27/17 1051
EDIT DOCTOR: CHO,YUSIK MD PGY-2
08/27/17 1053 - POM COPY AND EDIT by YCHO
TO: Rx #U01426587
08/27/17 1551 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by YCHO Eff: 08/27/17 1053
Discontinue by YCHO Eff: 08/27/17 1053
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/21/17-2200 Stop Date 08/26/17 0900 DC: 08/25/17-1530
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 24 Total Costs $0.00 Total Charges $9.00
Rx Number 01538834

Discontinued Comments new orders

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2152 - VERIFIED by AADEGBAMIG
Items Dispensed: 11 Doses Dispensed: 11
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/25/17 1525 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/21/17-2200 STOP: 09/20/17 2159 SOFT STOP: 0
DISPENSE: 6
TO:
START: 08/21/17-2200 STOP: 08/26/17-0900 SOFT STOP:
DISPENSE: 14
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

08/25/17 1526 - POM COPY AND EDIT by SMOHAMED

TO: Rx #U01426279
08/25/17 1530 - DISCONTINUE by MHAIMOWITZ Eff: 08/25/17 1530
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/25/17 - 2200
For: 08/26/17 - 0600
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
new orders
08/25/17 1530 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 08/25/17 1526
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@1400 (SCH)
Start Date 08/26/17-1400 Stop Date 08/28/17 1143 DC: 08/28/17-1143
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $1.50
Rx Number 01540120

History
08/25/17 1526 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538834
Result of Frequency/Schedule Edit
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/25/17 - 1400
Last Actual Administration Time: 08/25/17 - 1313
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: DAILY@1400 (SCH)
Old Order Stop: 08/26/17 - 0900
New Order Start: 08/26/17 - 1400
New Order Stop: 09/20/17 - 2159
08/25/17 1529 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SMOHAMED Eff: 08/25/17 1526
Ordering Doctor: MOHAMED,SALAH ELDIN MD PGY-2
Last Scheduled Administration Time: 08/25/17 - 1400
Last Actual Administration Time: 08/25/17 - 1313
Old Freq/Sch: EVERY 8 HOURS (SCH)
New Freq/Sch: DAILY@1400 (SCH)
Old Order Stop: 08/26/17 - 0900
New Order Start: 08/26/17 - 1400
New Order Stop: 09/20/17 - 2159
08/25/17 1529 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/26/17 - 1400
For: 08/27/17 - 1400
For: 08/28/17 - 1400
For: 08/29/17 - 1400
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1400
For: 08/31/17 - 1400
08/28/17 1144 - DISCONTINUE by SMOHAMED Eff: 08/28/17 1143
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

Allergies/Duplicates/Interactions differ from order entry

08/28/17 1144 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/26/17-1400 STOP: 09/20/17 2159 SOFT STOP:
TO:
START: 08/26/17-1400 STOP: 08/28/17-1143 SOFT STOP:
08/28/17 1144 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01426760
08/28/17 1209 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by SMOHAMED Eff: 08/28/17 1144
Discontinue by SMOHAMED Eff: 08/28/17 1144
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@0600,2200 (SCH)
Start Date 08/25/17-2200 Stop Date 08/28/17 1143 DC: 08/28/17-1143
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 14 Total Costs $0.00 Total Charges $4.50
Rx Number 01540119

History
08/25/17 1526 - POM ORDER by SMOHAMED
08/25/17 1529 - VERIFIED by MHAIMOWITZ
Items Dispensed: 10 Doses Dispensed: 10
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 2200
For: 08/28/17 - 0600
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/28/17 1144 - EDIT by SMOHAMED
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
START: 08/25/17-2200 STOP: 09/24/17 2159 SOFT STOP: 0
DISPENSE: 4
TO:
START: 08/25/17-2200 STOP: 08/28/17-1143 SOFT STOP:
DISPENSE: 6
08/28/17 1144 - DISCONTINUE by SMOHAMED Eff: 08/28/17 1143
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/28/17 1144 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01426759
08/28/17 1209 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

Edit by SMOHAMED Eff: 08/28/17 1144

Discontinue by SMOHAMED Eff: 08/28/17 1144

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/30/17-1400 Stop Date 09/02/17 1136 DC: 09/02/17-1136
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01541242

History
08/30/17 1015 - POM ORDER by SMOHAMED
08/30/17 1045 - VERIFIED by AMOLINARI
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
09/02/17 1137 - EDIT by HAZIZI
EDIT DOCTOR: AZIZI,HANA MD
FROM:
START: 08/30/17-1400 STOP: 09/06/17 1359 SOFT STOP: 0
TO:
START: 08/30/17-1400 STOP: 09/02/17-1136 SOFT STOP:
09/02/17 1137 - DISCONTINUE by HAZIZI Eff: 09/02/17 1136
EDIT DOCTOR: AZIZI,HANA MD
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
09/02/17 1137 - POM COPY AND EDIT by HAZIZI
TO: Rx #U01428208
09/02/17 1145 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by HAZIZI Eff: 09/02/17 1137
Discontinue by HAZIZI Eff: 09/02/17 1137
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

MS15TCR - MORPHINE SULFATE 15 MG TABCR

Dose 15 MG (1 TABLET, CONTROLLED-RELEASE)

Admin Route ORAL
Frequency 1012 (ONE)
Start Date 08/30/17-1012 Stop Date 08/30/17 1013 DC: 08/30/17-1013
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541241

Discontinued Comments Reached Stop Date

History
08/30/17 1015 - POM ORDER by SMOHAMED
08/30/17 1045 - VERIFIED by AMOLINARI
08/30/17 1045 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 1013
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Oxaydo 4mg

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: pain
Start Date 08/21/17-2115 Stop Date 09/20/17 2114 DC: 08/21/17-2206
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538851

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2206 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 2206
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/21/17 2206 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Oxaydo 7.5mg

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: pain
Start Date 08/21/17-2115 Stop Date 09/20/17 2114 DC: 08/21/17-2206
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538852

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2206 - VERIFIED by SYSTEM
Verified in order to DC
08/21/17 2206 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 2206
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE

NF-MED - NON FORMULARY MEDICATION

Dose Instructions Aciphex 20mg delayed release

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 DC: 08/22/17-0900
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538846

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2158 - VERIFIED by SYSTEM
Verified in order to DC
08/21/17 2158 - DISCONTINUE by AADEGBAMIG Eff: 08/22/17 0900
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

OXYC5SOL14 - OXYCODONE HCL 5 MG/5 ML UDC

Dose 4 MG (4 ML)
Dose Instructions FOR MODERATE PAIN(P/SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/21/17-2215 Stop Date 08/28/17 2214 DC: 08/21/17-2305
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538849

History
08/21/17 2204 - ENTER by AADEGBAMIG
08/21/17 2307 - DISCONTINUE by HMOHAMED Eff: 08/21/17 2305
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
08/21/17 2307 - POM COPY AND EDIT by HMOHAMED
TO: Rx #U01425058
08/22/17 0739 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by HMOHAMED Eff: 08/21/17 2307

OXYC5SOL14 - OXYCODONE HCL 5 MG/5 ML UDC

Dose 7.5 MG (7.5 ML)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/21/17-2215 Stop Date 08/28/17 2214 DC: 08/22/17-1057
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538850

History
08/21/17 2205 - ENTER by AADEGBAMIG
08/22/17 1058 - DISCONTINUE by SMOHAMED Eff: 08/22/17 1057
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/22/17 1106 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SMOHAMED Eff: 08/22/17 1058
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

OXYC5SOL14 - OXYCODONE HCL 5 MG/5 ML UDC

Dose 5 MG (5 ML)
Dose Instructions FOR MODERATE PAIN(P/SCALE 4-6)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/21/17-2315 Stop Date 08/28/17 2314 DC: 08/22/17-1057
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538868

History
08/21/17 2307 - POM COPY AND EDIT by HMOHAMED
FROM: Rx #01538849
08/22/17 0739 - VERIFIED by AMOLINARI
08/22/17 1058 - DISCONTINUE by SMOHAMED Eff: 08/22/17 1057
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/22/17 1106 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SMOHAMED Eff: 08/22/17 1058

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MILD PAIN (PAIN SCALE 1-3)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/22/17-1100 Stop Date 08/29/17 1059 DC: 08/28/17-1142
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538919

History
08/22/17 1059 - POM ORDER by SMOHAMED
08/22/17 1103 - VERIFIED by EBALILO
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 1142 - DISCONTINUE by SMOHAMED Eff: 08/28/17 1142
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/28/17 1142 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01426756
08/28/17 1210 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SMOHAMED Eff: 08/28/17 1142
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/22/17-1100 Stop Date 08/29/17 1059 DC: 08/28/17-1142
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $2.75
Rx Number 01538920

History
08/22/17 1059 - POM ORDER by SMOHAMED
08/22/17 1103 - VERIFIED by EBALILO
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0812 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 1142 - DISCONTINUE by SMOHAMED Eff: 08/28/17 1142
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/28/17 1142 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01426757
08/28/17 1210 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SMOHAMED Eff: 08/28/17 1142
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 5 MG (1 TABLET)
Dose Instructions PRN MILD PAIN (PAIN SCALE 1-3)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/28/17-1145 Stop Date 09/04/17 1144 DC: 09/01/17-1712
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540618

History
08/28/17 1142 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538919
08/28/17 1210 - EDIT by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1145 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-1145 STOP: 09/04/17-1144 SOFT STOP: 0
08/28/17 1210 - VERIFIED by MHAIMOWITZ
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 1713 - DISCONTINUE by JVALLES Eff: 09/01/17 1712
EDIT DOCTOR: VALLES,JENNIE MD
09/01/17 1713 - POM COPY AND EDIT by JVALLES
TO: Rx #U01428134
09/01/17 1720 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JVALLES Eff: 09/01/17 1713
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

OXC5T - OXYCODONE HCL 5 MG IMMEDIATE RELEASE TAB

Dose 10 MG (2 TABLETS)
Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/28/17-1145 Stop Date 09/04/17 1144 DC: 09/01/17-1712
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540619

History
08/28/17 1142 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538920
08/28/17 1210 - EDIT by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1145 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/28/17-1145 STOP: 09/04/17-1144 SOFT STOP: 0
08/28/17 1210 - VERIFIED by MHAIMOWITZ
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 1713 - DISCONTINUE by JVALLES Eff: 09/01/17 1712
EDIT DOCTOR: VALLES,JENNIE MD
09/01/17 1713 - POM COPY AND EDIT by JVALLES
TO: Rx #U01428135
09/01/17 1720 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JVALLES Eff: 09/01/17 1713
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

PRD2.5T - PREDNISONE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/29/17 0859 DC: 08/28/17-1143
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed 7 Total Costs $0.00 Total Charges $1.40
Rx Number 01538842

History
08/21/17 2113 - POM ORDER by HMOHAMED
08/21/17 2153 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0834 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 0900
08/28/17 1143 - DISCONTINUE by SMOHAMED Eff: 08/28/17 1143
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/28/17 1143 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01426758
08/28/17 1210 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by SMOHAMED Eff: 08/28/17 1143
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

PRD2.5T - PREDNISONE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/04/17 0859 DC: 09/01/17-1712
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 4 Total Costs $0.00 Total Charges $0.80
Rx Number 01540615

History
08/28/17 1143 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01538842
08/28/17 1206 - EDIT by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/29/17-0900 STOP: 09/04/17 SOFT STOP:
TO:
START: 08/29/17-0900 STOP: 09/04/17-0859 SOFT STOP: 0
08/28/17 1206 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0815 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 1712 - DISCONTINUE by JVALLES Eff: 09/01/17 1712
Items Auto Credited: 2 Doses Auto Credited: 2
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: VALLES,JENNIE MD
09/01/17 1712 - POM COPY AND EDIT by JVALLES
TO: Rx #U01428133
09/01/17 1720 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JVALLES Eff: 09/01/17 1712
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

LUCIA,DORA W00001219369 (Continued)

CYAN500T - CYANOCOBALAMIN 500 MCG TAB

Dose 500 MCG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A WEEK (SCH)
Start Date 08/25/17-0900 Stop Date 09/24/17 0859 CAN: 08/22/17-0815
Ordering Doctor MOHAMED,HOSSAM ELDIN MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01425060

History
08/21/17 2307 - POM ORDER by HMOHAMED
08/22/17 0815 - CANCEL by AMOLINARI
EDIT DOCTOR: MOHAMED,HOSSAM ELDIN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
changed to daily per dr. s. mohammed
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient MACMORAN,DOROTHY Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001218927 Location B1WE Unit Number M000161660
Age/Sex 86/F Room 151 Registered Date 08/05/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 2.01 in 157.5 cm Body Surface Area 1.53 m2

Weight 118 lb 11.2 oz 53.841 kg
Hem-Onc No

Drug Allergies [citrus fruit], Contrast Media, clindamycin, meperidine (From Demerol)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

BISM262O4 - BISMUTH SUBSALICYLATE (KAOPECTATE) BTL

Dose 15 ML (0.0635593 BOTTLES)

Dose Instructions PRN DIARRHEA
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: DIARRHEA - FOR DIARRHEA
Start Date 08/31/17-1030 Stop Date 09/30/17 1029
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $0.25
Rx Number 01541528

History
08/31/17 1018 - POM ORDER by NBALCETIS
08/31/17 1019 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 1030
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 09/01/17-1000 Stop Date 10/01/17 0959
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541844

History
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534561
09/01/17 1010 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1000 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/01/17-1000 STOP: 10/01/17-0959 SOFT STOP: 0
09/01/17 1010 - VERIFIED by AMOLINARI

ACPCT - ACIDOPHILUS/PECTIN TAB

Dose 2 EA (2 TABLETS)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/30/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 22 Total Costs $0.00 Total Charges $0.90
Rx Number 01541802

History
08/31/17 1649 - POM ORDER by NBALCETIS
08/31/17 1700 - VERIFIED by AMACCA
Items Dispensed: 14 Doses Dispensed: 7
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $1.26
Rx Number 01541845

History
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534601
09/01/17 1011 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 10/01/17-2059 SOFT STOP: 0
09/01/17 1011 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ANST1T - ANASTROZOLE 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $79.56
Rx Number 01541846

History
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534603
09/01/17 1011 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 10/01/17-2059 SOFT STOP: 0
09/01/17 1011 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/01/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.06
Rx Number 01541852

History
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534604
09/01/17 1013 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/02/17-0900 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/02/17-0900 STOP: 10/01/17-0859 SOFT STOP: 0
09/01/17 1013 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $136.60
Rx Number 01541847

History
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534605
09/01/17 1012 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 10/01/17-2059 SOFT STOP: 0
09/01/17 1012 - VERIFIED by AMOLINARI
Items Dispensed: 10 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

CRV6.25T - CARVEDILOL 6.25 MG TAB

Dose 12.5 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 18 Total Costs $0.00 Total Charges $1.95
Rx Number 01541848

History
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534606
09/01/17 1012 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 10/01/17-2059 SOFT STOP: 0
09/01/17 1012 - VERIFIED by AMOLINARI
Items Dispensed: 18 Doses Dispensed: 9
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/02/17-0900 Stop Date 10/01/17 0859
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 4 Total Costs $0.00 Total Charges $0.60
Rx Number 01541849

History
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534607
09/01/17 1012 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/02/17-0900 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/02/17-0900 STOP: 10/01/17-0859 SOFT STOP: 0
09/01/17 1012 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/21/17-2200 Stop Date 09/20/17 2159
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 47 Total Costs $0.00 Total Charges $361.92
Rx Number 01538776

History
08/21/17 1950 - ENTER by AADEGBAMIG
Items Dispensed: 11 Doses Dispensed: 11
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

For: 09/01/17 - 1400

For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600

LVT.075T1 - LEVOTHYROXINE SODIUM 75 MCG (SYNTHROID) TAB

Dose 75 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 09/02/17-0700 Stop Date 10/01/17 0659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $6.00
Rx Number 01541850

History
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534608
09/01/17 1012 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/02/17-0700 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/02/17-0700 STOP: 10/01/17-0659 SOFT STOP: 0
09/01/17 1012 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
For: 09/05/17 - 0700
For: 09/06/17 - 0700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY@1300 (SCH)
Start Date 09/01/17-1300 Stop Date 09/30/17 1259
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $0.90
Rx Number 01541851

History
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534687
09/01/17 1012 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1300 STOP: 09/30/17 SOFT STOP:
TO:
START: 09/01/17-1300 STOP: 09/30/17-1259 SOFT STOP: 0
09/01/17 1013 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 09/01/17 - 1300
For: 09/02/17 - 1300
For: 09/03/17 - 1300
For: 09/04/17 - 1300
For: 09/05/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/05/17-1230 Stop Date 09/04/17 1229
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534559

History
08/05/17 1227 - POM ORDER by HAZIZI
08/05/17 1316 - VERIFIED by MHAIMOWITZ
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ONDN4T - ONDANSETRON HCL 4 MG TAB

Dose 4 MG (1 TABLET)
Dose Instructions PRN NAUSEA
Admin Route ORAL
Frequency 3 TIMES A DAY (PRN) PRN REASON: NAUSEA - For Nausea
Start Date 08/05/17-1430 Stop Date 09/04/17 1429
Ordering Doctor AZIZI,HANA MD
Total Dispensed 4 Total Costs $ Total Charges $
Rx Number 01534609

History
08/05/17 1423 - POM ORDER by HAZIZI
08/05/17 1434 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/05/17 - 1430
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

FLT132EN - SOD PHOSPHATE/SOD BIPHOSPHATE 132 ML BTL

Dose 132 ML (1 BOTTLE)

Admin Route RECTALLY
Frequency EVERY 2 HOURS (SCH)
Start Date 08/06/17-1730 Stop Date 08/06/17 1801 DC: 08/06/17-1801
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534729

Discontinued Comments Reached Stop Date

History
08/06/17 1709 - POM ORDER by NCHANDEL
08/06/17 1709 - NOW DOSE by NCHANDEL
Now Dose: 08/06/17 1730
08/06/17 1709 - KEEP NEXT DOSE by System
Keep Next Dose: 08/06/17 1800
08/06/17 1725 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Now Dose by NCHANDEL Eff: 08/06/17 1709
Now Dose 08/06/17 - 1730
Keep Next Dose 08/06/17 - 1800
08/06/17 1725 - VERIFIED by MHAIMOWITZ
08/06/17 1801 - DISCONTINUE by PHABKGJOB Eff: 08/06/17 1801
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/15/17-2100 Stop Date 08/22/17 2059 DC: 08/22/17-1118
Ordering Doctor NOVITCH, RICHARD MD.
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01536955

History
08/15/17 1419 - POM ORDER by RNOVITCH
08/15/17 1421 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/15/17 - 2100
08/22/17 1119 - DISCONTINUE by NBALCETIS Eff: 08/22/17 1118
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/22/17 1119 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01425137
08/22/17 1126 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/22/17 1119
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/22/17-2100 Stop Date 08/29/17 2059 DC: 08/29/17-2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538940

Discontinued Comments Reached Stop Date

History
08/22/17 1119 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01536955
08/22/17 1126 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/22/17-2100 STOP: 08/29/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/22/17-2100 STOP: 08/29/17-2059 SOFT STOP: 0
DISPENSE: 0
08/22/17 1126 - VERIFIED by AMOLINARI
08/29/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/05/17-1230 Stop Date 09/04/17 1229 DC: 09/01/17-0951
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01534561

History
08/05/17 1227 - POM ORDER by HAZIZI
08/05/17 1316 - VERIFIED by MHAIMOWITZ
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0952 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0951
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427895
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ALPR.25T - ALPRAZOLAM 0.25 MG TAB

Dose 0.25 MG (1 TABLET)

Dose Instructions PRN ANXIETY
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/05/17-1800 Stop Date 08/12/17 1759 DC: 08/11/17-0952
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01534656

History
08/05/17 1802 - POM ORDER by HAZIZI
08/05/17 1902 - VERIFIED by MHAIMOWITZ
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0952 - DISCONTINUE by NBALCETIS Eff: 08/11/17 0952
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/11/17 0952 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01422311
08/11/17 1209 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/11/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ALPR.25T - ALPRAZOLAM 0.25 MG TAB

Dose 0.25 MG (1 TABLET)

Dose Instructions PRN ANXIETY
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: ANXIETY - For Anxiety
Start Date 08/11/17-1000 Stop Date 08/18/17 0959 DC: 08/18/17-0959
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536026

Discontinued Comments Reached Stop Date

History
08/11/17 0952 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534656
08/11/17 1209 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/11/17-1000 STOP: 08/18/17 SOFT STOP:
TO:
START: 08/11/17-1000 STOP: 08/18/17-0959 SOFT STOP: 0
08/11/17 1209 - VERIFIED by AMOLINARI
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0959 - DISCONTINUE by PHABKGJOB Eff: 08/18/17 0959
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/05/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-0951
Ordering Doctor AZIZI,HANA MD
Total Dispensed 27 Total Costs $0.00 Total Charges $16.38
Rx Number 01534601

History
08/05/17 1423 - POM ORDER by HAZIZI
08/05/17 1432 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

For: 08/27/17 - 2100

08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0952 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0951
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427896
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ANST1T - ANASTROZOLE 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/05/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-0951
Ordering Doctor AZIZI,HANA MD
Total Dispensed 27 Total Costs $0.00 Total Charges $1074.06
Rx Number 01534603

History
08/05/17 1423 - POM ORDER by HAZIZI
08/05/17 1433 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

08/25/17 0835 - FILL by AMOLINARI

Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0952 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0951
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427897
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/06/17-0900 Stop Date 09/05/17 0859 DC: 09/01/17-0951
Ordering Doctor AZIZI,HANA MD
Total Dispensed 27 Total Costs $0.00 Total Charges $0.81
Rx Number 01534604

History
08/05/17 1423 - POM ORDER by HAZIZI
08/05/17 1433 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0900
09/01/17 0952 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0951
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427898
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/05/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-0951
Ordering Doctor AZIZI,HANA MD
Total Dispensed 54 Total Costs $0.00 Total Charges $1844.10
Rx Number 01534605

History
08/05/17 1423 - POM ORDER by HAZIZI
08/05/17 1434 - VERIFIED by MHAIMOWITZ
Items Dispensed: 8 Doses Dispensed: 4
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

08/25/17 0835 - FILL by AMOLINARI

Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0952 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0951
Items Auto Credited: 6 Doses Auto Credited: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427899
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/05/17-1230 Stop Date 09/04/17 1229 DC: 08/31/17-1016
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534557

Discontinued Comments dc

History
08/05/17 1227 - POM ORDER by HAZIZI
08/05/17 1315 - VERIFIED by MHAIMOWITZ
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/31/17 1018 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1016
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/31/17 1019 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/31/17 1018
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

CRV6.25T - CARVEDILOL 6.25 MG TAB

Dose 12.5 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/05/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-0951
Ordering Doctor AZIZI,HANA MD
Total Dispensed 108 Total Costs $0.00 Total Charges $33.80
Rx Number 01534606

History
08/05/17 1423 - POM ORDER by HAZIZI
08/05/17 1434 - VERIFIED by MHAIMOWITZ
Items Dispensed: 14 Doses Dispensed: 7
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

For: 08/19/17 - 2100

For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 09/04/17 - 0900
09/01/17 0952 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0951
Items Auto Credited: 12 Doses Auto Credited: 6
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
For: 09/04/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

09/01/17 0952 - POM COPY AND EDIT by NBALCETIS

TO: Rx #U01427900
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0952

CFR250T - CEFUROXIME AXETIL 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/09/17-2100 Stop Date 08/12/17 2333 DC: 08/11/17-0919
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 4 Total Costs $0.00 Total Charges $16.92
Rx Number 01535457

History
08/09/17 1614 - POM ORDER by NBALCETIS
08/09/17 1615 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
08/11/17 0920 - DISCONTINUE by NBALCETIS Eff: 08/11/17 0919
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
08/11/17 0920 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01422290
08/11/17 1209 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/11/17 0920
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

CFR250T - CEFUROXIME AXETIL 250 MG TAB

Dose 250 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 08/14/17 2333 DC: 08/14/17-2333
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 7 Total Costs $0.00 Total Charges $29.61
Rx Number 01536025

Discontinued Comments Reached Stop Date

History
08/11/17 0920 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01535457
08/11/17 1209 - VERIFIED by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
08/14/17 2333 - DISCONTINUE by PHABKGJOB Eff: 08/14/17 2333
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 200 MG (2 CAPSULES)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/05/17-1700 Stop Date 09/04/17 1659 DC: 08/31/17-1017
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01534556

Discontinued Comments diarrhea

History
08/05/17 1227 - POM ORDER by HAZIZI
08/05/17 1315 - VERIFIED by MHAIMOWITZ
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 1700
For: 08/10/17 - 1700
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 1700
For: 08/12/17 - 1700
For: 08/13/17 - 1700
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 1700
For: 08/15/17 - 1700
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 1700
For: 08/17/17 - 1700
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 1700
For: 08/19/17 - 1700
For: 08/20/17 - 1700
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 1700
For: 08/22/17 - 1700
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 1700
For: 08/24/17 - 1700
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

08/28/17 0813 - FILL by BGIRLING

Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
08/31/17 1018 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1017
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
diarrhea
08/31/17 1019 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/31/17 1018
diarrhea
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 08/22/17 0900 DC: 08/22/17-0900
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01538775

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.68
MG/KG/DAY is below the Low Daily Dose.

History
08/21/17 1941 - POM ORDER by YCHO
08/21/17 1946 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/21/17 1948 - EDIT by YCHO
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
START: 08/22/17-0900 STOP: 09/21/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/22/17-0900 STOP: 08/22/17-0900 SOFT STOP:
DISPENSE: 0
08/21/17 1948 - DISCONTINUE by YCHO Eff: 08/22/17 0900
EDIT DOCTOR: CHO,YUSIK MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
08/21/17 1948 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by YCHO Eff: 08/21/17 1948
Discontinue by YCHO Eff: 08/21/17 1948
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

FLC1T - FOLIC ACID 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/06/17-0900 Stop Date 09/05/17 0859 DC: 09/01/17-0951
Ordering Doctor AZIZI,HANA MD
Total Dispensed 27 Total Costs $0.00 Total Charges $8.10
Rx Number 01534607

History
08/05/17 1423 - POM ORDER by HAZIZI
08/05/17 1434 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0835 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0900
09/01/17 0952 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0951
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/02/17 - 0900
For: 09/03/17 - 0900
For: 09/04/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427901
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/05/17-2200 Stop Date 09/04/17 2159 DC: 08/21/17-1946
Ordering Doctor AZIZI,HANA MD
Total Dispensed 48 Total Costs $0.00 Total Charges $445.44
Rx Number 01534602

History
08/05/17 1423 - POM ORDER by HAZIZI
08/05/17 1433 - VERIFIED by MHAIMOWITZ
Items Dispensed: 11 Doses Dispensed: 11
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
For: 08/09/17 - 0600
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 1400
For: 08/09/17 - 2200
For: 08/10/17 - 0600
For: 08/10/17 - 1400
For: 08/10/17 - 2200
For: 08/11/17 - 0600
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 1400
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/14/17 0811 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 1400
For: 08/18/17 - 2200
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
For: 08/21/17 - 0600
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 1400
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/21/17 1946 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 1946
Items Auto Credited: 11 Doses Auto Credited: 11
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

LVT.075T1 - LEVOTHYROXINE SODIUM 75 MCG (SYNTHROID) TAB

Dose 75 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/06/17-0700 Stop Date 09/05/17 0659 DC: 09/01/17-0951
Ordering Doctor AZIZI,HANA MD
Total Dispensed 27 Total Costs $0.00 Total Charges $81.00
Rx Number 01534608

History
08/05/17 1423 - POM ORDER by HAZIZI
08/05/17 1434 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/06/17 - 0700
For: 08/07/17 - 0700
For: 08/08/17 - 0700
For: 08/09/17 - 0700
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/10/17 - 0700
For: 08/11/17 - 0700
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/12/17 - 0700
For: 08/13/17 - 0700
For: 08/14/17 - 0700
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/15/17 - 0700
For: 08/16/17 - 0700
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/17/17 - 0700
For: 08/18/17 - 0700
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/19/17 - 0700
For: 08/20/17 - 0700
For: 08/21/17 - 0700
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/22/17 - 0700
For: 08/23/17 - 0700
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/24/17 - 0700
For: 08/25/17 - 0700
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/26/17 - 0700
For: 08/27/17 - 0700
For: 08/28/17 - 0700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

08/25/17 0835 - FILL by AMOLINARI

Items Dispensed: 2 Doses Dispensed: 2
For: 08/29/17 - 0700
For: 08/30/17 - 0700
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/31/17 - 0700
For: 09/01/17 - 0700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
09/01/17 0952 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0951
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427902
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/06/17-0900 Stop Date 08/06/17 1013 DC: 08/06/17-1013
Ordering Doctor AZIZI,HANA MD
Total Dispensed 3 Total Costs $ Total Charges $
Rx Number 01534657

History
08/05/17 1802 - POM ORDER by HAZIZI
08/05/17 1902 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/06/17 - 0900
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/06/17 1014 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 08/06/17-0900 STOP: 09/05/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/06/17-0900 STOP: 08/06/17-1013 SOFT STOP:
DISPENSE: 1
08/06/17 1014 - DISCONTINUE by JRUSSO Eff: 08/06/17 1013
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/06/17 1014 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01421041
08/06/17 1115 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by JRUSSO Eff: 08/06/17 1014
Discontinue by JRUSSO Eff: 08/06/17 1014
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY@1300 (SCH)
Start Date 08/06/17-1300 Stop Date 09/05/17 0859 DC: 09/01/17-0951
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 26 Total Costs $0.00 Total Charges $7.20
Rx Number 01534687

History
08/06/17 1014 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01534657
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/06/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@1300 (SCH)
Old Order Stop: 08/06/17 - 1013
New Order Start: 08/06/17 - 1300
New Order Stop: 09/05/17 - 0859
08/06/17 1115 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by JRUSSO Eff: 08/06/17 1014
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/06/17 - 0900
Last Actual Administration Time:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@1300 (SCH)
Old Order Stop: 08/06/17 - 1013
New Order Start: 08/06/17 - 1300
New Order Stop: 09/05/17 - 0859
08/06/17 1115 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/06/17 - 1300
For: 08/07/17 - 1300
For: 08/08/17 - 1300
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 1300
For: 08/10/17 - 1300
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 1300
For: 08/12/17 - 1300
For: 08/13/17 - 1300
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1300
For: 08/15/17 - 1300
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

For: 08/16/17 - 1300

For: 08/17/17 - 1300
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 1300
For: 08/19/17 - 1300
For: 08/20/17 - 1300
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 1300
For: 08/22/17 - 1300
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 1300
For: 08/24/17 - 1300
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1300
For: 08/26/17 - 1300
For: 08/27/17 - 1300
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1300
For: 08/29/17 - 1300
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1300
For: 08/31/17 - 1300
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1300
For: 09/02/17 - 1300
For: 09/03/17 - 1300
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 1300
09/01/17 0952 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0951
Items Auto Credited: 4 Doses Auto Credited: 4
For: 09/01/17 - 1300
For: 09/02/17 - 1300
For: 09/03/17 - 1300
For: 09/04/17 - 1300
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0952 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427903
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0952
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/05/17-1230 Stop Date 09/04/17 1229 DC: 08/31/17-1016
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534558

Discontinued Comments dc

History
08/05/17 1227 - POM ORDER by HAZIZI
08/05/17 1316 - VERIFIED by MHAIMOWITZ
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/31/17 1018 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1016
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/31/17 1019 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/31/17 1018
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/23/17-2100 Stop Date 08/30/17 2059 DC: 08/30/17-2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 14 Total Costs $0.00 Total Charges $112.42
Rx Number 01539349

Discontinued Comments Reached Stop Date

History
08/23/17 1543 - POM ORDER by NBALCETIS
08/23/17 1551 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
08/30/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

NTR100C - NITROFURANTOIN MONOHYD MACROCR 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/31/17-2100 Stop Date 09/07/17 2059 DC: 09/01/17-0949
Ordering Doctor BALCETIS,NOMEDA M.D.
Clinical Indication UNCOMPLICATED UTI
Total Dispensed 2 Total Costs $0.00 Total Charges $16.06
Rx Number 01541643

Discontinued Comments dc

History
08/31/17 1458 - POM ORDER by NBALCETIS
08/31/17 1501 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/31/17 - 2100
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0820 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
09/01/17 0951 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0949
Items Auto Credited: 9 Doses Auto Credited: 9
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
09/01/17 1013 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0951
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/05/17-2100 Stop Date 08/08/17 1111 DC: 08/08/17-1111
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534560

History
08/05/17 1227 - POM ORDER by HAZIZI
08/05/17 1316 - VERIFIED by MHAIMOWITZ
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/08/17 1113 - EDIT by NBALCETIS
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
START: 08/05/17-2100 STOP: 09/06/17 2059 SOFT STOP: 0
TO:
START: 08/05/17-2100 STOP: 08/08/17-1111 SOFT STOP:
08/08/17 1113 - DISCONTINUE by NBALCETIS Eff: 08/08/17 1111
For: 08/08/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/08/17 1113 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01421461
08/08/17 1155 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by NBALCETIS Eff: 08/08/17 1113
Discontinue by NBALCETIS Eff: 08/08/17 1113
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/08/17-1700 Stop Date 09/06/17 2059 DC: 08/31/17-1016
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535127

Discontinued Comments dc

History
08/08/17 1113 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01534560
Result of Frequency/Schedule Edit
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/07/17 - 2100
Last Actual Administration Time: 08/07/17 - 2100 (Not Given)
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: EVERY EVENING (SCH)
Old Order Stop: 08/08/17 - 1111
New Order Start: 08/08/17 - 1700
New Order Stop: 09/06/17 - 2059
08/08/17 1155 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by NBALCETIS Eff: 08/08/17 1113
Ordering Doctor: BALCETIS,NOMEDA M.D.
Last Scheduled Administration Time: 08/07/17 - 2100
Last Actual Administration Time: 08/07/17 - 2100 (Not Given)
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: EVERY EVENING (SCH)
Old Order Stop: 08/08/17 - 1111
New Order Start: 08/08/17 - 1700
New Order Stop: 09/06/17 - 2059
08/08/17 1155 - VERIFIED by EBALILO
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 1700
For: 08/12/17 - 1700
For: 08/13/17 - 1700
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1700
For: 08/15/17 - 1700
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 1700
For: 08/17/17 - 1700
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 1700
For: 08/19/17 - 1700
For: 08/20/17 - 1700
08/18/17 0819 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/21/17 - 1700
For: 08/22/17 - 1700
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 1700
For: 08/24/17 - 1700
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0835 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
08/31/17 1018 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1016
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/31/17 1019 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/31/17 1018
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/06/17-2100 Stop Date 09/05/17 2059 DC: 08/31/17-1016
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 50 Total Costs $0.00 Total Charges $1.60
Rx Number 01534728

Discontinued Comments dc

History
08/06/17 1709 - POM ORDER by NCHANDEL
08/06/17 1724 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0826 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

MACMORAN,DOROTHY W00001218927 (Continued)

08/25/17 0835 - FILL by AMOLINARI

Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0814 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
08/31/17 1018 - DISCONTINUE by NBALCETIS Eff: 08/31/17 1016
Items Auto Credited: 8 Doses Auto Credited: 4
For: 08/31/17 - 2100
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/31/17 1019 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/31/17 1018
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient MACRI,JOAN M Responsible Doctor BALCETIS,NOMEDA M.D.

Account Number W00001219495 Location B1WE Unit Number M000209354
Age/Sex 79/F Room 144 Registered Date 08/28/17
Status ADM IN Bed 01 Discharged Date

Height 4 ft 11.02 in 149.9 cm Body Surface Area 1.48 m2

Weight 119 lb 6.4 oz 54.159 kg
Hem-Onc No

Drug Allergies codeine

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: BILAT TKRS
Secondary Diagnosis:

HC1C30 - HYDROCORTISONE 1% CR 28 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions back, L posterior thigh
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/31/17-2100 Stop Date 09/05/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $7.98
Rx Number 01541820

History
08/31/17 1728 - POM ORDER by NBALCETIS
08/31/17 1731 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 2100

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 2 EA (2 PATCHS)
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 15 Total Costs $0.00 Total Charges $330.75
Rx Number 01540855

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1748 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 1
For: 08/29/17 - 0900
09/03/17 1232 - DEBIT by MHAIMOWITZ
ITEMS: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

TERI2.4P2 - TERIPARATIDE 20MCG (FORTEO) PEN INJECTOR

Dose 20 MCG (1 PEN.INJCTR)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $3716.82
Rx Number 01540863

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1752 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 0900

AC500T - ACETAMINOPHEN 500 MG TAB

Dose 1,000 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (SCH)
Start Date 08/29/17-1400 Stop Date 09/08/17 1359
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $4.00
Rx Number 01540915

History
08/29/17 1031 - POM ORDER by NBALCETIS
08/29/17 1032 - VERIFIED by AMACCA
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
For: 09/06/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $85.20
Rx Number 01540850

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1748 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

ATRV10T - ATORVASTATIN 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 9 Total Costs $0.00 Total Charges $143.70
Rx Number 01540851

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1748 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

CLCX200C - CELECOXIB 200 MG CAP

Dose 200 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-1700 Stop Date 09/29/17 1659
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 13 Total Costs $0.00 Total Charges $220.40
Rx Number 01541283

History
08/30/17 1207 - POM ORDER by NBALCETIS
08/30/17 1211 - VERIFIED by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 2,000 UNIT (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 16 Total Costs $0.00 Total Charges $1.50
Rx Number 01540879

History
08/28/17 1832 - POM ORDER by JRUSSO
08/28/17 1837 - VERIFIED by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900

CLNZ.5T - CLONAZEPAM 0.5 MG TAB

Dose 0.25 MG (0.5 TABLETS)

Dose Instructions For insomnia/sleep disorder
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541868

History
09/01/17 0957 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540852
09/01/17 1019 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP: 0
09/01/17 1019 - VERIFIED by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

CYAN-125 - CYANOCOBALAMIN 1,000 MCG TAB

Dose 5,000 MCG (5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 40 Total Costs $0.00 Total Charges $2.28
Rx Number 01540875

History
08/28/17 1832 - POM ORDER by JRUSSO
08/28/17 1837 - VERIFIED by AADEGBAMIG
Items Dispensed: 15 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 15 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 10 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $4.25
Rx Number 01540853

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1748 - VERIFIED by AADEGBAMIG
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

ESCI10TA - ESCITALOPRAM OXALATE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $114.18
Rx Number 01540854

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1748 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency WITH MEALS (SCH)
Start Date 08/29/17-0800 Stop Date 09/28/17 0759
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $4.25
Rx Number 01540876

History
08/28/17 1832 - POM ORDER by JRUSSO
08/28/17 1837 - VERIFIED by AADEGBAMIG
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0800
For: 09/01/17 - 1200
For: 09/01/17 - 1700
For: 09/02/17 - 0800
For: 09/02/17 - 1200
For: 09/02/17 - 1700
For: 09/03/17 - 0800
For: 09/03/17 - 1200
For: 09/03/17 - 1700
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0800
For: 09/04/17 - 1200
For: 09/04/17 - 1700
For: 09/05/17 - 0800
For: 09/05/17 - 1200
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1730 Stop Date 09/27/17 1729
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540856

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1749 - VERIFIED by AADEGBAMIG
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 9 Total Costs $0.00 Total Charges $1.20
Rx Number 01540877

History
08/28/17 1832 - POM ORDER by JRUSSO
08/28/17 1837 - VERIFIED by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

PNT40TEC - PANTOPRAZOLE SOD 40 MG TABEC

Dose 40 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY@08 (SCH)
Start Date 08/29/17-0800 Stop Date 09/28/17 0759
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $125.28
Rx Number 01540858

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1749 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0800
For: 08/30/17 - 0800
For: 08/31/17 - 0800
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0800
For: 09/02/17 - 0800
For: 09/03/17 - 0800
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0800
For: 09/05/17 - 0800

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-1730 Stop Date 09/29/17 1729
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540859

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1750 - VERIFIED by AADEGBAMIG
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 18 Total Costs $0.00 Total Charges $0.60
Rx Number 01540860

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1750 - VERIFIED by AADEGBAMIG
Items Dispensed: 8 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/01/17-1000 Stop Date 09/08/17 0959
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01541871

Alternating Links: Rx Num 01541870

History
09/01/17 0957 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540914
09/01/17 1020 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1000 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1000 STOP: 09/08/17-0959 SOFT STOP: 0
09/01/17 1020 - VERIFIED by AMOLINARI
09/01/17 1020 - LINK by AMOLINARI
FROM:
TO: Alternating: 01541870
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN MODERATE PAIN (4-6)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 09/01/17-1030 Stop Date 09/08/17 0959
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541870

Alternating Links: Rx Num 01541871

History
09/01/17 1020 - SYSTEM COPY AND EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
START: 09/01/17-1000 STOP: 09/08/17 0959 SOFT STOP: 0
DOSE INSTRUCTIONS:
PRN SEVERE PAIN (7-10)
MDD = 400MG/DAY
TO:
PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
START: 09/01/17-1030 STOP: 09/08/17-0959 SOFT STOP: 0
DOSE INSTRUCTIONS:
PRN MODERATE PAIN (4-6)
MDD = 400MG/DAY
09/01/17 1020 - COPY AND EDIT by AMOLINARI
FROM: Rx #01541869
09/01/17 1020 - ENTER by AMOLINARI
09/01/17 1020 - LINK by AMOLINARI
FROM:
TO: Alternating: 01541871

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/02/17-2100 Stop Date 09/04/17 2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542262

History
09/02/17 1618 - POM ORDER by HAZIZI
09/02/17 1720 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: FEVER - Fever
Start Date 08/28/17-1730 Stop Date 09/27/17 1729 DC: 08/28/17-1931
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540849

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1748 - VERIFIED by AADEGBAMIG
08/28/17 1934 - DISCONTINUE by JRUSSO Eff: 08/28/17 1931
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/28/17 1934 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01426988
08/28/17 1941 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JRUSSO Eff: 08/28/17 1934

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN
Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/28/17-1945 Stop Date 09/27/17 1944 DC: 08/29/17-1029
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540883

Discontinued Comments dc

History
08/28/17 1934 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540849
08/28/17 1941 - VERIFIED by AADEGBAMIG
08/29/17 1031 - DISCONTINUE by NBALCETIS Eff: 08/29/17 1029
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/29/17 1032 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by NBALCETIS Eff: 08/29/17 1031
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

CLNZ.5T - CLONAZEPAM 0.5 MG TAB

Dose 0.25 MG (0.5 TABLETS)

Dose Instructions For insomnia/sleep disorder
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-0957
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01540852

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1748 - VERIFIED by AADEGBAMIG
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0957 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0957
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0957 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427914
09/01/17 1020 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0957
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

MLX7.5T - MELOXICAM 7.5 MG TAB

Dose 7.5 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/28/17 0859 DC: 08/30/17-1205
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $1.05
Rx Number 01540857

Discontinued Comments dc

History
08/28/17 1740 - POM ORDER by JRUSSO
08/28/17 1749 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/30/17 1207 - DISCONTINUE by NBALCETIS Eff: 08/30/17 1205
Items Auto Credited: 3 Doses Auto Credited: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
dc
08/30/17 1211 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 08/30/17 1207
dc
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN SEVERE PAIN (7-10)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MODERATE - FOR MODERATE PAIN(P/SCALE 4-6)
Start Date 08/28/17-1830 Stop Date 09/04/17 1829 DC: 08/28/17-1933
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540878

History
08/28/17 1832 - POM ORDER by JRUSSO
08/28/17 1837 - VERIFIED by AADEGBAMIG
08/28/17 1935 - DISCONTINUE by JRUSSO Eff: 08/28/17 1933
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/28/17 1935 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01426989
08/28/17 1941 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JRUSSO Eff: 08/28/17 1935

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN SEVERE PAIN (7-10)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/28/17-1945 Stop Date 09/04/17 1944 DC: 09/01/17-0957
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540884

History
08/28/17 1935 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540878
08/28/17 1941 - VERIFIED by AADEGBAMIG
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0957 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0957
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0957 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427915
09/01/17 1020 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0957
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 100 MG (2 TABLETS)

Dose Instructions PRN SIGNIFICANT PAIN (PAIN SCALE 7-10)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 08/29/17-1030 Stop Date 09/05/17 1029 DC: 09/01/17-0957
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01540914

History
08/29/17 1031 - POM ORDER by NBALCETIS
08/29/17 1032 - VERIFIED by AMACCA
08/30/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0957 - DISCONTINUE by NBALCETIS Eff: 09/01/17 0957
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
09/01/17 0957 - POM COPY AND EDIT by NBALCETIS
TO: Rx #U01427916
09/01/17 1020 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by NBALCETIS Eff: 09/01/17 0957
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

TRM50T - TRAMADOL HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Dose Instructions PRN SEVERE PAIN (7-10)
MDD = 400MG/DAY
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: SEVERE - FOR SIGNIFICANT PAIN (PS 7-10)
Start Date 09/01/17-1000 Stop Date 09/08/17 0959 DC: 09/01/17-1020
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541869

History
09/01/17 0957 - POM COPY AND EDIT by NBALCETIS
FROM: Rx #01540884
09/01/17 1019 - EDIT by AMOLINARI
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-1000 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-1000 STOP: 09/08/17-0959 SOFT STOP: 0
09/01/17 1019 - VERIFIED by AMOLINARI
09/01/17 1020 - COPY AND EDIT by AMOLINARI
TO: Rx #01541870
09/01/17 1020 - DISCONTINUE by AMOLINARI Eff: 09/01/17 1020
EDIT DOCTOR: BALCETIS,NOMEDA M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/28/17-2100 Stop Date 08/28/17 2101 DC: 08/28/17-2101
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540835

Warnings
Type: BURKE
Range: WARFARIN SOD
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.5 MG/DAY - 15 MG/DAY. Ordered dose of 0 MG/DAY is
below the Low Daily Dose.

Discontinued Comments Reached Stop Date

History
08/28/17 1728 - POM ORDER by JRUSSO
08/28/17 1738 - VERIFIED by AADEGBAMIG
08/28/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/28/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF3T - WARFARIN SOD 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/29/17-2100 Stop Date 08/29/17 2101 DC: 08/29/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541160

Discontinued Comments Reached Stop Date

History
08/29/17 1718 - POM ORDER by NBALCETIS
08/29/17 1719 - VERIFIED by AADEGBAMIG
08/29/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

WRF5T - WARFARIN SOD 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/30/17-2100 Stop Date 08/30/17 2101 DC: 08/30/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541380

Discontinued Comments Reached Stop Date

History
08/30/17 1637 - POM ORDER by NBALCETIS
08/30/17 1638 - VERIFIED by MHAIMOWITZ
08/30/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/30/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 4 MG (2 TABLETS)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/31/17-2100 Stop Date 08/31/17 2101 DC: 08/31/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541645

Discontinued Comments Reached Stop Date

History
08/31/17 1503 - POM ORDER by NBALCETIS
08/31/17 1505 - VERIFIED by AMACCA
08/31/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

MACRI,JOAN M W00001219495 (Continued)

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/01/17-2100 Stop Date 09/01/17 2101 DC: 09/01/17-2101
Ordering Doctor BALCETIS,NOMEDA M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541882

Discontinued Comments Reached Stop Date

History
09/01/17 1107 - POM ORDER by NBALCETIS
09/01/17 1119 - VERIFIED by AMOLINARI
09/01/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient MAGILL,JOHN A Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001219349 Location B2WEII Unit Number M000209208
Age/Sex 74/M Room 253 Registered Date 08/21/17
Status ADM IN Bed 02 Discharged Date

Height 6 ft 3 in 190.5 cm Body Surface Area 2.25 m2

Weight 212 lb oz 96.162 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/21/17-1748 CLARIFY ORDER-STATE CLARIFICAT ACTIVE

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/21/17-1700 Stop Date 09/20/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01538703

History
08/21/17 1653 - POM ORDER by SDAS
08/21/17 1658 - VERIFIED by EBALILO
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $7.56
Rx Number 01538724

History
08/21/17 1729 - POM ORDER by SDAS
08/21/17 1729 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01538725

History
08/21/17 1729 - POM ORDER by SDAS
08/21/17 1730 - VERIFIED by MHAIMOWITZ
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $9.75
Rx Number 01538730

History
08/21/17 1732 - ENTER by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 2100
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-1700 Stop Date 09/20/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01538704

History
08/21/17 1653 - POM ORDER by SDAS
08/21/17 1658 - VERIFIED by EBALILO
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

CHLR25T - CHLORTHALIDONE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $62.14
Rx Number 01538726

History
08/21/17 1729 - POM ORDER by SDAS
08/21/17 1730 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/21/17-1700 Stop Date 09/20/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $9.50
Rx Number 01538705

History
08/21/17 1653 - POM ORDER by SDAS
08/21/17 1659 - VERIFIED by EBALILO
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

For: 09/04/17 - 0900

For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700

ENLP5T - ENALAPRIL MALEATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 30 Total Costs $0.00 Total Charges $31.20
Rx Number 01538731

History
08/21/17 1739 - ENTER by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/21/17-1700 Stop Date 09/20/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538706

History
08/21/17 1653 - POM ORDER by SDAS
08/21/17 1659 - VERIFIED by EBALILO
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/21/17-1700 Stop Date 09/20/17 1659
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538707

History
08/21/17 1653 - POM ORDER by SDAS
08/21/17 1659 - VERIFIED by EBALILO
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $2.60
Rx Number 01538727

History
08/21/17 1729 - POM ORDER by SDAS
08/21/17 1730 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 2100
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

MELA3TAB - MELATONIN 3 MG TAB

Dose 3 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059 DC: 08/29/17-2100
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01541203

History
08/29/17 1746 - POM ORDER by JRUSSO
08/29/17 1748 - DISCONTINUE by AADEGBAMIG Eff: 08/29/17 2100
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/29/17 1748 - VERIFIED by SYSTEM
Verified in order to DC

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 CAN: 08/21/17-1731
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424937

History
08/21/17 1729 - POM ORDER by SDAS
08/21/17 1731 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
change to 80mg tablet
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

MAGILL,JOHN A W00001219349 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 10 EA (0 EACHS)
Admin Route PO
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 CAN: 08/21/17-1737
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424939

History
08/21/17 1729 - POM ORDER by SDAS
08/21/17 1737 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO NF ENTRY
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient MAHARAJ,DEONARINE Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001218143 Location B2EA Unit Number M000208788
Age/Sex 87/M Room 206 Registered Date 08/01/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 2.99 in 160 cm Body Surface Area 1.58 m2

Weight 125 lb 1.6 oz 56.744 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/01/17-1803 ALLERGY VERIFICATION CALL COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

BIMA2.5D7 - BIMATOPROST 0.01% OPHTH. SOLN 5ML BOTTLE

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions left eye
Admin Route OPHTHALMIC
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540657

History
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01533563
08/28/17 1303 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/27/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/28/17-2100 STOP: 09/27/17-2059 SOFT STOP: 0
DISPENSE: 0
08/28/17 1304 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

INSU100V7 - INSULIN GLARGINE,HUM.REC.ANLOG 100 UNIT/ML VIAL

Dose 3 UNIT (0.03 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 09/17/17 2059
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $140.97
Rx Number 01538088

History
08/18/17 1511 - POM ORDER by CDOHLE
08/18/17 1512 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 2100

INSU100V26 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose 3 UNIT (0.03 ML)

Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 08/28/17-1200 Stop Date 09/27/17 1159
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540662

History
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01533560
08/28/17 1306 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1200 STOP: 09/27/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/28/17-1200 STOP: 09/27/17-1159 SOFT STOP: 0
DISPENSE: 0
08/28/17 1306 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions apply to right knee
Admin Route TOPICALLY
Frequency NIGHTLY (SCH)
Start Date 08/23/17-2100 Stop Date 09/22/17 2059
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $110.25
Rx Number 01539334

History
08/23/17 1523 - POM ORDER by CDOHLE
08/23/17 1524 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 1
For: 08/23/17 - 2100

NF-MED - NON FORMULARY MEDICATION

Dose Instructions water 350cc , 3 times per day

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/10/17-1700 Stop Date 09/09/17 1659
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535641

History
08/10/17 1358 - POM ORDER by RMINASSIAN
08/10/17 1405 - EDIT by MHAIMOWITZ
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
TO:
ORDER TYPE: BULK - BULK ORDER
08/10/17 1405 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

TML5OP5 - TIMOLOL MALEATE 0.5% OP SOLN 5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions left eye
Admin Route OPHTHALMIC
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 09/30/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $51.00
Rx Number 01541639

History
08/31/17 1456 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01533565
08/31/17 1459 - EDIT by AMACCA
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-0900 STOP: 09/30/17 SOFT STOP:
TO:
START: 09/01/17-0900 STOP: 09/30/17-0859 SOFT STOP:
08/31/17 1459 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/10/17-1400 Stop Date 09/09/17 1359
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535643

History
08/10/17 1407 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01533543
08/10/17 1410 - VERIFIED by AMOLINARI
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 15 Total Costs $0.00 Total Charges $8.19
Rx Number 01538576

History
08/21/17 1333 - ENTER by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 18 Total Costs $0.00 Total Charges $1.60
Rx Number 01537910

History
08/18/17 1000 - POM ORDER by TKOUTZEVA
08/18/17 1154 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 9 Total Costs $0.00 Total Charges $204.90
Rx Number 01540653

History
08/28/17 0925 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01533556
08/28/17 1257 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-2100 STOP: 09/27/17-2059 SOFT STOP: 0
08/28/17 1257 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-0930 Stop Date 09/27/17 0929
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540660

History
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01533544
08/28/17 1305 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0930 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-0930 STOP: 09/27/17-0929 SOFT STOP: 0
08/28/17 1305 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/28/17-1300 Stop Date 09/27/17 1259
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $4.75
Rx Number 01540661

History
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01533557
08/28/17 1305 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-1300 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-1300 STOP: 09/27/17-1259 SOFT STOP: 0
08/28/17 1305 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/31/17-1700 Stop Date 09/29/17 1259
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $1.35
Rx Number 01541649

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/31/17 1456 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01541281
Result of Frequency/Schedule Edit
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: 08/31/17 - 1300
Last Actual Administration Time: 08/31/17 - 1316
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/31/17 - 2100
New Order Start: 08/31/17 - 1700
New Order Stop: 09/29/17 - 1259
08/31/17 1507 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Freq/Sch Edit by RMINASSIAN Eff: 08/31/17 1456
Ordering Doctor: MINASSIAN,RAIA MD PGY-3
Last Scheduled Administration Time: 08/31/17 - 1300
Last Actual Administration Time: 08/31/17 - 1316
Old Freq/Sch: 3 TIMES A DAY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/31/17 - 2100
New Order Start: 08/31/17 - 1700
New Order Stop: 09/29/17 - 1259
08/31/17 1507 - VERIFIED by AADEGBAMIG
Items Dispensed: 10 Doses Dispensed: 10
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0821 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

LBT100T - LABETALOL HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 100 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/09/17-2100 Stop Date 09/08/17 2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 55 Total Costs $0.00 Total Charges $60.00
Rx Number 01535379

History
08/09/17 0941 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01533561
08/09/17 1210 - VERIFIED by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

For: 08/23/17 - 0900

For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

LVT.025T1 - LEVOTHYROXINE SODIUM 25 MCG (SYNTHROID) TAB

Dose 25 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 09/01/17-0700 Stop Date 09/30/17 0659
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $8.40
Rx Number 01541636

History
08/31/17 1456 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01533564
08/31/17 1458 - EDIT by AMACCA
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-0700 STOP: 09/30/17 SOFT STOP:
TO:
START: 09/01/17-0700 STOP: 09/30/17-0659 SOFT STOP:
08/31/17 1458 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 09/01/17 - 0700
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/05/17 - 0700
For: 09/06/17 - 0700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/28/17-0930 Stop Date 09/27/17 0929
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540663

History
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01533546
08/28/17 1307 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0930 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-0930 STOP: 09/27/17-0929 SOFT STOP: 0
08/28/17 1307 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-0930 Stop Date 09/27/17 0929
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540665

History
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01533545
08/28/17 1307 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0930 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-0930 STOP: 09/27/17-0929 SOFT STOP: 0
08/28/17 1307 - VERIFIED by MHAIMOWITZ
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/28/17-0930 Stop Date 09/27/17 0929
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 4 Total Costs $0.00 Total Charges $0.40
Rx Number 01540659

History
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01533547
08/28/17 1305 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-0930 STOP: 09/27/17 SOFT STOP:
TO:
START: 08/28/17-0930 STOP: 09/27/17-0929 SOFT STOP: 0
08/28/17 1305 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0930
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 09/01/17-2100 Stop Date 10/01/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $0.46
Rx Number 01541925

History
09/01/17 1228 - POM COPY AND EDIT by SDAS
FROM: Rx #01534534
09/01/17 1307 - EDIT by AADEGBAMIG
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 10/01/17-2059 SOFT STOP:
09/01/17 1307 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BIMA2.5D7 - BIMATOPROST 0.01% OPHTH. SOLN 5ML BOTTLE

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions left eye
Admin Route OPHTHALMIC
Frequency NIGHTLY (SCH)
Start Date 08/01/17-2100 Stop Date 08/31/17 2059 DC: 08/28/17-0925
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $197.13
Rx Number 01533563

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1705 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/01/17 - 2100
08/28/17 0925 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0925
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426709
08/28/17 1304 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0925
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency BEFORE MEALS & BED (SCH)
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/18/17-1457
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $229.32
Rx Number 01533559

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1704 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/01/17 - 1700
08/18/17 1511 - DISCONTINUE by CDOHLE Eff: 08/18/17 1457
EDIT DOCTOR: DOHLE,CAROLIN MD
08/18/17 1512 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by CDOHLE Eff: 08/18/17 1511

INSU100V26 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose 3 UNIT (0.03 ML)

Admin Route SUBCUTAN.
Frequency BEFORE MEALS (SCH)
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/28/17-0925
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 3 Total Costs $0.00 Total Charges $723.78
Rx Number 01533560

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1705 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/01/17 - 1700
08/20/17 1008 - DEBIT by AADEGBAMIG
ITEMS: 1
08/24/17 1020 - DEBIT by MHAIMOWITZ
ITEMS: 1
08/28/17 0925 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0925
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426712
08/28/17 1306 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0925
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

TML5OP5 - TIMOLOL MALEATE 0.5% OP SOLN 5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Dose Instructions left eye
Admin Route OPHTHALMIC
Frequency DAILY (SCH)
Start Date 08/02/17-0900 Stop Date 09/01/17 0859 DC: 08/31/17-1456
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $51.00
Rx Number 01533565

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1706 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/02/17 - 0900
08/31/17 1456 - DISCONTINUE by RMINASSIAN Eff: 08/31/17 1456
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/31/17 1456 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01427701
08/31/17 1458 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RMINASSIAN Eff: 08/31/17 1456

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/10/17-1358
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533543

History
08/01/17 1649 - POM ORDER by RMINASSIAN
08/01/17 1657 - VERIFIED by AMACCA
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/10/17 1407 - DISCONTINUE by RMINASSIAN Eff: 08/10/17 1358
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/10/17 1407 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01421972
08/10/17 1411 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/10/17 1407
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/15/17-0900 Stop Date 09/14/17 0859 DC: 08/16/17-1059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $28.40
Rx Number 01536643

History
08/14/17 1610 - POM ORDER by RMINASSIAN
08/14/17 1611 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/15/17 - 0900
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/16/17 1103 - DISCONTINUE by RMINASSIAN Eff: 08/16/17 1059
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/17/17 - 0900
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/16/17 1120 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/16/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency 1609 (ONE)
Start Date 08/14/17-1609 Stop Date 08/14/17 1610 DC: 08/14/17-1610
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $14.20
Rx Number 01536642

Discontinued Comments Reached Stop Date

History
08/14/17 1610 - POM ORDER by RMINASSIAN
08/14/17 1611 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/14/17 - 1609
08/14/17 1611 - DISCONTINUE by PHABKGJOB Eff: 08/14/17 1610
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 DC: 08/21/17-1306
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 3 Total Costs $0.00 Total Charges $42.60
Rx Number 01538190

History
08/18/17 1720 - POM ORDER by CDOHLE
08/18/17 1729 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/21/17 1307 - DISCONTINUE by RMINASSIAN Eff: 08/21/17 1306
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/21/17 1307 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01424792
08/21/17 1333 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by RMINASSIAN Eff: 08/21/17 1307
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/22/17-0900 Stop Date 09/21/17 0859 DC: 08/22/17-0900
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538577

History
08/21/17 1307 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01538190
08/21/17 1333 - DISCONTINUE by AADEGBAMIG Eff: 08/22/17 0900
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/21/17 1333 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/02/17-0900 Stop Date 09/01/17 0859 DC: 08/18/17-0957
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 17 Total Costs $0.00 Total Charges $0.51
Rx Number 01533555

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1704 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/18/17 0958 - DISCONTINUE by TKOUTZEVA Eff: 08/18/17 0957
Items Auto Credited: 4 Doses Auto Credited: 4
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

For: 08/19/17 - 0900

For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/18/17 1154 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/18/17 0958
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/01/17-2100 Stop Date 08/31/17 2059 DC: 08/28/17-0925
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 27 Total Costs $0.00 Total Charges $910.25
Rx Number 01533556

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1704 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 2100
For: 08/02/17 - 2100
For: 08/03/17 - 2100
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 2100
08/28/17 0925 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0925
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0925 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426708
08/28/17 1304 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0925
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/28/17-0925
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01533544

History
08/01/17 1649 - POM ORDER by RMINASSIAN
08/01/17 1657 - VERIFIED by AMACCA
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0925 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0925
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426710
08/28/17 1306 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0925
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/28/17-0925
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $19.75
Rx Number 01533557

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1704 - VERIFIED by AMACCA
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/04/17 - 0900
For: 08/04/17 - 1300
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 0900
For: 08/11/17 - 1300
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

For: 08/14/17 - 0900

For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

For: 08/28/17 - 1300

For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 5 Doses Dispensed: 5
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
08/28/17 0925 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0925
For: 08/28/17 - 2100
For: 08/29/17 - 2100
For: 08/30/17 - 2100
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426711
08/28/17 1306 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0925
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/30/17-1300 Stop Date 08/31/17 2100 DC: 08/31/17-1507
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 13 Total Costs $0.00 Total Charges $0.60
Rx Number 01541281

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

Discontinued Comments duplicate order

History
08/30/17 1209 - POM ORDER by RMINASSIAN
08/30/17 1210 - VERIFIED by AMOLINARI
Items Dispensed: 14 Doses Dispensed: 14
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
08/31/17 1456 - EDIT by RMINASSIAN
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
FROM:
START: 08/30/17-1300 STOP: 09/29/17 1259 SOFT STOP: 0
DISPENSE: 14
TO:
START: 08/30/17-1300 STOP: 08/31/17-2100 SOFT STOP:
DISPENSE: 5
08/31/17 1456 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01427699
08/31/17 1507 - DISCONTINUE by AADEGBAMIG Eff: 08/31/17 1507
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/31/17 - 1700
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

DC COMMENTS:
TO:
DC COMMENTS:
duplicate order
08/31/17 1507 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by RMINASSIAN Eff: 08/31/17 1456
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

HYDR25TA14 - HYDRALAZINE HCL 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/09/17-1450
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 24 Total Costs $0.00 Total Charges $6.00
Rx Number 01533558

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1704 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/01/17 - 1700
For: 08/02/17 - 0900
For: 08/02/17 - 1300
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1300
For: 08/03/17 - 1700
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/04/17 - 0900
For: 08/04/17 - 1300
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1300
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1300
For: 08/06/17 - 1700
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/07/17 - 0900
For: 08/07/17 - 1300
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1300
For: 08/08/17 - 1700
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/09/17 - 0900
For: 08/09/17 - 1300
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 0900
For: 08/11/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

For: 08/11/17 - 1700

For: 08/12/17 - 0900
For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
08/09/17 1451 - DISCONTINUE by CDOHLE Eff: 08/09/17 1450
Items Auto Credited: 13 Doses Auto Credited: 13
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1300
For: 08/10/17 - 1700
For: 08/11/17 - 0900
For: 08/11/17 - 1300
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
EDIT DOCTOR: DOHLE,CAROLIN MD
08/10/17 1411 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 1451
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

LBT100T - LABETALOL HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/01/17-2100 Stop Date 08/31/17 2059 DC: 08/09/17-0939
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $18.00
Rx Number 01533561

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1705 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/01/17 - 2100
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/09/17 0941 - DISCONTINUE by RMINASSIAN Eff: 08/09/17 0939
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

For: 08/11/17 - 0900

For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/09/17 0941 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01421682
08/09/17 1210 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/09/17 0941

LBT100T - LABETALOL HCL 100 MG TAB

Dose 100 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/09/17-1045 Stop Date 08/09/17 1046 DC: 08/09/17-1046
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 1 Total Costs $0.00 Total Charges $1.20
Rx Number 01535378

Discontinued Comments Reached Stop Date

History
08/09/17 1044 - POM ORDER by RMINASSIAN
08/09/17 1210 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by JKUCHAREWI Eff: 08/09/17 1048
08/09/17 1210 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 1045
08/09/17 1210 - DISCONTINUE by PHABKGJOB Eff: 08/09/17 1046
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

LVT.025T1 - LEVOTHYROXINE SODIUM 25 MCG (SYNTHROID) TAB

Dose 25 MCG (1 TABLET)

Admin Route ORAL
Frequency DAILY@07 (SCH)
Start Date 08/02/17-0700 Stop Date 09/01/17 0659 DC: 08/31/17-1456
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 30 Total Costs $0.00 Total Charges $84.00
Rx Number 01533564

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1705 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/02/17 - 0700
For: 08/03/17 - 0700
For: 08/04/17 - 0700
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/05/17 - 0700
For: 08/06/17 - 0700
For: 08/07/17 - 0700
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/08/17 - 0700
For: 08/09/17 - 0700
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/10/17 - 0700
For: 08/11/17 - 0700
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/12/17 - 0700
For: 08/13/17 - 0700
For: 08/14/17 - 0700
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/15/17 - 0700
For: 08/16/17 - 0700
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/17/17 - 0700
For: 08/18/17 - 0700
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/19/17 - 0700
For: 08/20/17 - 0700
For: 08/21/17 - 0700
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/22/17 - 0700
For: 08/23/17 - 0700
08/21/17 0830 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/24/17 - 0700
For: 08/25/17 - 0700
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/26/17 - 0700
For: 08/27/17 - 0700
For: 08/28/17 - 0700
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/29/17 - 0700
For: 08/30/17 - 0700
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 0700
08/31/17 1456 - DISCONTINUE by RMINASSIAN Eff: 08/31/17 1456
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/31/17 1456 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01427700
08/31/17 1458 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by RMINASSIAN Eff: 08/31/17 1456
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/08/17-0900 Stop Date 09/07/17 0859 DC: 08/09/17-0939
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 4 Total Costs $0.00 Total Charges $0.05
Rx Number 01534962

History
08/07/17 1600 - POM ORDER by RMINASSIAN
08/07/17 1602 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 08/08/17 - 0900
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/09/17 0941 - DISCONTINUE by RMINASSIAN Eff: 08/09/17 0939
Items Auto Credited: 8 Doses Auto Credited: 4
For: 08/10/17 - 0900
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/09/17 0941 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01421683
08/09/17 1210 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/09/17 0941
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 100
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/10/17-0900 Stop Date 09/09/17 0859 DC: 08/16/17-1059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $0.05
Rx Number 01535380

History
08/09/17 0941 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01534962
08/09/17 1210 - VERIFIED by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/10/17 - 0900
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/10/17 1407 - HOLD by RMINASSIAN Eff: 08/10/17 1358
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
Items Auto Credited: 6 Doses Auto Credited: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/10/17 1411 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Hold/Resume by RMINASSIAN Eff: 08/10/17 1407
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 1103 - DISCONTINUE by RMINASSIAN Eff: 08/16/17 1059
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/16/17 1120 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RMINASSIAN Eff: 08/16/17 1103
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/09/17-1045 Stop Date 08/09/17 1046 DC: 08/09/17-1046
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $0.05
Rx Number 01535381

Discontinued Comments Reached Stop Date

History
08/09/17 1044 - POM ORDER by RMINASSIAN
08/09/17 1210 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by JKUCHAREWI Eff: 08/09/17 1048
08/09/17 1210 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 1
For: 08/09/17 - 1045
08/09/17 1210 - DISCONTINUE by PHABKGJOB Eff: 08/09/17 1046
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/28/17-0925
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533546

History
08/01/17 1649 - POM ORDER by RMINASSIAN
08/01/17 1657 - VERIFIED by AMACCA
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0925 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0925
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426713
08/28/17 1307 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0925
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/28/17-0925
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533545

History
08/01/17 1649 - POM ORDER by RMINASSIAN
08/01/17 1657 - VERIFIED by AMACCA
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0925 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0925
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426714
08/28/17 1307 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0925
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/01/17-1700 Stop Date 08/31/17 1659 DC: 08/28/17-0925
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 2 Total Costs $0.00 Total Charges $0.40
Rx Number 01533547

History
08/01/17 1649 - POM ORDER by RMINASSIAN
08/01/17 1657 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 08/01/17 - 1700
08/02/17 0821 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0828 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0925 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0925
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0926 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426715
08/28/17 1307 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0925
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/04/17-2100 Stop Date 09/03/17 2059 DC: 09/01/17-1227
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 28 Total Costs $0.00 Total Charges $6.44
Rx Number 01534534

History
08/04/17 2048 - POM ORDER by SDAS
08/04/17 2057 - VERIFIED by MHAIMOWITZ
Items Dispensed: 5 Doses Dispensed: 5
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0811 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0811 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0827 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0823 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

For: 08/27/17 - 2100

08/25/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/01/17 - 2100
For: 09/02/17 - 2100
09/01/17 1228 - DISCONTINUE by SDAS Eff: 09/01/17 1227
Items Auto Credited: 2 Doses Auto Credited: 2
For: 09/01/17 - 2100
For: 09/02/17 - 2100
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
09/01/17 1228 - POM COPY AND EDIT by SDAS
TO: Rx #U01427963
09/01/17 1307 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 09/01/17 1228
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/01/17-2100 Stop Date 08/01/17 2101 DC: 08/01/17-2100
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533562

Warnings
Type: BURKE
Range: WARFARIN SOD
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.5 MG/DAY - 15 MG/DAY. Ordered dose of 0 MG/DAY is
below the Low Daily Dose.

History
08/01/17 1658 - POM ORDER by RMINASSIAN
08/01/17 1705 - VERIFIED by AMACCA
08/01/17 2041 - DISCONTINUE by RSHARMA Eff: 08/01/17 2100
For: 08/01/17 - 2100
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/01/17 2050 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RSHARMA Eff: 08/01/17 2041
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/01/17-2100 Stop Date 08/01/17 2101 DC: 08/01/17-2101
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533584

Discontinued Comments Reached Stop Date

History
08/01/17 2041 - POM ORDER by RSHARMA
08/01/17 2050 - VERIFIED by MHAIMOWITZ
08/01/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/01/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/02/17-2100 Stop Date 08/02/17 2101 DC: 08/02/17-2101
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01533817

Discontinued Comments Reached Stop Date

History
08/02/17 2033 - POM ORDER by SMOHAMED
08/02/17 2042 - EDIT by MHAIMOWITZ
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/02/17-2100 STOP: 08/03/17 2059 SOFT STOP: 0
TO:
START: 08/02/17-2100 STOP: 08/02/17-2101 SOFT STOP: 0
08/02/17 2042 - VERIFIED by MHAIMOWITZ
08/02/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/02/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/03/17-2100 Stop Date 08/03/17 2101 DC: 08/03/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01533967

Discontinued Comments Reached Stop Date

History
08/03/17 1320 - POM ORDER by RMINASSIAN
08/03/17 1321 - VERIFIED by EBALILO
08/03/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/03/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/04/17-2100 Stop Date 08/06/17 2101 DC: 08/06/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01534239

Discontinued Comments Reached Stop Date

History
08/04/17 1329 - POM ORDER by RMINASSIAN
08/04/17 1331 - EDIT by EBALILO
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/04/17-2100 STOP: 08/07/17 2059 SOFT STOP:
TO:
START: 08/04/17-2100 STOP: 08/06/17-2101 SOFT STOP: 0
08/04/17 1331 - VERIFIED by EBALILO
08/06/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/06/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF1T - WARFARIN SOD 1 MG TAB

Dose 1 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/07/17-2100 Stop Date 08/07/17 2101 DC: 08/07/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01534885

Discontinued Comments Reached Stop Date

History
08/07/17 1452 - POM ORDER by RMINASSIAN
08/07/17 1455 - VERIFIED by AMACCA
08/07/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/07/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/08/17-2100 Stop Date 08/10/17 2059 DC: 08/10/17-2059
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01534886

Discontinued Comments Reached Stop Date

History
08/07/17 1452 - POM ORDER by RMINASSIAN
08/07/17 1455 - VERIFIED by AMACCA
08/10/17 2059 - DISCONTINUE by PHABKGJOB Eff: 08/10/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/10/17-2100 Stop Date 08/10/17 2101 DC: 08/10/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01535644

Discontinued Comments Reached Stop Date

History
08/10/17 1408 - POM ORDER by RMINASSIAN
08/10/17 1411 - VERIFIED by AMOLINARI
08/10/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/10/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/11/17-2100 Stop Date 08/13/17 2101 DC: 08/13/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01535996

Discontinued Comments Reached Stop Date

History
08/11/17 1021 - POM ORDER by RMINASSIAN
08/11/17 1156 - EDIT by AMOLINARI
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/11/17-2100 STOP: 08/14/17 2059 SOFT STOP:
TO:
START: 08/11/17-2100 STOP: 08/13/17-2101 SOFT STOP: 0
08/11/17 1156 - VERIFIED by AMOLINARI
08/13/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/13/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/14/17-2100 Stop Date 08/16/17 2059 DC: 08/16/17-1120
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01536587

History
08/14/17 1456 - POM ORDER by RMINASSIAN
08/14/17 1458 - VERIFIED by AADEGBAMIG
08/16/17 1120 - DISCONTINUE by AMOLINARI Eff: 08/16/17 1120
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/16/17-2100 Stop Date 08/17/17 2101 DC: 08/17/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01537144

Discontinued Comments Reached Stop Date

History
08/16/17 1103 - POM ORDER by RMINASSIAN
08/16/17 1120 - EDIT by AMOLINARI
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/16/17-2100 STOP: 08/18/17 2059 SOFT STOP:
TO:
START: 08/16/17-2100 STOP: 08/17/17-2101 SOFT STOP: 0
08/16/17 1120 - VERIFIED by AMOLINARI
08/17/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 08/19/17 2101 DC: 08/19/17-2101
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01538191

Discontinued Comments Reached Stop Date

History
08/18/17 1719 - POM ORDER by CDOHLE
08/18/17 1732 - VERIFIED by EBALILO
08/19/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/19/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/20/17-2100 Stop Date 08/20/17 2101 DC: 08/20/17-2101
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538382

Discontinued Comments Reached Stop Date

History
08/20/17 1150 - POM ORDER by RSHARMA
08/20/17 1233 - VERIFIED by AADEGBAMIG
08/20/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/20/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 08/23/17 2059 DC: 08/23/17-1523
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01538575

Discontinued Comments new order on file

History
08/21/17 1309 - POM ORDER by RMINASSIAN
08/21/17 1332 - VERIFIED by AADEGBAMIG
08/23/17 1523 - DISCONTINUE by MHAIMOWITZ Eff: 08/23/17 1523
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
new order on file

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/23/17-2100 Stop Date 08/23/17 2101 DC: 08/23/17-2101
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539331

Discontinued Comments Reached Stop Date

History
08/23/17 1520 - POM ORDER by CDOHLE
08/23/17 1524 - VERIFIED by MHAIMOWITZ
08/23/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 08/24/17-2100 Stop Date 08/24/17 2101 DC: 08/24/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539733

Discontinued Comments Reached Stop Date

History
08/24/17 1608 - POM ORDER by RMINASSIAN
08/24/17 1611 - VERIFIED by EBALILO
08/24/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/26/17-2100 Stop Date 08/28/17 2059 DC: 08/26/17-2100
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539902

History
08/25/17 1050 - POM ORDER by RMINASSIAN
08/25/17 1218 - DISCONTINUE by RMINASSIAN Eff: 08/26/17 2100
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/25/17 1218 - VERIFIED by SYSTEM
Verified in order to DC
08/25/17 1218 - POM COPY AND EDIT by RMINASSIAN
TO: Rx #U01426176
08/25/17 1226 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 08/25/17 1218
Discontinue by RMINASSIAN Eff: 08/25/17 1218
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency 2100 (ONE)
Start Date 08/25/17-2100 Stop Date 08/25/17 2101 DC: 08/25/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539936

Discontinued Comments Reached Stop Date

History
08/25/17 1050 - POM ORDER by RMINASSIAN
08/25/17 1226 - VERIFIED by AMOLINARI
08/25/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/26/17-2100 Stop Date 08/26/17 2101 DC: 08/26/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539935

Discontinued Comments Reached Stop Date

History
08/25/17 1226 - ENTER by AMOLINARI
08/26/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/26/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/27/17-2100 Stop Date 08/27/17 2101 DC: 08/27/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540465

Discontinued Comments Reached Stop Date

History
08/27/17 1326 - POM ORDER by RMINASSIAN
08/27/17 1413 - VERIFIED by AADEGBAMIG
08/27/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/27/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/28/17-2100 Stop Date 08/29/17 2101 DC: 08/29/17-2101
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01540699

Discontinued Comments Reached Stop Date

History
08/28/17 1313 - POM ORDER by CDOHLE
08/28/17 1340 - VERIFIED by AADEGBAMIG
08/29/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/30/17-2100 Stop Date 08/31/17 2101 DC: 08/31/17-2101
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01541282

Discontinued Comments Reached Stop Date

History
08/30/17 1208 - POM ORDER by RMINASSIAN
08/30/17 1210 - EDIT by AMOLINARI
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/30/17-2100 STOP: 09/01/17 2059 SOFT STOP:
TO:
START: 08/30/17-2100 STOP: 08/31/17-2101 SOFT STOP: 0
08/30/17 1210 - VERIFIED by AMOLINARI
08/31/17 2101 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

WRF2T - WARFARIN SOD 2 MG TAB

Dose 2 MG (1 TABLET)
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/01/17-2100 Stop Date 09/01/17 2101 DC: 09/01/17-2101
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542012

Discontinued Comments Reached Stop Date

History
09/01/17 1547 - POM ORDER by SDAS
09/01/17 1550 - VERIFIED by AADEGBAMIG
09/01/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/01/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

COUMNODOSE - WARFARIN SOD 0 MG HOLD DOSE

Dose 1 NODOSE (1 DOSAGE HELD)

Dose Instructions DOSE ON HOLD FOR TONIGHT.
DO NOT GIVE.
Admin Route ORAL
Frequency COUMADIN ONETIME (ONE)
Start Date 09/02/17-2100 Stop Date 09/02/17 2101 DC: 09/02/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542264

Discontinued Comments Reached Stop Date

History
09/02/17 1616 - POM ORDER by HAZIZI
09/02/17 1721 - VERIFIED by MHAIMOWITZ
09/02/17 2101 - DISCONTINUE by PHABKGJOB Eff: 09/02/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

MAHARAJ,DEONARINE W00001218143 (Continued)

WRF2.5T - WARFARIN SOD 2.5 MG TAB

Dose 2 MG (0.8 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/26/17-2100 Stop Date 08/26/17 2101 CAN: 08/25/17-1225
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed Total Costs $ Total Charges $
Rx Number U01426176

History
08/25/17 1218 - POM COPY AND EDIT by RMINASSIAN
FROM: Rx #01539902
08/25/17 1225 - EDIT by AMOLINARI
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/26/17-2100 STOP: 08/27/17 2059 SOFT STOP: 0
TO:
START: 08/26/17-2100 STOP: 08/26/17-2101 SOFT STOP: 0
08/25/17 1225 - CANCEL by AMOLINARI
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
changed to use 2mg tab
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient MALONEY,PATRICK F Responsible Doctor HILL,JUSTIN M.D.

Account Number W00001215850 Location B2WEII Unit Number M000207360
Age/Sex 65/M Room 259 Registered Date 06/06/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 1.69 m2

Weight 131 lb 9.6 oz 59.693 kg
Hem-Onc No

Drug Allergies No Known Allergies (NKA)

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/03/17-1107 DRUG REGIMEN REVIEW COMPLETE
08/31/17-0952 DRUG REGIMEN REVIEW ACTIVE

Med Allergies:
Food Allergies:
Primary Diagnosis: ANOXIC BRAIN INJURY
Secondary Diagnosis:

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (0 EACHS)
Dose Instructions Acuity AZ (Multivitamin)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/15/17-0900 Stop Date 09/11/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536514

History
08/14/17 1206 - COPY AND EDIT by AMOLINARI
FROM: Rx #01536156
08/14/17 1206 - ENTER by AMOLINARI
08/14/17 1206 - SYSTEM COPY AND EDIT by AMOLINARI
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
START: 08/12/17-0900 STOP: 09/11/17 0859 SOFT STOP: 0
DISPENSE: 2
TO:
ORDER TYPE: BULK - BULK ORDER
START: 08/15/17-0900 STOP: 09/11/17-0859 SOFT STOP: 0
DISPENSE: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions To buttock
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01542124

History
09/01/17 1859 - POM COPY AND EDIT by YCHO
FROM: Rx #01540557
09/01/17 1911 - EDIT by MHAIMOWITZ
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
DISPENSE: 1
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP: 0
DISPENSE: 0
09/01/17 1911 - VERIFIED by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 17 Total Costs $0.00 Total Charges $8.16
Rx Number 01540558

History
08/28/17 0932 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01532927
08/28/17 1044 - VERIFIED by JDIMARCO
Items Dispensed: 7 Doses Dispensed: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/01/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 3 Total Costs $0.00 Total Charges $0.10
Rx Number 01542289

History
09/03/17 0843 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01534807
09/03/17 1037 - EDIT by MHAIMOWITZ
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/03/17-0900 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/03/17-0900 STOP: 10/01/17-0859 SOFT STOP: 0
09/03/17 1037 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by JDEPAOLO Eff: 09/03/17 0942
09/03/17 1037 - VERIFIED by MHAIMOWITZ
Items Dispensed: 3 Doses Dispensed: 3
For: 09/03/17 - 0900
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/07/17-2100 Stop Date 09/06/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 60 Total Costs $0.00 Total Charges $1844.10
Rx Number 01534808

History
08/07/17 1045 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01527573
08/07/17 1202 - EDIT by EBALILO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/07/17-2100 STOP: 09/06/17 SOFT STOP:
TO:
START: 08/07/17-2100 STOP: 09/06/17-2059 SOFT STOP: 0
08/07/17 1202 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/07/17 - 2100
For: 08/08/17 - 2100
For: 08/09/17 - 2100
For: 08/10/17 - 2100
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Items Dispensed: 6 Doses Dispensed: 3

For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency 2 TIMES A DAY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/14/17-2300 Stop Date 09/13/17 2259
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536817

History
08/14/17 2258 - POM ORDER by RSHARMA
08/15/17 0737 - VERIFIED by AMOLINARI
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CRV3.125T - CARVEDILOL 3.125 MG TAB

Dose 3.125 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 17 Total Costs $0.00 Total Charges $2.97
Rx Number 01540559

History
08/28/17 0932 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01532928
08/28/17 1044 - VERIFIED by JDIMARCO
Items Dispensed: 7 Doses Dispensed: 7
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/27/17
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $96.78
Rx Number 01540560

History
08/28/17 0932 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01532929
08/28/17 1044 - VERIFIED by JDIMARCO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 50 MG (2 CAPSULES)
Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $2.25
Rx Number 01540028

History
08/25/17 1259 - POM COPY AND EDIT by JHILL
FROM: Rx #01538217
08/25/17 1315 - VERIFIED by AADEGBAMIG
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/07/17-1045 Stop Date 09/06/17 1044
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01534805

History
08/07/17 1045 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01527586
08/07/17 1200 - EDIT by EBALILO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/07/17-1045 STOP: 09/06/17 SOFT STOP:
TO:
START: 08/07/17-1045 STOP: 09/06/17-1044 SOFT STOP: 0
08/07/17 1200 - VERIFIED by EBALILO
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/03/17-0900 Stop Date 10/01/17 0859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01542290

History
09/03/17 0843 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01534806
09/03/17 1037 - EDIT by MHAIMOWITZ
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/03/17-0900 STOP: 10/01/17 SOFT STOP:
TO:
START: 09/03/17-0900 STOP: 10/01/17-0859 SOFT STOP: 0
09/03/17 1037 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Administration of Unverified Order by JDEPAOLO Eff: 09/03/17 0942
09/03/17 1037 - VERIFIED by MHAIMOWITZ

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 8 Total Costs $0.00 Total Charges $48.65
Rx Number 01540996

History
08/29/17 1416 - POM ORDER by JRUSSO
08/29/17 1417 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 2100
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

RNT150T - RANITIDINE HCL 150 MG TAB

Dose 150 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-1700 Stop Date 09/29/17
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 13 Total Costs $0.00 Total Charges $2.80
Rx Number 01541245

History
08/30/17 0921 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01533866
08/30/17 1111 - VERIFIED by JDIMARCO
Items Dispensed: 9 Doses Dispensed: 9
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP - 900 MG

GBPN100C - GABAPENTIN 100 MG CAP - 100 MG

Dose 1,000 MG (4 CAPSULES)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/25/17-1330 Stop Date 09/08/17 1259
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 140 Total Costs $0.00 Total Charges $20.25
Rx Number 01540030

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Maximum Daily Dose is 1,800 MG/DAY. Ordered dose of 3,000 MG/DAY
exceeds the Maximum Daily Dose.

History
08/25/17 1318 - ENTER by AADEGBAMIG
Items Dispensed: 56 Doses Dispensed: 14
For: 08/25/17 - 1330
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/25/17 1318 - NOW DOSE by AADEGBAMIG
Now Dose: 08/25/17 1330
08/25/17 1318 - KEEP NEXT DOSE by AADEGBAMIG
Keep Next Dose: 08/25/17 1700
08/25/17 1320 - EDIT by AADEGBAMIG
EDIT DOCTOR: HILL,JUSTIN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/25/17-1330 STOP: 09/24/17 1329 SOFT STOP: 0
TO:
START: 08/25/17-1330 STOP: 09/08/17-1259 SOFT STOP: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 24 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 08/31/17 - 1300

For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 36 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 24 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions ear abrasion
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 05/23/17-2100 Stop Date 05/30/17 2059 DC: 05/30/17-1223
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01514824

History
05/23/17 1310 - POM ORDER by GGARRISON
05/23/17 1311 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 05/23/17 - 2100
05/30/17 1224 - DISCONTINUE by GGARRISON Eff: 05/30/17 1223
EDIT DOCTOR: GARRISON,GRAHAM MD
05/30/17 1224 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
05/30/17 1224 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01403245
05/30/17 1225 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by GGARRISON Eff: 05/30/17 1224
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions ear abrasion
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 05/30/17-2100 Stop Date 06/06/17 2059 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01516299

Discontinued Comments DC'd by Discharge

History
05/30/17 1224 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01514824
05/30/17 1225 - EDIT by EBALILO
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 05/30/17-2100 STOP: 06/06/17 SOFT STOP:
TO:
START: 05/30/17-2100 STOP: 06/06/17-2059 SOFT STOP: 0
05/30/17 1225 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 05/30/17 - 2100
05/30/17 1226 - CREDIT by EBALILO
ITEMS: 1
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions ear abrasion
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 06/06/17-2100 Stop Date 06/13/17 2059 DC: 06/12/17-1048
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01518263

History
06/06/17 1444 - POM COPY AND EDIT by GGARRISON
FROM: Rx #U01405152
06/06/17 1445 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 06/06/17 - 2100
06/12/17 1049 - DISCONTINUE by GGARRISON Eff: 06/12/17 1048
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1049 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01406800
06/12/17 1120 - REVIEW PROVIDER ACTIVITY by JORPHAL
Discontinue by GGARRISON Eff: 06/12/17 1049

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions right hip abrasion
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 06/09/17-2100 Stop Date 06/16/17 2059 DC: 06/16/17-2059
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01519411

Discontinued Comments Reached Stop Date

History
06/09/17 1405 - POM ORDER by GGARRISON
06/09/17 1410 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 06/09/17 - 2100
06/16/17 2059 - DISCONTINUE by PHABKGJOB Eff: 06/16/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions ear abrasion
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 06/12/17-2100 Stop Date 06/19/17 2059 DC: 06/19/17-2059
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01519913

Discontinued Comments Reached Stop Date

History
06/12/17 1049 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518263
06/12/17 1120 - EDIT by JORPHAL
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 06/12/17-2100 STOP: 06/19/17 SOFT STOP:
TO:
START: 06/12/17-2100 STOP: 06/19/17-2059 SOFT STOP: 0
06/12/17 1120 - VERIFIED by JORPHAL
Items Dispensed: 1 Doses Dispensed: 1
For: 06/12/17 - 2100
06/12/17 1121 - CREDIT by JORPHAL
ITEMS: 1
06/19/17 2059 - DISCONTINUE by PHABKGJOB Eff: 06/19/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions To left elbow abrasion
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 07/18/17-2100 Stop Date 07/25/17 2059 DC: 07/24/17-1057
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Clinical Indication OTHER
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01529570

History
07/18/17 1034 - POM ORDER by JRUSSO
07/18/17 1048 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/18/17 - 2100
07/24/17 1057 - DISCONTINUE by JRUSSO Eff: 07/24/17 1057
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/24/17 1057 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01417316
07/24/17 1213 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by JRUSSO Eff: 07/24/17 1057
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions To left elbow abrasion
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 07/24/17-2100 Stop Date 07/31/17 2059 DC: 07/31/17-0953
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Clinical Indication OTHER
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01530852

History
07/24/17 1057 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01529570
07/24/17 1212 - EDIT by MHAIMOWITZ
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/24/17-2100 STOP: 07/31/17 SOFT STOP:
TO:
START: 07/24/17-2100 STOP: 07/31/17-2059 SOFT STOP: 0
07/24/17 1212 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 07/24/17 - 2100
07/24/17 1213 - CREDIT by MHAIMOWITZ
ITEMS: 1
07/31/17 0954 - DISCONTINUE by JRUSSO Eff: 07/31/17 0953
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/31/17 1130 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 07/31/17 0954
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BACI3.5O3 - BACITRACIN/POLYMYXIN B SULFATE 3.5 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions around the neck
Admin Route OPHTHALMIC
Frequency DAILY@0600,2100 (SCH)
Start Date 07/25/17-0600 Stop Date 08/01/17 0559 DC: 07/25/17-0710
Ordering Doctor CHO,YUSIK MD PGY-2
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01531172

Discontinued Comments change to polysporin ointment- not opth

History
07/24/17 2156 - POM ORDER by YCHO
07/25/17 0711 - DISCONTINUE by AMACCA Eff: 07/25/17 0710
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
change to polysporin ointment- not opth
07/25/17 0711 - REVIEW PROVIDER ACTIVITY by SYSTEM
Administration of Unverified Order by BYOHANNAN Eff: 07/25/17 0635
07/25/17 0711 - VERIFIED by SYSTEM
Verified in order to DC

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Admin Route TOPICALLY
Frequency DAILY@0600,2100 (SCH)
Start Date 07/25/17-0600 Stop Date 08/01/17 0559 DC: 07/25/17-0714
Ordering Doctor CHO,YUSIK MD PGY-2
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01531173

History
07/25/17 0713 - ENTER by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/25/17 - 0600
07/25/17 0714 - COPY AND EDIT by AMACCA
TO: Rx #01531174
07/25/17 0714 - DISCONTINUE by AMACCA Eff: 07/25/17 0714
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions AROUND THE NECK
Admin Route TOPICALLY
Frequency DAILY@0600,2100 (SCH)
Start Date 07/25/17-2100 Stop Date 08/01/17 0559 DC: 07/28/17-0946
Ordering Doctor CHO,YUSIK MD PGY-2
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01531174

History
07/25/17 0714 - COPY AND EDIT by AMACCA
FROM: Rx #01531173
07/25/17 0714 - ENTER by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/25/17 - 2100
07/25/17 0714 - SYSTEM COPY AND EDIT by AMACCA
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/25/17-0600 STOP: 08/01/17 0559 SOFT STOP: 0
DOSE INSTRUCTIONS:
TO:
START: 07/25/17-2100 STOP: 08/01/17-0559 SOFT STOP: 0
DOSE INSTRUCTIONS:
AROUND THE NECK
07/28/17 0946 - DISCONTINUE by JRUSSO Eff: 07/28/17 0946
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/28/17 0946 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01418779
07/31/17 1130 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 07/28/17 0946
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions AROUND THE NECK
Admin Route TOPICALLY
Frequency DAILY@0600,2100 (SCH)
Start Date 07/28/17-2100 Stop Date 08/03/17 2059 DC: 07/31/17-0953
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Clinical Indication SKIN & SOFT TISSUE INFECTION
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01532351

History
07/28/17 0946 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01531174
07/28/17 1016 - EDIT by AADEGBAMIG
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/28/17-2100 STOP: 08/03/17 SOFT STOP:
TO:
START: 07/28/17-2100 STOP: 08/03/17-2059 SOFT STOP:
07/28/17 1016 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 07/28/17 - 2100
07/31/17 0954 - DISCONTINUE by JRUSSO Eff: 07/31/17 0953
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/31/17 1130 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 07/31/17 0954

DIPH12.5L - DIPHENHYDRAMINE HCL ELIXIR 12.5 MG/5 ML

Dose 25 MG (10 ML)

Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059 DC: 08/18/17-1249
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 118 Total Costs $0.00 Total Charges $3.54
Rx Number 01535974

History
08/11/17 1118 - POM ORDER by JRUSSO
08/11/17 1138 - VERIFIED by AMOLINARI
Items Dispensed: 118 Doses Dispensed: 1
For: 08/11/17 - 2100
08/18/17 1250 - DISCONTINUE by JRUSSO Eff: 08/18/17 1249
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/18/17 1811 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by JRUSSO Eff: 08/18/17 1250
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

HC.5C30 - HYDROCORTISONE 0.5% CR 28.35 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions back and chest rash
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 06/06/17-2100 Stop Date 06/13/17 2059 DC: 06/12/17-1048
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 2 Total Costs $0.00 Total Charges $19.44
Rx Number 01518399

History
06/06/17 1702 - POM ORDER by GGARRISON
06/06/17 1715 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 06/06/17 - 2100
06/10/17 1034 - DEBIT by EBALILO
ITEMS: 1
06/12/17 1049 - DISCONTINUE by GGARRISON Eff: 06/12/17 1048
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1049 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01406801
06/12/17 1120 - REVIEW PROVIDER ACTIVITY by JORPHAL
Discontinue by GGARRISON Eff: 06/12/17 1049
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

HC.5C30 - HYDROCORTISONE 0.5% CR 28.35 GM TUBE

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions back and chest rash
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 06/12/17-2100 Stop Date 06/19/17 2059 DC: 06/19/17-2059
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01519914

Discontinued Comments Reached Stop Date

History
06/12/17 1049 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518399
06/12/17 1120 - EDIT by JORPHAL
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 06/12/17-2100 STOP: 06/19/17 SOFT STOP:
TO:
START: 06/12/17-2100 STOP: 06/19/17-2059 SOFT STOP:
06/12/17 1120 - VERIFIED by JORPHAL
Items Dispensed: 1 Doses Dispensed: 1
For: 06/12/17 - 2100
06/12/17 1121 - CREDIT by JORPHAL
ITEMS: 1
06/19/17 2059 - DISCONTINUE by PHABKGJOB Eff: 06/19/17 2059
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions To buttock
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-1859
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01540557

History
08/28/17 0927 - POM ORDER by JRUSSO
08/28/17 1044 - VERIFIED by JDIMARCO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/28/17 - 2100
09/01/17 1859 - DISCONTINUE by YCHO Eff: 09/01/17 1859
EDIT DOCTOR: CHO,YUSIK MD PGY-2
09/01/17 1859 - POM COPY AND EDIT by YCHO
TO: Rx #U01428171
09/01/17 1911 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by YCHO Eff: 09/01/17 1859
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Dose Instructions FOR MILD PAIN OR FEVER
Admin Route PEG TUBE
Frequency 4 TIMES A DAY (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 05/23/17-1245 Stop Date 06/22/17 1244 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01514816

Discontinued Comments DC'd by Discharge

History
05/23/17 1246 - POM ORDER by GGARRISON
05/23/17 1250 - VERIFIED by AMACCA
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
For: 06/05/17 - 0900
For: 06/05/17 - 1300
For: 06/05/17 - 1700
For: 06/06/17 - 0900
For: 06/06/17 - 1300
For: 06/06/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Dose Instructions FOR MILD PAIN OR FEVER
Admin Route PEG TUBE
Frequency 4 TIMES A DAY (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 06/06/17-1430 Stop Date 07/06/17 1429 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01518248

History
06/06/17 1431 - POM ORDER by GGARRISON
06/06/17 1435 - VERIFIED by EBALILO
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 0 Doses Dispensed: 0
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407013
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Dose Instructions FOR MILD PAIN OR FEVER
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 06/12/17-1615 Stop Date 07/12/17 1614 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01520148

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518248
06/12/17 1614 - VERIFIED by AMACCA
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 0 Doses Dispensed: 0
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 0 Doses Dispensed: 0
06/26/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/28/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414205
07/11/17 1018 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/11/17 1012
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Dose Instructions FOR MILD PAIN OR FEVER
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 07/11/17-1015 Stop Date 08/10/17 1014 DC: 08/04/17-1021
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01527564

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520148
07/11/17 1018 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/11/17-1015 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/11/17-1015 STOP: 08/10/17-1014 SOFT STOP:
07/11/17 1018 - VERIFIED by AMACCA
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 1022 - DISCONTINUE by JRUSSO Eff: 08/04/17 1021
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/09/17 1140 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/04/17 1022
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Dose Instructions PEG tube
Admin Route XX
Frequency EVERY 12 HOURS (SCH)
Start Date 05/23/17-2100 Stop Date 06/22/17 2059 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 25 Total Costs $0.00 Total Charges $15.64
Rx Number 01514825

Discontinued Comments DC'd by Discharge

History
05/23/17 1309 - POM ORDER by GGARRISON
05/23/17 1311 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 05/23/17 - 2100
For: 05/24/17 - 0900
For: 05/24/17 - 2100
For: 05/25/17 - 0900
For: 05/25/17 - 2100
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/26/17 - 0900
For: 05/26/17 - 2100
For: 05/27/17 - 0900
For: 05/27/17 - 2100
For: 05/28/17 - 0900
For: 05/28/17 - 2100
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 05/29/17 - 0900
For: 05/29/17 - 2100
For: 05/30/17 - 0900
For: 05/30/17 - 2100
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 05/31/17 - 0900
For: 05/31/17 - 2100
For: 06/01/17 - 0900
For: 06/01/17 - 2100
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/02/17 - 0900
For: 06/02/17 - 2100
For: 06/03/17 - 0900
For: 06/03/17 - 2100
For: 06/04/17 - 0900
For: 06/04/17 - 2100
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 06/05/17 - 0900
For: 06/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 06/06/17 - 0900

For: 06/06/17 - 2100
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
Items Auto Credited: 4 Doses Auto Credited: 4
For: 06/05/17 - 0900
For: 06/05/17 - 2100
For: 06/06/17 - 0900
For: 06/06/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Dose Instructions PEG tube
Admin Route XX
Frequency EVERY 12 HOURS (SCH)
Start Date 06/06/17-2100 Stop Date 07/06/17 2059 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 12 Total Costs $0.00 Total Charges $7.48
Rx Number 01518255

History
06/06/17 1431 - POM ORDER by GGARRISON
06/06/17 1439 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 06/06/17 - 2100
For: 06/07/17 - 0900
For: 06/07/17 - 2100
For: 06/08/17 - 0900
For: 06/08/17 - 2100
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/09/17 - 0900
For: 06/09/17 - 2100
For: 06/10/17 - 0900
For: 06/10/17 - 2100
For: 06/11/17 - 0900
For: 06/11/17 - 2100
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 4 Doses Dispensed: 4
For: 06/12/17 - 0900
For: 06/12/17 - 2100
For: 06/13/17 - 0900
For: 06/13/17 - 2100
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 06/14/17 - 0900
For: 06/14/17 - 2100
For: 06/15/17 - 0900
For: 06/15/17 - 2100
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
Items Auto Credited: 7 Doses Auto Credited: 7
For: 06/12/17 - 2100
For: 06/13/17 - 0900
For: 06/13/17 - 2100
For: 06/14/17 - 0900
For: 06/14/17 - 2100
For: 06/15/17 - 0900
For: 06/15/17 - 2100
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407014
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Discontinue by GGARRISON Eff: 06/12/17 1609

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Dose Instructions PEG tube
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/12/17-2100 Stop Date 07/12/17 2059 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 58 Total Costs $0.00 Total Charges $30.60
Rx Number 01520149

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518255
06/12/17 1614 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 06/12/17 - 2100
For: 06/13/17 - 0900
For: 06/13/17 - 2100
For: 06/14/17 - 0900
For: 06/14/17 - 2100
For: 06/15/17 - 0900
For: 06/15/17 - 2100
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/16/17 - 0900
For: 06/16/17 - 2100
For: 06/17/17 - 0900
For: 06/17/17 - 2100
For: 06/18/17 - 0900
For: 06/18/17 - 2100
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 06/19/17 - 0900
For: 06/19/17 - 2100
For: 06/20/17 - 0900
For: 06/20/17 - 2100
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 06/21/17 - 0900
For: 06/21/17 - 2100
For: 06/22/17 - 0900
For: 06/22/17 - 2100
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/23/17 - 0900
For: 06/23/17 - 2100
For: 06/24/17 - 0900
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 2100
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 06/26/17 - 0900

For: 06/26/17 - 2100
For: 06/27/17 - 0900
For: 06/27/17 - 2100
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 06/28/17 - 0900
For: 06/28/17 - 2100
For: 06/29/17 - 0900
For: 06/29/17 - 2100
06/28/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 06/30/17 - 0900
For: 06/30/17 - 2100
For: 07/01/17 - 0900
For: 07/01/17 - 2100
For: 07/02/17 - 0900
For: 07/02/17 - 2100
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/03/17 - 0900
For: 07/03/17 - 2100
For: 07/04/17 - 0900
For: 07/04/17 - 2100
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/05/17 - 0900
For: 07/05/17 - 2100
For: 07/06/17 - 0900
For: 07/06/17 - 2100
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/07/17 - 0900
For: 07/07/17 - 2100
For: 07/08/17 - 0900
For: 07/08/17 - 2100
For: 07/09/17 - 0900
For: 07/09/17 - 2100
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/10/17 - 0900
For: 07/10/17 - 2100
For: 07/11/17 - 0900
For: 07/11/17 - 2100
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/12/17 - 0900
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/11/17 - 2100
For: 07/12/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414206
07/11/17 1018 - REVIEW PROVIDER ACTIVITY by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Discontinue by JRUSSO Eff: 07/11/17 1012

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Dose Instructions PEG tube
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/11/17-2100 Stop Date 08/10/17 2059 DC: 07/31/17-1002
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 40 Total Costs $0.00 Total Charges $22.44
Rx Number 01527567

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520149
07/11/17 1019 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/11/17-2100 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/11/17-2100 STOP: 08/10/17-2059 SOFT STOP:
07/11/17 1019 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 07/11/17 - 2100
For: 07/12/17 - 0900
For: 07/12/17 - 2100
For: 07/13/17 - 0900
For: 07/13/17 - 2100
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/14/17 - 0900
For: 07/14/17 - 2100
For: 07/15/17 - 0900
For: 07/15/17 - 2100
For: 07/16/17 - 0900
For: 07/16/17 - 2100
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/17/17 - 0900
For: 07/17/17 - 2100
For: 07/18/17 - 0900
For: 07/18/17 - 2100
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/19/17 - 0900
For: 07/19/17 - 2100
For: 07/20/17 - 0900
For: 07/20/17 - 2100
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 2100
For: 07/22/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/22/17 - 2100

For: 07/23/17 - 0900
For: 07/23/17 - 2100
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 2100
For: 07/25/17 - 0900
For: 07/25/17 - 2100
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 2100
For: 07/27/17 - 0900
For: 07/27/17 - 2100
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
For: 07/30/17 - 2100
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/17 - 0900
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 2100
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
07/31/17 1004 - DISCONTINUE by JRUSSO Eff: 07/31/17 1002
Items Auto Credited: 7 Doses Auto Credited: 7
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 2100
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/31/17 1004 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01419357
07/31/17 1130 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 07/31/17 1004
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/31/17-2100 Stop Date 08/30/17 2059 DC: 08/28/17-0931
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 56 Total Costs $0.00 Total Charges $37.40
Rx Number 01532927

History
07/31/17 1004 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01527567
07/31/17 1130 - VERIFIED by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 2100
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 08/14/17 - 2100

For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
08/28/17 0931 - DISCONTINUE by JRUSSO Eff: 08/28/17 0931
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/28/17 0932 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01426718
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

08/28/17 1044 - REVIEW PROVIDER ACTIVITY by JDIMARCO

Discontinue by JRUSSO Eff: 08/28/17 0931

AMD200T - AMIODARONE 200 MG TAB

Dose 200 MG (1 TABLET)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 07/31/17-1215 Stop Date 07/31/17 1216 DC: 07/31/17-1216
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.68
Rx Number 01533037

Discontinued Comments Reached Stop Date

History
07/31/17 1217 - POM ORDER by JRUSSO
07/31/17 1302 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by JDEPAOLO Eff: 07/31/17 1240
07/31/17 1302 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 1215
07/31/17 1302 - DISCONTINUE by PHABKGJOB Eff: 07/31/17 1216
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 05/24/17-0900 Stop Date 06/23/17 0859 DC: 05/26/17-1523
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 3 Total Costs $0.00 Total Charges $1.89
Rx Number 01514826

History
05/23/17 1309 - POM ORDER by GGARRISON
05/23/17 1311 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 05/24/17 - 0900
For: 05/25/17 - 0900
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 05/26/17 - 0900
For: 05/27/17 - 0900
For: 05/28/17 - 0900
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/29/17 - 0900
For: 05/30/17 - 0900
05/26/17 1523 - DISCONTINUE by JHILL Eff: 05/26/17 1523
Items Auto Credited: 4 Doses Auto Credited: 4
For: 05/27/17 - 0900
For: 05/28/17 - 0900
For: 05/29/17 - 0900
For: 05/30/17 - 0900
EDIT DOCTOR: HILL,JUSTIN M.D.
05/26/17 1523 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
05/26/17 1524 - POM COPY AND EDIT by JHILL
TO: Rx #U01402723
05/26/17 1524 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JHILL Eff: 05/26/17 1523
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 05/27/17-0900 Stop Date 06/26/17 0859 DC: 05/27/17-0900
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01515709

History
05/26/17 1524 - POM COPY AND EDIT by JHILL
FROM: Rx #01514826
05/26/17 1525 - VERIFIED by SYSTEM
Verified in order to DC
05/26/17 1525 - DISCONTINUE by AMACCA Eff: 05/27/17 0900
EDIT DOCTOR: HILL,JUSTIN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 05/27/17-0900 Stop Date 06/26/17 0859 DC: 06/04/17-2255
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 9 Total Costs $0.00 Total Charges $103.84
Rx Number 01515710

Discontinued Comments DC'd by Discharge

History
05/26/17 1526 - ENTER by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 05/27/17 - 0900
For: 05/28/17 - 0900
For: 05/29/17 - 0900
For: 05/30/17 - 0900
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/02/17 - 0900
For: 06/03/17 - 0900
For: 06/04/17 - 0900
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/05/17 - 0900
For: 06/06/17 - 0900
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
Items Auto Credited: 2 Doses Auto Credited: 2
For: 06/05/17 - 0900
For: 06/06/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 06/07/17-0900 Stop Date 07/07/17 0859 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 6 Total Costs $0.00 Total Charges $64.90
Rx Number 01518254

History
06/06/17 1431 - POM ORDER by GGARRISON
06/06/17 1438 - EDIT by EBALILO
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
06/06/17 1438 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/07/17 - 0900
For: 06/08/17 - 0900
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/09/17 - 0900
For: 06/10/17 - 0900
For: 06/11/17 - 0900
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 2 Doses Dispensed: 2
For: 06/12/17 - 0900
For: 06/13/17 - 0900
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/14/17 - 0900
For: 06/15/17 - 0900
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
Items Auto Credited: 3 Doses Auto Credited: 3
For: 06/13/17 - 0900
For: 06/14/17 - 0900
For: 06/15/17 - 0900
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407015
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/13/17-0900 Stop Date 07/13/17 0859 DC: 07/03/17-1611
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 21 Total Costs $0.00 Total Charges $181.72
Rx Number 01520150

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518254
06/12/17 1614 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 06/13/17 - 0900
For: 06/14/17 - 0900
For: 06/15/17 - 0900
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/16/17 - 0900
For: 06/17/17 - 0900
For: 06/18/17 - 0900
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/19/17 - 0900
For: 06/20/17 - 0900
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/21/17 - 0900
For: 06/22/17 - 0900
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/26/17 - 0900
For: 06/27/17 - 0900
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/04/17 - 0900

07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/03/17 1614 - DISCONTINUE by JHILL Eff: 07/03/17 1611
Items Auto Credited: 3 Doses Auto Credited: 3
For: 07/04/17 - 0900
For: 07/05/17 - 0900
For: 07/06/17 - 0900
EDIT DOCTOR: HILL,JUSTIN M.D.
07/03/17 1614 - POM COPY AND EDIT by JHILL
TO: Rx #U01412443
07/03/17 1630 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by JHILL Eff: 07/03/17 1614
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AML2.5T - AMLODIPINE BESYLATE 2.5 MG TAB

Dose 2.5 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/04/17-0900 Stop Date 08/03/17 0859 DC: 07/17/17-1625
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 14 Total Costs $0.00 Total Charges $3.87
Rx Number 01525761

History
07/03/17 1630 - ENTER by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 07/04/17 - 0900
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/17/17 1626 - DISCONTINUE by JRUSSO Eff: 07/17/17 1625
Items Auto Credited: 3 Doses Auto Credited: 3
For: 07/18/17 - 0900
For: 07/19/17 - 0900
For: 07/20/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/18/17 1037 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/17/17 1626
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 05/24/17-0900 Stop Date 06/23/17 0859 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 12 Total Costs $0.00 Total Charges $1.20
Rx Number 01514830

Discontinued Comments DC'd by Discharge

History
05/23/17 1309 - POM ORDER by GGARRISON
05/23/17 1326 - EDIT by AMACCA
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
05/23/17 1326 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 05/24/17 - 0900
For: 05/25/17 - 0900
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 05/26/17 - 0900
For: 05/27/17 - 0900
For: 05/28/17 - 0900
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/29/17 - 0900
For: 05/30/17 - 0900
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/02/17 - 0900
For: 06/03/17 - 0900
For: 06/04/17 - 0900
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/05/17 - 0900
For: 06/06/17 - 0900
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
Items Auto Credited: 2 Doses Auto Credited: 2
For: 06/05/17 - 0900
For: 06/06/17 - 0900
FROM:
DC COMMENTS:
TO:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

DC COMMENTS:
DC'd by Discharge
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 06/07/17-0900 Stop Date 07/07/17 0859 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 6 Total Costs $0.00 Total Charges $0.60
Rx Number 01518256

History
06/06/17 1431 - POM ORDER by GGARRISON
06/06/17 1439 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/07/17 - 0900
For: 06/08/17 - 0900
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/09/17 - 0900
For: 06/10/17 - 0900
For: 06/11/17 - 0900
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 2 Doses Dispensed: 2
For: 06/12/17 - 0900
For: 06/13/17 - 0900
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/14/17 - 0900
For: 06/15/17 - 0900
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
Items Auto Credited: 3 Doses Auto Credited: 3
For: 06/13/17 - 0900
For: 06/14/17 - 0900
For: 06/15/17 - 0900
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407016
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/13/17-0900 Stop Date 07/13/17 0859 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 29 Total Costs $0.00 Total Charges $2.90
Rx Number 01520151

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518256
06/12/17 1614 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 06/13/17 - 0900
For: 06/14/17 - 0900
For: 06/15/17 - 0900
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/16/17 - 0900
For: 06/17/17 - 0900
For: 06/18/17 - 0900
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/19/17 - 0900
For: 06/20/17 - 0900
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/21/17 - 0900
For: 06/22/17 - 0900
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/26/17 - 0900
For: 06/27/17 - 0900
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0818 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

07/03/17 0815 - FILL by BGIRLING

Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/12/17 - 0900
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
Items Auto Credited: 1 Doses Auto Credited: 1
For: 07/12/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414207
07/11/17 1018 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/11/17 1012
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/12/17-0900 Stop Date 08/10/17 0859 DC: 08/07/17-1045
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 27 Total Costs $0.00 Total Charges $2.70
Rx Number 01527569

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520151
07/11/17 1019 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/12/17-0900 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/12/17-0900 STOP: 08/10/17-0859 SOFT STOP:
07/11/17 1019 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/29/17 - 0900

For: 07/30/17 - 0900
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 0900
08/07/17 1045 - DISCONTINUE by JRUSSO Eff: 08/07/17 1045
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/08/17 - 0900
For: 08/09/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/07/17 1045 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01421135
08/07/17 1205 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by JRUSSO Eff: 08/07/17 1045
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/08/17-0900 Stop Date 09/05/17 0859 DC: 09/03/17-0842
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 26 Total Costs $0.00 Total Charges $2.60
Rx Number 01534807

History
08/07/17 1045 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01527569
08/07/17 1201 - EDIT by EBALILO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-0900 STOP: 09/05/17 SOFT STOP:
TO:
START: 08/08/17-0900 STOP: 09/05/17-0859 SOFT STOP: 0
08/07/17 1202 - VERIFIED by EBALILO
Items Dispensed: 3 Doses Dispensed: 3
For: 08/08/17 - 0900
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 08/25/17 - 0900

For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0900
09/03/17 0843 - DISCONTINUE by JRUSSO Eff: 09/03/17 0842
Items Auto Credited: 2 Doses Auto Credited: 2
For: 09/03/17 - 0900
For: 09/04/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/03/17 0843 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01428329
09/03/17 1038 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by JRUSSO Eff: 09/03/17 0843
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route PEG TUBE
Frequency NIGHTLY (SCH)
Start Date 05/23/17-2100 Stop Date 06/22/17 2059 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 26 Total Costs $0.00 Total Charges $748.80
Rx Number 01514828

Discontinued Comments DC'd by Discharge

History
05/23/17 1315 - ENTER by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 05/23/17 - 2100
For: 05/24/17 - 2100
For: 05/25/17 - 2100
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 05/26/17 - 2100
For: 05/27/17 - 2100
For: 05/28/17 - 2100
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/29/17 - 2100
For: 05/30/17 - 2100
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 05/31/17 - 2100
For: 06/01/17 - 2100
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 06/02/17 - 2100
For: 06/03/17 - 2100
For: 06/04/17 - 2100
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 06/05/17 - 2100
For: 06/06/17 - 2100
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
Items Auto Credited: 4 Doses Auto Credited: 2
For: 06/05/17 - 2100
For: 06/06/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route PEG TUBE
Frequency NIGHTLY (SCH)
Start Date 06/06/17-2100 Stop Date 07/06/17 2059 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 12 Total Costs $0.00 Total Charges $374.40
Rx Number 01518257

History
06/06/17 1431 - POM ORDER by GGARRISON
06/06/17 1439 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 3
For: 06/06/17 - 2100
For: 06/07/17 - 2100
For: 06/08/17 - 2100
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 06/09/17 - 2100
For: 06/10/17 - 2100
For: 06/11/17 - 2100
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 4 Doses Dispensed: 2
For: 06/12/17 - 2100
For: 06/13/17 - 2100
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 06/14/17 - 2100
For: 06/15/17 - 2100
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
Items Auto Credited: 8 Doses Auto Credited: 4
For: 06/12/17 - 2100
For: 06/13/17 - 2100
For: 06/14/17 - 2100
For: 06/15/17 - 2100
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407017
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 06/12/17-2100 Stop Date 07/12/17 2059 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 58 Total Costs $0.00 Total Charges $1747.20
Rx Number 01520152

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518257
06/12/17 1614 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 4
For: 06/12/17 - 2100
For: 06/13/17 - 2100
For: 06/14/17 - 2100
For: 06/15/17 - 2100
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 06/16/17 - 2100
For: 06/17/17 - 2100
For: 06/18/17 - 2100
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 4 Doses Dispensed: 2
For: 06/19/17 - 2100
For: 06/20/17 - 2100
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 06/21/17 - 2100
For: 06/22/17 - 2100
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 06/23/17 - 2100
For: 06/24/17 - 2100
For: 06/25/17 - 2100
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 2
For: 06/26/17 - 2100
For: 06/27/17 - 2100
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 06/28/17 - 2100
For: 06/29/17 - 2100
06/28/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 06/30/17 - 2100
For: 07/01/17 - 2100
For: 07/02/17 - 2100
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/03/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/04/17 - 2100

07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/05/17 - 2100
For: 07/06/17 - 2100
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 07/07/17 - 2100
For: 07/08/17 - 2100
For: 07/09/17 - 2100
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/10/17 - 2100
For: 07/11/17 - 2100
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
Items Auto Credited: 2 Doses Auto Credited: 1
For: 07/11/17 - 2100
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414208
07/11/17 1018 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/11/17 1012
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 07/11/17-2100 Stop Date 08/10/17 2059 DC: 08/07/17-1045
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 54 Total Costs $0.00 Total Charges $1696.60
Rx Number 01527573

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520152
07/11/17 1019 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/11/17-2100 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/11/17-2100 STOP: 08/10/17-2059 SOFT STOP:
07/11/17 1019 - VERIFIED by AMACCA
Items Dispensed: 6 Doses Dispensed: 3
For: 07/11/17 - 2100
For: 07/12/17 - 2100
For: 07/13/17 - 2100
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 07/14/17 - 2100
For: 07/15/17 - 2100
For: 07/16/17 - 2100
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/17/17 - 2100
For: 07/18/17 - 2100
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/19/17 - 2100
For: 07/20/17 - 2100
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 07/21/17 - 2100
For: 07/22/17 - 2100
For: 07/23/17 - 2100
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/24/17 - 2100
For: 07/25/17 - 2100
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/26/17 - 2100
For: 07/27/17 - 2100
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/28/17 - 2100

For: 07/29/17 - 2100
For: 07/30/17 - 2100
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/31/17 - 2100
For: 08/01/17 - 2100
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/02/17 - 2100
For: 08/03/17 - 2100
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/04/17 - 2100
For: 08/05/17 - 2100
For: 08/06/17 - 2100
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/07/17 - 2100
For: 08/08/17 - 2100
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 1
For: 08/09/17 - 2100
08/07/17 1045 - DISCONTINUE by JRUSSO Eff: 08/07/17 1045
Items Auto Credited: 6 Doses Auto Credited: 3
For: 08/07/17 - 2100
For: 08/08/17 - 2100
For: 08/09/17 - 2100
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/07/17 1045 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01421136
08/07/17 1205 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by JRUSSO Eff: 08/07/17 1045
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 05/23/17-1245 Stop Date 06/22/17 1244 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01514814

Discontinued Comments DC'd by Discharge

History
05/23/17 1246 - POM ORDER by GGARRISON
05/23/17 1250 - VERIFIED by AMACCA
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 06/06/17-1430 Stop Date 07/06/17 1429 DC: 07/05/17-1238
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01518249

History
06/06/17 1431 - POM ORDER by GGARRISON
06/06/17 1435 - VERIFIED by EBALILO
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 0 Doses Dispensed: 0
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 0 Doses Dispensed: 0
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 0 Doses Dispensed: 0
06/26/17 0829 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/28/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 1238 - DISCONTINUE by JHILL Eff: 07/05/17 1238
EDIT DOCTOR: HILL,JUSTIN M.D.
07/05/17 1238 - POM COPY AND EDIT by JHILL
TO: Rx #U01412745
07/05/17 1241 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JHILL Eff: 07/05/17 1238
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/05/17-1245 Stop Date 08/04/17 1244 DC: 08/01/17-1007
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01526075

History
07/05/17 1238 - POM COPY AND EDIT by JHILL
FROM: Rx #01518249
07/05/17 1241 - VERIFIED by AMACCA
07/06/17 1205 - EDIT by AMOLINARI
EDIT DOCTOR: HILL,JUSTIN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/05/17-1245 STOP: 08/04/17 SOFT STOP:
TO:
START: 07/05/17-1245 STOP: 08/04/17-1244 SOFT STOP: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/01/17 1007 - DISCONTINUE by JRUSSO Eff: 08/01/17 1007
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/01/17 1007 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01419731
08/02/17 1049 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by JRUSSO Eff: 08/01/17 1007
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/01/17-1015 Stop Date 08/31/17 1014 DC: 08/04/17-1021
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01533330

History
08/01/17 1007 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01526075
08/01/17 1021 - EDIT by AADEGBAMIG
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/01/17-1015 STOP: 08/31/17 SOFT STOP:
TO:
START: 08/01/17-1015 STOP: 08/31/17-1014 SOFT STOP:
08/01/17 1021 - VERIFIED by AADEGBAMIG
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 1022 - DISCONTINUE by JRUSSO Eff: 08/04/17 1021
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/09/17 1140 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/04/17 1022
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CRV6.25T - CARVEDILOL 6.25 MG TAB

Dose 12.5 MG (2 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
PEG TUBE
Admin Route XX
Frequency EVERY 12 HOURS (SCH)
Start Date 05/23/17-2100 Stop Date 06/22/17 2059 DC: 05/31/17-1457
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 32 Total Costs $0.00 Total Charges $9.10
Rx Number 01514829

History
05/23/17 1319 - ENTER by EBALILO
Items Dispensed: 10 Doses Dispensed: 5
For: 05/23/17 - 2100
For: 05/24/17 - 0900
For: 05/24/17 - 2100
For: 05/25/17 - 0900
For: 05/25/17 - 2100
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 05/26/17 - 0900
For: 05/26/17 - 2100
For: 05/27/17 - 0900
For: 05/27/17 - 2100
For: 05/28/17 - 0900
For: 05/28/17 - 2100
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 05/29/17 - 0900
For: 05/29/17 - 2100
For: 05/30/17 - 0900
For: 05/30/17 - 2100
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 8 Doses Dispensed: 4
For: 05/31/17 - 0900
For: 05/31/17 - 2100
For: 06/01/17 - 0900
For: 06/01/17 - 2100
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 06/02/17 - 0900
For: 06/02/17 - 2100
For: 06/03/17 - 0900
For: 06/03/17 - 2100
For: 06/04/17 - 0900
For: 06/04/17 - 2100
05/31/17 1458 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
05/31/17 1458 - DISCONTINUE by GGARRISON Eff: 05/31/17 1457
Items Auto Credited: 18 Doses Auto Credited: 9
For: 05/31/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 06/01/17 - 0900

For: 06/01/17 - 2100
For: 06/02/17 - 0900
For: 06/02/17 - 2100
For: 06/03/17 - 0900
For: 06/03/17 - 2100
For: 06/04/17 - 0900
For: 06/04/17 - 2100
EDIT DOCTOR: GARRISON,GRAHAM MD
05/31/17 1458 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01403598
05/31/17 1500 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by GGARRISON Eff: 05/31/17 1458
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CRV6.25T - CARVEDILOL 6.25 MG TAB

Dose 6.25 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
PEG TUBE
Admin Route XX
Frequency EVERY 12 HOURS (SCH)
Start Date 05/31/17-2100 Stop Date 06/30/17 2059 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 9 Total Costs $0.00 Total Charges $1.98
Rx Number 01516657

Discontinued Comments DC'd by Discharge

History
05/31/17 1458 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01514829
05/31/17 1459 - VERIFIED by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 05/31/17 - 2100
For: 06/01/17 - 0900
For: 06/01/17 - 2100
For: 06/02/17 - 0900
For: 06/02/17 - 2100
For: 06/03/17 - 0900
For: 06/03/17 - 2100
For: 06/04/17 - 0900
For: 06/04/17 - 2100
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 06/05/17 - 0900
For: 06/05/17 - 2100
For: 06/06/17 - 0900
For: 06/06/17 - 2100
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
Items Auto Credited: 4 Doses Auto Credited: 4
For: 06/05/17 - 0900
For: 06/05/17 - 2100
For: 06/06/17 - 0900
For: 06/06/17 - 2100
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CRV6.25T - CARVEDILOL 6.25 MG TAB

Dose 6.25 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
PEG TUBE
Admin Route XX
Frequency EVERY 12 HOURS (SCH)
Start Date 06/06/17-2100 Stop Date 07/06/17 2059 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 12 Total Costs $0.00 Total Charges $3.63
Rx Number 01518258

History
06/06/17 1432 - POM ORDER by GGARRISON
06/06/17 1440 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 06/06/17 - 2100
For: 06/07/17 - 0900
For: 06/07/17 - 2100
For: 06/08/17 - 0900
For: 06/08/17 - 2100
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/09/17 - 0900
For: 06/09/17 - 2100
For: 06/10/17 - 0900
For: 06/10/17 - 2100
For: 06/11/17 - 0900
For: 06/11/17 - 2100
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 4 Doses Dispensed: 4
For: 06/12/17 - 0900
For: 06/12/17 - 2100
For: 06/13/17 - 0900
For: 06/13/17 - 2100
06/12/17 0835 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 06/14/17 - 0900
For: 06/14/17 - 2100
For: 06/15/17 - 0900
For: 06/15/17 - 2100
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
Items Auto Credited: 7 Doses Auto Credited: 7
For: 06/12/17 - 2100
For: 06/13/17 - 0900
For: 06/13/17 - 2100
For: 06/14/17 - 0900
For: 06/14/17 - 2100
For: 06/15/17 - 0900
For: 06/15/17 - 2100
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407018
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA

Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CRV6.25T - CARVEDILOL 6.25 MG TAB

Dose 6.25 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
PEG TUBE
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 06/12/17-2100 Stop Date 07/12/17 2059 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 58 Total Costs $0.00 Total Charges $13.86
Rx Number 01520153

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518258
06/12/17 1614 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 06/12/17 - 2100
For: 06/13/17 - 0900
For: 06/13/17 - 2100
For: 06/14/17 - 0900
For: 06/14/17 - 2100
For: 06/15/17 - 0900
For: 06/15/17 - 2100
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/16/17 - 0900
For: 06/16/17 - 2100
For: 06/17/17 - 0900
For: 06/17/17 - 2100
For: 06/18/17 - 0900
For: 06/18/17 - 2100
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 06/19/17 - 0900
For: 06/19/17 - 2100
For: 06/20/17 - 0900
For: 06/20/17 - 2100
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 06/21/17 - 0900
For: 06/21/17 - 2100
For: 06/22/17 - 0900
For: 06/22/17 - 2100
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/23/17 - 0900
For: 06/23/17 - 2100
For: 06/24/17 - 0900
For: 06/24/17 - 2100
For: 06/25/17 - 0900
For: 06/25/17 - 2100
06/23/17 0822 - FILL by AADEGBAMIG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Items Dispensed: 4 Doses Dispensed: 4

For: 06/26/17 - 0900
For: 06/26/17 - 2100
For: 06/27/17 - 0900
For: 06/27/17 - 2100
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 06/28/17 - 0900
For: 06/28/17 - 2100
For: 06/29/17 - 0900
For: 06/29/17 - 2100
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 06/30/17 - 0900
For: 06/30/17 - 2100
For: 07/01/17 - 0900
For: 07/01/17 - 2100
For: 07/02/17 - 0900
For: 07/02/17 - 2100
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/03/17 - 0900
For: 07/03/17 - 2100
For: 07/04/17 - 0900
For: 07/04/17 - 2100
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/05/17 - 0900
For: 07/05/17 - 2100
For: 07/06/17 - 0900
For: 07/06/17 - 2100
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/07/17 - 0900
For: 07/07/17 - 2100
For: 07/08/17 - 0900
For: 07/08/17 - 2100
For: 07/09/17 - 0900
For: 07/09/17 - 2100
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/10/17 - 0900
For: 07/10/17 - 2100
For: 07/11/17 - 0900
For: 07/11/17 - 2100
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/12/17 - 0900
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/11/17 - 2100
For: 07/12/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414209
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

07/11/17 1020 - REVIEW PROVIDER ACTIVITY by AMACCA

Discontinue by JRUSSO Eff: 07/11/17 1012
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CRV6.25T - CARVEDILOL 6.25 MG TAB

Dose 6.25 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
PEG TUBE
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/11/17-2100 Stop Date 08/10/17 2059 DC: 07/18/17-1020
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 14 Total Costs $0.00 Total Charges $3.30
Rx Number 01527577

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520153
07/11/17 1020 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/11/17-2100 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/11/17-2100 STOP: 08/10/17-2059 SOFT STOP:
07/11/17 1020 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 07/11/17 - 2100
For: 07/12/17 - 0900
For: 07/12/17 - 2100
For: 07/13/17 - 0900
For: 07/13/17 - 2100
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/14/17 - 0900
For: 07/14/17 - 2100
For: 07/15/17 - 0900
For: 07/15/17 - 2100
For: 07/16/17 - 0900
For: 07/16/17 - 2100
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/17/17 - 0900
For: 07/17/17 - 2100
For: 07/18/17 - 0900
For: 07/18/17 - 2100
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/19/17 - 0900
For: 07/19/17 - 2100
For: 07/20/17 - 0900
For: 07/20/17 - 2100
07/18/17 1022 - DISCONTINUE by JRUSSO Eff: 07/18/17 1020
Items Auto Credited: 5 Doses Auto Credited: 5
For: 07/18/17 - 2100
For: 07/19/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/19/17 - 2100

For: 07/20/17 - 0900
For: 07/20/17 - 2100
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/18/17 1022 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01416115
07/18/17 1037 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/18/17 1022

CRV6.25T - CARVEDILOL 6.25 MG TAB

Dose 3.125 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
PEG TUBE
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/18/17-2100 Stop Date 08/17/17 2059 DC: 07/18/17-2100
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01529564

History
07/18/17 1022 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01527577
07/18/17 1040 - VERIFIED by SYSTEM
Verified in order to DC
07/18/17 1040 - DISCONTINUE by AMACCA Eff: 07/18/17 2100
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CRV3.125T - CARVEDILOL 3.125 MG TAB

Dose 3.125 MG (1 TABLET)

Dose Instructions HOLDFOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/18/17-2100 Stop Date 08/17/17 2059 DC: 07/31/17-1002
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 26 Total Costs $0.00 Total Charges $6.60
Rx Number 01529566

History
07/18/17 1041 - ENTER by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 07/18/17 - 2100
For: 07/19/17 - 0900
For: 07/19/17 - 2100
For: 07/20/17 - 0900
For: 07/20/17 - 2100
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 2100
For: 07/22/17 - 0900
For: 07/22/17 - 2100
For: 07/23/17 - 0900
For: 07/23/17 - 2100
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 2100
For: 07/25/17 - 0900
For: 07/25/17 - 2100
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 2100
For: 07/27/17 - 0900
For: 07/27/17 - 2100
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 2100
For: 07/29/17 - 0900
For: 07/29/17 - 2100
For: 07/30/17 - 0900
For: 07/30/17 - 2100
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/17 - 0900
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

07/31/17 0831 - FILL by BGIRLING

Items Dispensed: 4 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
07/31/17 1004 - DISCONTINUE by JRUSSO Eff: 07/31/17 1002
Items Auto Credited: 7 Doses Auto Credited: 7
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 2100
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/31/17 1004 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01419358
07/31/17 1130 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 07/31/17 1004
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CRV3.125T - CARVEDILOL 3.125 MG TAB

Dose 3.125 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 07/31/17-2100 Stop Date 08/30/17 2059 DC: 08/28/17-0931
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 56 Total Costs $0.00 Total Charges $15.51
Rx Number 01532928

History
07/31/17 1004 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01529566
07/31/17 1130 - VERIFIED by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 07/31/17 - 2100
For: 08/01/17 - 0900
For: 08/01/17 - 2100
For: 08/02/17 - 0900
For: 08/02/17 - 2100
For: 08/03/17 - 0900
For: 08/03/17 - 2100
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 2100
For: 08/05/17 - 0900
For: 08/05/17 - 2100
For: 08/06/17 - 0900
For: 08/06/17 - 2100
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 2100
For: 08/08/17 - 0900
For: 08/08/17 - 2100
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 2100
For: 08/10/17 - 0900
For: 08/10/17 - 2100
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 08/14/17 - 0900

For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
08/28/17 0932 - DISCONTINUE by JRUSSO Eff: 08/28/17 0931
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
For: 08/30/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/28/17 0932 - POM COPY AND EDIT by JRUSSO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

TO: Rx #U01426719
08/28/17 1044 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by JRUSSO Eff: 08/28/17 0932

CRV3.125T - CARVEDILOL 3.125 MG TAB

Dose 3.125 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 07/31/17-1215 Stop Date 07/31/17 1216 DC: 07/31/17-1216
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.33
Rx Number 01533038

Discontinued Comments Reached Stop Date

History
07/31/17 1217 - POM ORDER by JRUSSO
07/31/17 1302 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by JDEPAOLO Eff: 07/31/17 1240
07/31/17 1302 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/31/17 - 1215
07/31/17 1302 - DISCONTINUE by PHABKGJOB Eff: 07/31/17 1216
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Dose Instructions PEG tube
Admin Route XX
Frequency DAILY (SCH)
Start Date 05/24/17-0900 Stop Date 06/23/17 0859 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 12 Total Costs $0.00 Total Charges $193.56
Rx Number 01514952

Discontinued Comments DC'd by Discharge

History
05/23/17 1310 - POM ORDER by GGARRISON
05/23/17 1518 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 05/24/17 - 0900
For: 05/25/17 - 0900
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 05/26/17 - 0900
For: 05/27/17 - 0900
For: 05/28/17 - 0900
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/29/17 - 0900
For: 05/30/17 - 0900
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/02/17 - 0900
For: 06/03/17 - 0900
For: 06/04/17 - 0900
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/05/17 - 0900
For: 06/06/17 - 0900
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
Items Auto Credited: 2 Doses Auto Credited: 2
For: 06/05/17 - 0900
For: 06/06/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 83
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Dose Instructions PEG tube
Admin Route XX
Frequency DAILY (SCH)
Start Date 06/07/17-0900 Stop Date 07/07/17 0859 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 6 Total Costs $0.00 Total Charges $96.78
Rx Number 01518259

History
06/06/17 1432 - POM ORDER by GGARRISON
06/06/17 1440 - VERIFIED by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/07/17 - 0900
For: 06/08/17 - 0900
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/09/17 - 0900
For: 06/10/17 - 0900
For: 06/11/17 - 0900
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 2 Doses Dispensed: 2
For: 06/12/17 - 0900
For: 06/13/17 - 0900
06/12/17 0835 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/14/17 - 0900
For: 06/15/17 - 0900
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
Items Auto Credited: 3 Doses Auto Credited: 3
For: 06/13/17 - 0900
For: 06/14/17 - 0900
For: 06/15/17 - 0900
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407019
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 84
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Dose Instructions PEG tube
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/13/17-0900 Stop Date 07/13/17 0859 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 29 Total Costs $0.00 Total Charges $467.77
Rx Number 01520154

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518259
06/12/17 1614 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 06/13/17 - 0900
For: 06/14/17 - 0900
For: 06/15/17 - 0900
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/16/17 - 0900
For: 06/17/17 - 0900
For: 06/18/17 - 0900
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/19/17 - 0900
For: 06/20/17 - 0900
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/21/17 - 0900
For: 06/22/17 - 0900
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/26/17 - 0900
For: 06/27/17 - 0900
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 85
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/04/17 - 0900

07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/12/17 - 0900
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
Items Auto Credited: 1 Doses Auto Credited: 1
For: 07/12/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414210
07/11/17 1020 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/11/17 1012
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 86
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Dose Instructions PEG tube
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/12/17-0900 Stop Date 08/10/17 0859 DC: 07/31/17-1002
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 20 Total Costs $0.00 Total Charges $322.60
Rx Number 01527579

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520154
07/11/17 1020 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/12/17-0900 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/12/17-0900 STOP: 08/10/17-0859 SOFT STOP:
07/11/17 1020 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 07/12/17 - 0900
For: 07/13/17 - 0900
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 87
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/28/17 - 0900

For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
07/31/17 1004 - DISCONTINUE by JRUSSO Eff: 07/31/17 1002
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/31/17 1004 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01419359
07/31/17 1130 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 07/31/17 1004
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 88
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/01/17-0900 Stop Date 08/31/17 0859 DC: 08/28/17-0931
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 28 Total Costs $0.00 Total Charges $451.64
Rx Number 01532929

History
07/31/17 1004 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01527579
07/31/17 1130 - VERIFIED by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/01/17 - 0900
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 89
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

08/21/17 0833 - FILL by AMOLINARI

Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/30/17 - 0900
08/28/17 0932 - DISCONTINUE by JRUSSO Eff: 08/28/17 0931
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/29/17 - 0900
For: 08/30/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/28/17 0932 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01426720
08/28/17 1044 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by JRUSSO Eff: 08/28/17 0932
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 90
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

DIPH25CA16 - DIPHENHYDRAMINE HCL 25 MG CAP

Dose 25 MG (1 CAPSULE)
Admin Route ORAL
Frequency EVERY BEDTIME (SCH)
Start Date 08/18/17-2100 Stop Date 09/17/17 2059 DC: 08/25/17-1251
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $1.75
Rx Number 01538217

History
08/18/17 1805 - POM ORDER by JRUSSO
08/18/17 1810 - VERIFIED by EBALILO
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/25/17 1259 - DISCONTINUE by JHILL Eff: 08/25/17 1251
EDIT DOCTOR: HILL,JUSTIN M.D.
08/25/17 1259 - POM COPY AND EDIT by JHILL
TO: Rx #U01426201
08/25/17 1318 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JHILL Eff: 08/25/17 1259
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 91
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

DOCU100T10 - DOCUSATE SODIUM TABLET 100 MG

Dose 100 MG (1 TABLET)

Admin Route PEG TUBE
Frequency 3 TIMES A DAY (SCH)
Start Date 05/23/17-1300 Stop Date 06/22/17 1259 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 38 Total Costs $0.00 Total Charges $2.88
Rx Number 01514815

Discontinued Comments DC'd by Discharge

History
05/23/17 1246 - POM ORDER by GGARRISON
05/23/17 1250 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 8
For: 05/23/17 - 1300
For: 05/23/17 - 1700
For: 05/24/17 - 0900
For: 05/24/17 - 1300
For: 05/24/17 - 1700
For: 05/25/17 - 0900
For: 05/25/17 - 1300
For: 05/25/17 - 1700
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 05/26/17 - 0900
For: 05/26/17 - 1300
For: 05/26/17 - 1700
For: 05/27/17 - 0900
For: 05/27/17 - 1300
For: 05/27/17 - 1700
For: 05/28/17 - 0900
For: 05/28/17 - 1300
For: 05/28/17 - 1700
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/29/17 - 0900
For: 05/29/17 - 1300
For: 05/29/17 - 1700
For: 05/30/17 - 0900
For: 05/30/17 - 1300
For: 05/30/17 - 1700
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/31/17 - 0900
For: 05/31/17 - 1300
For: 05/31/17 - 1700
For: 06/01/17 - 0900
For: 06/01/17 - 1300
For: 06/01/17 - 1700
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 06/02/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 92
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 06/02/17 - 1300

For: 06/02/17 - 1700
For: 06/03/17 - 0900
For: 06/03/17 - 1300
For: 06/03/17 - 1700
For: 06/04/17 - 0900
For: 06/04/17 - 1300
For: 06/04/17 - 1700
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/05/17 - 0900
For: 06/05/17 - 1300
For: 06/05/17 - 1700
For: 06/06/17 - 0900
For: 06/06/17 - 1300
For: 06/06/17 - 1700
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
Items Auto Credited: 6 Doses Auto Credited: 6
For: 06/05/17 - 0900
For: 06/05/17 - 1300
For: 06/05/17 - 1700
For: 06/06/17 - 0900
For: 06/06/17 - 1300
For: 06/06/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 93
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ESOM20SU2 - ESOMEPRAZOLE MAG TRIHYDRATE 20 MG PKT

Dose 10 MG (0.5 PACKETS)

Admin Route PEG TUBE
Frequency DAILY@08 (SCH)
Start Date 05/24/17-0800 Stop Date 05/24/17 0800 DC: 05/24/17-0800
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01514954

History
05/23/17 1310 - POM ORDER by GGARRISON
05/23/17 1518 - EDIT by GGARRISON
EDIT DOCTOR: GARRISON,GRAHAM MD
FROM:
START: 05/24/17-0800 STOP: 06/23/17 0759 SOFT STOP: 0
TO:
START: 05/24/17-0800 STOP: 05/24/17-0800 SOFT STOP:
05/23/17 1518 - VERIFIED by SYSTEM
Verified in order to DC
05/23/17 1518 - DISCONTINUE by GGARRISON Eff: 05/24/17 0800
EDIT DOCTOR: GARRISON,GRAHAM MD
05/23/17 1522 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
by GGARRISON Eff: 05/23/17 1518
by SYSTEM Eff: 05/23/17 1518
by GGARRISON Eff: 05/23/17 1518
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 94
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 05/24/17-0900 Stop Date 06/23/17 0859 DC: 05/24/17-0900
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01514958

History
05/23/17 1518 - POM ORDER by GGARRISON
05/23/17 1521 - EDIT by AADEGBAMIG
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
05/23/17 1529 - VERIFIED by SYSTEM
Verified in order to DC
05/23/17 1529 - DISCONTINUE by GGARRISON Eff: 05/24/17 0900
EDIT DOCTOR: GARRISON,GRAHAM MD
05/23/17 1529 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01401953
05/23/17 1532 - REVIEW PROVIDER ACTIVITY by EBALILO
by SYSTEM Eff: 05/23/17 1529
by GGARRISON Eff: 05/23/17 1529
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 95
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route PEG TUBE
Frequency 2 TIMES A DAY (SCH)
Start Date 05/24/17-0900 Stop Date 06/23/17 0859 DC: 05/24/17-0900
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01514959

History
05/23/17 1529 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01514958
Result of Sig/Schedule Edit
Ordering Doctor: GARRISON,GRAHAM MD
Last Scheduled Dose: 05/24/17 - 0900
Last Administration:
Old Sig/Sch: DAILY (SCH)
New Sig/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 05/24/17 - 0900
New Order Start: 05/24/17 - 0900
05/23/17 1532 - REVIEW PROVIDER ACTIVITY by EBALILO
by GGARRISON Eff: 05/23/17 1529
Ordering Doctor: GARRISON,GRAHAM MD
Last Scheduled Dose: 05/24/17 - 0900
Last Administration:
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 05/24/17 - 0900
New Order Start: 05/24/17 - 0900
05/23/17 1532 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 05/24/17 - 0900
For: 05/24/17 - 1700
For: 05/25/17 - 0900
For: 05/25/17 - 1700
05/23/17 1537 - DISCONTINUE by GGARRISON Eff: 05/24/17 0900
Items Auto Credited: 4 Doses Auto Credited: 4
For: 05/24/17 - 0900
For: 05/24/17 - 1700
For: 05/25/17 - 0900
For: 05/25/17 - 1700
EDIT DOCTOR: GARRISON,GRAHAM MD
05/23/17 1537 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01401955
05/23/17 1538 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
by GGARRISON Eff: 05/23/17 1537
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 96
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route PEG TUBE
Frequency 2 TIMES A DAY (SCH)
Start Date 05/23/17-2100 Stop Date 06/22/17 2059 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 25 Total Costs $0.00 Total Charges $8.75
Rx Number 01514961

Discontinued Comments DC'd by Discharge

History
05/23/17 1537 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01514959
05/23/17 1537 - NOW DOSE by GGARRISON
Now Dose: 05/23/17 2100
05/23/17 1537 - KEEP NEXT DOSE by System
Keep Next Dose: 05/24/17 0900
05/23/17 1538 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
by GGARRISON Eff: 05/23/17 1537
Now Dose 05/23/17 - 2100
Keep Next Dose 05/24/17 - 0900
05/23/17 1538 - VERIFIED by AADEGBAMIG
Items Dispensed: 5 Doses Dispensed: 5
For: 05/23/17 - 2100
For: 05/24/17 - 0900
For: 05/24/17 - 1700
For: 05/25/17 - 0900
For: 05/25/17 - 1700
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/26/17 - 0900
For: 05/26/17 - 1700
For: 05/27/17 - 0900
For: 05/27/17 - 1700
For: 05/28/17 - 0900
For: 05/28/17 - 1700
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 05/29/17 - 0900
For: 05/29/17 - 1700
For: 05/30/17 - 0900
For: 05/30/17 - 1700
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 05/31/17 - 0900
For: 05/31/17 - 1700
For: 06/01/17 - 0900
For: 06/01/17 - 1700
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/02/17 - 0900
For: 06/02/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 97
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 06/03/17 - 0900

For: 06/03/17 - 1700
For: 06/04/17 - 0900
For: 06/04/17 - 1700
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 06/05/17 - 0900
For: 06/05/17 - 1700
For: 06/06/17 - 0900
For: 06/06/17 - 1700
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
Items Auto Credited: 4 Doses Auto Credited: 4
For: 06/05/17 - 0900
For: 06/05/17 - 1700
For: 06/06/17 - 0900
For: 06/06/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 98
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route PEG TUBE
Frequency 2 TIMES A DAY (SCH)
Start Date 06/06/17-1700 Stop Date 07/06/17 1659 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 12 Total Costs $0.00 Total Charges $4.20
Rx Number 01518260

History
06/06/17 1432 - POM ORDER by GGARRISON
06/06/17 1440 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 06/06/17 - 1700
For: 06/07/17 - 0900
For: 06/07/17 - 1700
For: 06/08/17 - 0900
For: 06/08/17 - 1700
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/09/17 - 0900
For: 06/09/17 - 1700
For: 06/10/17 - 0900
For: 06/10/17 - 1700
For: 06/11/17 - 0900
For: 06/11/17 - 1700
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 4 Doses Dispensed: 4
For: 06/12/17 - 0900
For: 06/12/17 - 1700
For: 06/13/17 - 0900
For: 06/13/17 - 1700
06/12/17 0835 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 06/14/17 - 0900
For: 06/14/17 - 1700
For: 06/15/17 - 0900
For: 06/15/17 - 1700
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
Items Auto Credited: 7 Doses Auto Credited: 7
For: 06/12/17 - 1700
For: 06/13/17 - 0900
For: 06/13/17 - 1700
For: 06/14/17 - 0900
For: 06/14/17 - 1700
For: 06/15/17 - 0900
For: 06/15/17 - 1700
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407020
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 99
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 100
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 06/12/17-1700 Stop Date 07/12/17 1659 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 58 Total Costs $0.00 Total Charges $19.95
Rx Number 01520155

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518260
06/12/17 1615 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 06/12/17 - 1700
For: 06/13/17 - 0900
For: 06/13/17 - 1700
For: 06/14/17 - 0900
For: 06/14/17 - 1700
For: 06/15/17 - 0900
For: 06/15/17 - 1700
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/16/17 - 0900
For: 06/16/17 - 1700
For: 06/17/17 - 0900
For: 06/17/17 - 1700
For: 06/18/17 - 0900
For: 06/18/17 - 1700
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 06/19/17 - 0900
For: 06/19/17 - 1700
For: 06/20/17 - 0900
For: 06/20/17 - 1700
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 06/21/17 - 0900
For: 06/21/17 - 1700
For: 06/22/17 - 0900
For: 06/22/17 - 1700
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/23/17 - 0900
For: 06/23/17 - 1700
For: 06/24/17 - 0900
For: 06/24/17 - 1700
For: 06/25/17 - 0900
For: 06/25/17 - 1700
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 4 Doses Dispensed: 4
For: 06/26/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 101
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 06/26/17 - 1700

For: 06/27/17 - 0900
For: 06/27/17 - 1700
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 06/28/17 - 0900
For: 06/28/17 - 1700
For: 06/29/17 - 0900
For: 06/29/17 - 1700
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 06/30/17 - 0900
For: 06/30/17 - 1700
For: 07/01/17 - 0900
For: 07/01/17 - 1700
For: 07/02/17 - 0900
For: 07/02/17 - 1700
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/03/17 - 0900
For: 07/03/17 - 1700
For: 07/04/17 - 0900
For: 07/04/17 - 1700
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/05/17 - 0900
For: 07/05/17 - 1700
For: 07/06/17 - 0900
For: 07/06/17 - 1700
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/07/17 - 0900
For: 07/07/17 - 1700
For: 07/08/17 - 0900
For: 07/08/17 - 1700
For: 07/09/17 - 0900
For: 07/09/17 - 1700
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/10/17 - 0900
For: 07/10/17 - 1700
For: 07/11/17 - 0900
For: 07/11/17 - 1700
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/12/17 - 0900
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
Items Auto Credited: 2 Doses Auto Credited: 2
For: 07/11/17 - 1700
For: 07/12/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414211
07/11/17 1020 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/11/17 1012
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 102
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MALONEY,PATRICK F W00001215850 (Continued)

Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 103
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MALONEY,PATRICK F W00001215850 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 07/11/17-1700 Stop Date 08/10/17 1659 DC: 08/03/17-1017
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 46 Total Costs $0.00 Total Charges $16.10
Rx Number 01527583

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520155
07/11/17 1020 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/11/17-1700 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/11/17-1700 STOP: 08/10/17-1659 SOFT STOP:
07/11/17 1020 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 07/11/17 - 1700
For: 07/12/17 - 0900
For: 07/12/17 - 1700
For: 07/13/17 - 0900
For: 07/13/17 - 1700
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/14/17 - 0900
For: 07/14/17 - 1700
For: 07/15/17 - 0900
For: 07/15/17 - 1700
For: 07/16/17 - 0900
For: 07/16/17 - 1700
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/17/17 - 0900
For: 07/17/17 - 1700
For: 07/18/17 - 0900
For: 07/18/17 - 1700
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/19/17 - 0900
For: 07/19/17 - 1700
For: 07/20/17 - 0900
For: 07/20/17 - 1700
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 1700
For: 07/22/17 - 0900
For: 07/22/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 104
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MALONEY,PATRICK F W00001215850 (Continued)

For: 07/23/17 - 0900

For: 07/23/17 - 1700
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 1700
For: 07/25/17 - 0900
For: 07/25/17 - 1700
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 1700
For: 07/27/17 - 0900
For: 07/27/17 - 1700
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 1700
For: 07/29/17 - 0900
For: 07/29/17 - 1700
For: 07/30/17 - 0900
For: 07/30/17 - 1700
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/31/17 - 0900
For: 07/31/17 - 1700
For: 08/01/17 - 0900
For: 08/01/17 - 1700
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/02/17 - 0900
For: 08/02/17 - 1700
For: 08/03/17 - 0900
For: 08/03/17 - 1700
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
08/03/17 1018 - DISCONTINUE by JRUSSO Eff: 08/03/17 1017
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/03/17 - 1700
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/03/17 1025 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/03/17 1018
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 105
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MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 06/30/17-2100 Stop Date 07/06/17 1639 DC: 07/06/17-1639
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 10 Total Costs $0.00 Total Charges $1.00
Rx Number 01525097

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
06/30/17 1541 - POM ORDER by JHILL
06/30/17 1544 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 06/30/17 - 2100
For: 07/01/17 - 2100
For: 07/02/17 - 2100
For: 07/03/17 - 2100
For: 07/04/17 - 2100
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 2100
For: 07/06/17 - 2100
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 2100
For: 07/08/17 - 2100
For: 07/09/17 - 2100
07/06/17 1641 - EDIT by JHILL
EDIT DOCTOR: HILL,JUSTIN M.D.
FROM:
START: 06/30/17-2100 STOP: 07/30/17 2059 SOFT STOP: 0
DISPENSE: 3
TO:
START: 06/30/17-2100 STOP: 07/06/17-1639 SOFT STOP:
DISPENSE: 6
07/06/17 1641 - DISCONTINUE by JHILL Eff: 07/06/17 1639
EDIT DOCTOR: HILL,JUSTIN M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 106
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MALONEY,PATRICK F W00001215850 (Continued)

Order filed UNV:

Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
07/06/17 1641 - POM COPY AND EDIT by JHILL
TO: Rx #U01413168
07/06/17 1645 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by JHILL Eff: 07/06/17 1641
Discontinue by JHILL Eff: 07/06/17 1641
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 107
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MALONEY,PATRICK F W00001215850 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: AGITATION - for Agitation
Start Date 06/30/17-1545 Stop Date 07/30/17 1544 DC: 07/27/17-1046
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 5 Total Costs $0.00 Total Charges $0.60
Rx Number 01525098

History
06/30/17 1543 - POM ORDER by JHILL
06/30/17 1544 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 06/30/17 - 1545
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/27/17 1046 - DISCONTINUE by JRUSSO Eff: 07/27/17 1046
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/27/17 1046 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01418553
07/27/17 1050 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/27/17 1046
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 108
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MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 07/06/17-1700 Stop Date 07/30/17 2059 DC: 07/13/17-1016
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 20 Total Costs $0.00 Total Charges $3.80
Rx Number 01526514

History
07/06/17 1641 - POM COPY AND EDIT by JHILL
FROM: Rx #01525097
Result of Frequency/Schedule Edit
Ordering Doctor: HILL,JUSTIN M.D.
Last Scheduled Administration Time: 07/05/17 - 2100
Last Actual Administration Time: 07/05/17 - 2106
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 07/06/17 - 1639
New Order Start: 07/06/17 - 1700
New Order Stop: 07/30/17 - 2059
07/06/17 1646 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by JHILL Eff: 07/06/17 1641
Ordering Doctor: HILL,JUSTIN M.D.
Last Scheduled Administration Time: 07/05/17 - 2100
Last Actual Administration Time: 07/05/17 - 2106
Old Freq/Sch: NIGHTLY (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 07/06/17 - 1639
New Order Start: 07/06/17 - 1700
New Order Stop: 07/30/17 - 2059
07/06/17 1646 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 10
For: 07/06/17 - 1700
For: 07/07/17 - 0900
For: 07/07/17 - 1300
For: 07/07/17 - 1700
For: 07/08/17 - 0900
For: 07/08/17 - 1300
For: 07/08/17 - 1700
For: 07/09/17 - 0900
For: 07/09/17 - 1300
For: 07/09/17 - 1700
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/10/17 - 0900
For: 07/10/17 - 1300
For: 07/10/17 - 1700
For: 07/11/17 - 0900
For: 07/11/17 - 1300
For: 07/11/17 - 1700
07/10/17 0836 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 109
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MALONEY,PATRICK F W00001215850 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 07/12/17 - 0900
For: 07/12/17 - 1300
For: 07/12/17 - 1700
For: 07/13/17 - 0900
For: 07/13/17 - 1300
For: 07/13/17 - 1700
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 07/14/17 - 0900
For: 07/14/17 - 1300
For: 07/14/17 - 1700
For: 07/15/17 - 0900
For: 07/15/17 - 1300
For: 07/15/17 - 1700
For: 07/16/17 - 0900
For: 07/16/17 - 1300
For: 07/16/17 - 1700
07/13/17 1018 - DISCONTINUE by JRUSSO Eff: 07/13/17 1016
Items Auto Credited: 11 Doses Auto Credited: 11
For: 07/13/17 - 1300
For: 07/13/17 - 1700
For: 07/14/17 - 0900
For: 07/14/17 - 1300
For: 07/14/17 - 1700
For: 07/15/17 - 0900
For: 07/15/17 - 1300
For: 07/15/17 - 1700
For: 07/16/17 - 0900
For: 07/16/17 - 1300
For: 07/16/17 - 1700
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/13/17 1028 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by JRUSSO Eff: 07/13/17 1018
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 110
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MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@0900,2300 (SCH)
Start Date 07/13/17-2300 Stop Date 07/14/17 0930 DC: 07/14/17-0930
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 11 Total Costs $0.00 Total Charges $0.40
Rx Number 01528332

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
07/13/17 1022 - POM ORDER by JRUSSO
07/13/17 1027 - VERIFIED by EBALILO
Items Dispensed: 7 Doses Dispensed: 7
For: 07/13/17 - 2300
For: 07/14/17 - 0900
For: 07/14/17 - 2300
For: 07/15/17 - 0900
For: 07/15/17 - 2300
For: 07/16/17 - 0900
For: 07/16/17 - 2300
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/17/17 - 0900
For: 07/17/17 - 2300
For: 07/18/17 - 0900
For: 07/18/17 - 2300
07/14/17 0932 - DISCONTINUE by JRUSSO Eff: 07/14/17 0930
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
07/14/17 0932 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 111
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

START: 07/13/17-2300 STOP: 08/12/17 2259 SOFT STOP: 0

DISPENSE: 4
TO:
START: 07/13/17-2300 STOP: 07/14/17-0930 SOFT STOP:
DISPENSE: 2
07/14/17 0932 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01415256
07/14/17 1143 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by JRUSSO Eff: 07/14/17 0932
Discontinue by JRUSSO Eff: 07/14/17 0932
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 112
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MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency DAILY@1700 (SCH)
Start Date 07/13/17-1700 Stop Date 08/12/17 1659 DC: 07/25/17-1428
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 24 Total Costs $0.00 Total Charges $4.80
Rx Number 01528333

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
07/13/17 1022 - POM ORDER by JRUSSO
07/13/17 1027 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 07/13/17 - 1700
For: 07/14/17 - 1700
For: 07/15/17 - 1700
For: 07/16/17 - 1700
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/17/17 - 1700
For: 07/18/17 - 1700
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/19/17 - 1700
For: 07/20/17 - 1700
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 07/21/17 - 1700
For: 07/22/17 - 1700
For: 07/23/17 - 1700
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 07/24/17 - 1700
For: 07/25/17 - 1700
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/26/17 - 1700
For: 07/27/17 - 1700
07/25/17 1428 - DISCONTINUE by JRUSSO Eff: 07/25/17 1428
Items Auto Credited: 6 Doses Auto Credited: 3
For: 07/25/17 - 1700
For: 07/26/17 - 1700
For: 07/27/17 - 1700
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 113
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MALONEY,PATRICK F W00001215850 (Continued)

07/25/17 1428 - POM COPY AND EDIT by JRUSSO

TO: Rx #U01417874
07/25/17 1443 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/25/17 1428
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 114
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@0900,1300 (SCH)
Start Date 07/14/17-1300 Stop Date 07/27/17 0936 DC: 07/27/17-0936
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 33 Total Costs $0.00 Total Charges $5.00
Rx Number 01528697

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
07/14/17 0932 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01528332
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 07/14/17 - 0900
Last Actual Administration Time: 07/14/17 - 0916
Old Freq/Sch: DAILY@0900,2300 (SCH)
New Freq/Sch: DAILY@0900,1300 (SCH)
Old Order Stop: 07/14/17 - 0930
New Order Start: 07/14/17 - 1300
New Order Stop: 08/12/17 - 2259
07/14/17 1143 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by JRUSSO Eff: 07/14/17 0932
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 07/14/17 - 0900
Last Actual Administration Time: 07/14/17 - 0916
Old Freq/Sch: DAILY@0900,2300 (SCH)
New Freq/Sch: DAILY@0900,1300 (SCH)
Old Order Stop: 07/14/17 - 0930
New Order Start: 07/14/17 - 1300
New Order Stop: 08/12/17 - 2259
07/14/17 1143 - VERIFIED by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 07/14/17 - 1300
For: 07/15/17 - 0900
For: 07/15/17 - 1300
For: 07/16/17 - 0900
For: 07/16/17 - 1300
For: 07/17/17 - 0900
For: 07/17/17 - 1300
For: 07/18/17 - 0900
For: 07/18/17 - 1300
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 115
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/19/17 - 0900

For: 07/19/17 - 1300
For: 07/20/17 - 0900
For: 07/20/17 - 1300
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/21/17 - 0900
For: 07/21/17 - 1300
For: 07/22/17 - 0900
For: 07/22/17 - 1300
For: 07/23/17 - 0900
For: 07/23/17 - 1300
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 07/24/17 - 0900
For: 07/24/17 - 1300
For: 07/25/17 - 0900
For: 07/25/17 - 1300
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/26/17 - 0900
For: 07/26/17 - 1300
For: 07/27/17 - 0900
For: 07/27/17 - 1300
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/28/17 - 0900
For: 07/28/17 - 1300
For: 07/29/17 - 0900
For: 07/29/17 - 1300
For: 07/30/17 - 0900
For: 07/30/17 - 1300
07/27/17 0937 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 07/14/17-1300 STOP: 08/12/17 2259 SOFT STOP:
DISPENSE: 6
TO:
START: 07/14/17-1300 STOP: 07/27/17-0936 SOFT STOP:
DISPENSE: 26
07/27/17 0937 - DISCONTINUE by JRUSSO Eff: 07/27/17 0936
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 116
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Order filed UNV:

Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
07/27/17 0937 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01418525
07/27/17 0952 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Edit by JRUSSO Eff: 07/27/17 0937
Discontinue by JRUSSO Eff: 07/27/17 0937
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 117
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 900 MG (3 CAPSULES)

Admin Route ORAL
Frequency DAILY@1700 (SCH)
Start Date 07/25/17-1700 Stop Date 08/03/17 1018 DC: 08/03/17-1018
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 39 Total Costs $0.00 Total Charges $5.40
Rx Number 01531402

History
07/25/17 1428 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01528333
07/25/17 1444 - VERIFIED by AMACCA
Items Dispensed: 9 Doses Dispensed: 3
For: 07/25/17 - 1700
For: 07/26/17 - 1700
For: 07/27/17 - 1700
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 3
For: 07/28/17 - 1700
For: 07/29/17 - 1700
For: 07/30/17 - 1700
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 07/31/17 - 1700
For: 08/01/17 - 1700
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/02/17 - 1700
For: 08/03/17 - 1700
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 3
For: 08/04/17 - 1700
For: 08/05/17 - 1700
For: 08/06/17 - 1700
08/03/17 1019 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 07/25/17-1700 STOP: 08/24/17 1659 SOFT STOP: 0
DISPENSE: 9
TO:
START: 07/25/17-1700 STOP: 08/03/17-1018 SOFT STOP:
DISPENSE: 27
08/03/17 1019 - DISCONTINUE by JRUSSO Eff: 08/03/17 1018
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 118
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/03/17 1019 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01420261
08/03/17 1025 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by JRUSSO Eff: 08/03/17 1019
Discontinue by JRUSSO Eff: 08/03/17 1019
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 119
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@1300 (SCH)
Start Date 07/27/17-1300 Stop Date 08/12/17 2259 DC: 08/09/17-1050
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 13 Total Costs $0.00 Total Charges $2.60
Rx Number 01532065

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
07/27/17 0937 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01528697
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 07/27/17 - 0900
Last Actual Administration Time: 07/27/17 - 0840
Old Freq/Sch: DAILY@0900,1300 (SCH)
New Freq/Sch: DAILY@1300 (SCH)
Old Order Stop: 07/27/17 - 0936
New Order Start: 07/27/17 - 1300
New Order Stop: 08/12/17 - 2259
07/27/17 0951 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by JRUSSO Eff: 07/27/17 0937
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 07/27/17 - 0900
Last Actual Administration Time: 07/27/17 - 0840
Old Freq/Sch: DAILY@0900,1300 (SCH)
New Freq/Sch: DAILY@1300 (SCH)
Old Order Stop: 07/27/17 - 0936
New Order Start: 07/27/17 - 1300
New Order Stop: 08/12/17 - 2259
07/27/17 0951 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 07/27/17 - 1300
For: 07/28/17 - 1300
For: 07/29/17 - 1300
For: 07/30/17 - 1300
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 1300
For: 08/01/17 - 1300
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 1300
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 120
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 08/03/17 - 1300

08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 1300
For: 08/05/17 - 1300
For: 08/06/17 - 1300
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 1300
For: 08/08/17 - 1300
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 1300
For: 08/10/17 - 1300
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/11/17 - 1300
For: 08/12/17 - 1300
08/09/17 1051 - DISCONTINUE by JRUSSO Eff: 08/09/17 1050
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/09/17 - 1300
For: 08/10/17 - 1300
For: 08/11/17 - 1300
For: 08/12/17 - 1300
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/09/17 1051 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01421704
08/09/17 1140 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/09/17 1051
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 121
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/28/17-0900 Stop Date 08/27/17 0859 DC: 08/03/17-1018
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 14 Total Costs $0.00 Total Charges $2.80
Rx Number 01532066

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
07/27/17 0940 - POM ORDER by JRUSSO
07/27/17 0952 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/03/17 1019 - DISCONTINUE by JRUSSO Eff: 08/03/17 1018
Items Auto Credited: 6 Doses Auto Credited: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/03/17 1025 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/03/17 1019
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 122
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: AGITATION - for Agitation
Start Date 07/27/17-1045 Stop Date 08/26/17 1044 DC: 08/22/17-1733
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $0.30
Rx Number 01532098

History
07/27/17 1046 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01525098
07/27/17 1050 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/27/17-1045 STOP: 08/26/17 SOFT STOP:
TO:
START: 07/27/17-1045 STOP: 08/26/17-1044 SOFT STOP:
07/27/17 1050 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 07/27/17 - 1045
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/22/17 1734 - DISCONTINUE by SDAS Eff: 08/22/17 1733
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/22/17 1734 - POM COPY AND EDIT by SDAS
TO: Rx #U01425289
08/22/17 1735 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SDAS Eff: 08/22/17 1734
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 123
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 900 MG (3 CAPSULES)

Admin Route ORAL
Frequency DAILY@0900,1700 (SCH)
Start Date 08/03/17-1700 Stop Date 08/10/17 1213 DC: 08/10/17-1213
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 63 Total Costs $0.00 Total Charges $8.40
Rx Number 01533865

History
08/03/17 1019 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01531402
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/02/17 - 1700
Last Actual Administration Time: 08/02/17 - 1815
Old Freq/Sch: DAILY@1700 (SCH)
New Freq/Sch: DAILY@0900,1700 (SCH)
Old Order Stop: 08/03/17 - 1018
New Order Start: 08/03/17 - 1700
New Order Stop: 08/24/17 - 1659
08/03/17 1024 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by JRUSSO Eff: 08/03/17 1019
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/02/17 - 1700
Last Actual Administration Time: 08/02/17 - 1815
Old Freq/Sch: DAILY@1700 (SCH)
New Freq/Sch: DAILY@0900,1700 (SCH)
Old Order Stop: 08/03/17 - 1018
New Order Start: 08/03/17 - 1700
New Order Stop: 08/24/17 - 1659
08/03/17 1024 - VERIFIED by AMOLINARI
Items Dispensed: 21 Doses Dispensed: 7
For: 08/03/17 - 1700
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 124
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

08/09/17 0823 - FILL by BGIRLING

Items Dispensed: 18 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/10/17 1214 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 08/03/17-1700 STOP: 08/24/17 1659 SOFT STOP:
DISPENSE: 18
TO:
START: 08/03/17-1700 STOP: 08/10/17-1213 SOFT STOP:
DISPENSE: 42
08/10/17 1214 - DISCONTINUE by JRUSSO Eff: 08/10/17 1213
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/10/17 1214 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01421923
08/10/17 1224 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by JRUSSO Eff: 08/10/17 1214
Discontinue by JRUSSO Eff: 08/10/17 1214
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 125
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@1300 (SCH)
Start Date 08/09/17-1300 Stop Date 08/25/17 1259 DC: 08/23/17-1325
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 15 Total Costs $0.00 Total Charges $3.00
Rx Number 01535344

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/09/17 1051 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01532065
08/09/17 1139 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/09/17 - 1300
For: 08/10/17 - 1300
For: 08/11/17 - 1300
For: 08/12/17 - 1300
For: 08/13/17 - 1300
08/09/17 1455 - EDIT by AMOLINARI
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/09/17-1300 STOP: 08/25/17 SOFT STOP:
TO:
START: 08/09/17-1300 STOP: 08/25/17-1259 SOFT STOP: 0
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 1300
For: 08/15/17 - 1300
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 1300
For: 08/17/17 - 1300
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 1300
For: 08/19/17 - 1300
For: 08/20/17 - 1300
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 1300
For: 08/22/17 - 1300
08/21/17 0833 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 126
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/23/17 - 1300
For: 08/24/17 - 1300
08/23/17 1325 - DISCONTINUE by SDAS Eff: 08/23/17 1325
Items Auto Credited: 1 Doses Auto Credited: 1
For: 08/24/17 - 1300
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/23/17 1325 - POM COPY AND EDIT by SDAS
TO: Rx #U01425445
08/23/17 1423 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SDAS Eff: 08/23/17 1325
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 127
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 900 MG (3 CAPSULES)

Admin Route ORAL
Frequency DAILY@0900 (SCH)
Start Date 08/11/17-0900 Stop Date 08/24/17 1659 DC: 08/21/17-1820
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 33 Total Costs $0.00 Total Charges $6.60
Rx Number 01535591

History
08/10/17 1214 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01533865
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/10/17 - 0900
Last Actual Administration Time: 08/10/17 - 0841
Old Freq/Sch: DAILY@0900,1700 (SCH)
New Freq/Sch: DAILY@0900 (SCH)
Old Order Stop: 08/10/17 - 1213
New Order Start: 08/11/17 - 0900
New Order Stop: 08/24/17 - 1659
08/10/17 1224 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by JRUSSO Eff: 08/10/17 1214
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 08/10/17 - 0900
Last Actual Administration Time: 08/10/17 - 0841
Old Freq/Sch: DAILY@0900,1700 (SCH)
New Freq/Sch: DAILY@0900 (SCH)
Old Order Stop: 08/10/17 - 1213
New Order Start: 08/11/17 - 0900
New Order Stop: 08/24/17 - 1659
08/10/17 1224 - VERIFIED by EBALILO
Items Dispensed: 9 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/21/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 128
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 08/22/17 - 0900

08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/21/17 1820 - DISCONTINUE by SDAS Eff: 08/21/17 1820
Items Auto Credited: 9 Doses Auto Credited: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/21/17 1820 - POM COPY AND EDIT by SDAS
TO: Rx #U01424954
08/21/17 2035 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 08/21/17 1820
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 129
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 1,200 MG (3 CAPSULES)

Admin Route ORAL
Frequency DAILY@1700 (SCH)
Start Date 08/10/17-1700 Stop Date 09/09/17 1659 DC: 08/23/17-1325
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 39 Total Costs $0.00 Total Charges $156.00
Rx Number 01535592

History
08/10/17 1214 - POM ORDER by JRUSSO
08/10/17 1225 - VERIFIED by EBALILO
Items Dispensed: 12 Doses Dispensed: 4
For: 08/10/17 - 1700
For: 08/11/17 - 1700
For: 08/12/17 - 1700
For: 08/13/17 - 1700
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/14/17 - 1700
For: 08/15/17 - 1700
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/16/17 - 1700
For: 08/17/17 - 1700
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 3
For: 08/18/17 - 1700
For: 08/19/17 - 1700
For: 08/20/17 - 1700
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 2
For: 08/21/17 - 1700
For: 08/22/17 - 1700
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/23/17 - 1700
For: 08/24/17 - 1700
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 3
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/23/17 1325 - DISCONTINUE by SDAS Eff: 08/23/17 1325
Items Auto Credited: 15 Doses Auto Credited: 5
For: 08/23/17 - 1700
For: 08/24/17 - 1700
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/23/17 1325 - POM COPY AND EDIT by SDAS
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 130
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

TO: Rx #U01425446
08/23/17 1423 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by SDAS Eff: 08/23/17 1325

GBPN300C - GABAPENTIN 300 MG CAP

Dose 900 MG (3 CAPSULES)

Admin Route ORAL
Frequency DAILY@0900 (SCH)
Start Date 08/22/17-0900 Stop Date 09/03/17 0859 DC: 08/25/17-1251
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $2.40
Rx Number 01538819

History
08/21/17 1820 - POM COPY AND EDIT by SDAS
FROM: Rx #01535591
08/21/17 2034 - EDIT by AADEGBAMIG
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/22/17-0900 STOP: 09/03/17 SOFT STOP:
TO:
START: 08/22/17-0900 STOP: 09/03/17-0859 SOFT STOP:
08/21/17 2034 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 3
For: 08/22/17 - 0900
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/25/17 1259 - DISCONTINUE by JHILL Eff: 08/25/17 1251
Items Auto Credited: 12 Doses Auto Credited: 4
For: 08/26/17 - 0900
For: 08/27/17 - 0900
For: 08/28/17 - 0900
For: 08/29/17 - 0900
EDIT DOCTOR: HILL,JUSTIN M.D.
08/25/17 1318 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JHILL Eff: 08/25/17 1259
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 131
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 2 TIMES A DAY (PRN) PRN REASON: AGITATION - for Agitation
Start Date 08/22/17-1745 Stop Date 09/21/17 1744 DC: 08/25/17-1251
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.15
Rx Number 01539098

History
08/22/17 1734 - POM COPY AND EDIT by SDAS
FROM: Rx #01532098
08/22/17 1735 - EDIT by EBALILO
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/22/17-1745 STOP: 09/21/17 SOFT STOP:
TO:
START: 08/22/17-1745 STOP: 09/21/17-1744 SOFT STOP: 0
08/22/17 1735 - VERIFIED by EBALILO
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 1259 - DISCONTINUE by JHILL Eff: 08/25/17 1251
EDIT DOCTOR: HILL,JUSTIN M.D.
08/25/17 1318 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JHILL Eff: 08/25/17 1259
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 132
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 300 MG (1 CAPSULE)

Admin Route ORAL
Frequency DAILY@1300 (SCH)
Start Date 08/24/17-1300 Stop Date 08/25/17 1251 DC: 08/25/17-1251
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $0.20
Rx Number 01539287

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 300 MG/DAY
is below the Low Daily Dose.

History
08/23/17 1325 - POM COPY AND EDIT by SDAS
FROM: Rx #01535344
08/23/17 1420 - EDIT by EBALILO
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/24/17-1300 STOP: 09/08/17 SOFT STOP:
TO:
START: 08/24/17-1300 STOP: 09/08/17-1259 SOFT STOP: 0
08/23/17 1420 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 1300
For: 08/25/17 - 1300
For: 08/26/17 - 1300
For: 08/27/17 - 1300
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1300
For: 08/29/17 - 1300
08/25/17 1259 - EDIT by JHILL
EDIT DOCTOR: HILL,JUSTIN M.D.
FROM:
START: 08/24/17-1300 STOP: 09/08/17 1259 SOFT STOP: 0
DISPENSE: 2
TO:
START: 08/24/17-1300 STOP: 08/25/17-1251 SOFT STOP:
DISPENSE: 1
08/25/17 1259 - DISCONTINUE by JHILL Eff: 08/25/17 1251
EDIT DOCTOR: HILL,JUSTIN M.D.
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 133
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Order filed UNV:

Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Dose Warnings differ from order entry
08/25/17 1259 - POM COPY AND EDIT by JHILL
TO: Rx #U01426202
08/25/17 1318 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Edit by JHILL Eff: 08/25/17 1259
Discontinue by JHILL Eff: 08/25/17 1259
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 134
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 1,200 MG (3 CAPSULES)

Admin Route ORAL
Frequency DAILY@1700 (SCH)
Start Date 08/23/17-1700 Stop Date 09/22/17 1659 DC: 08/25/17-1251
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $24.00
Rx Number 01539288

History
08/23/17 1325 - POM COPY AND EDIT by SDAS
FROM: Rx #01535592
08/23/17 1421 - EDIT by EBALILO
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/23/17-1700 STOP: 09/22/17 SOFT STOP:
TO:
START: 08/23/17-1700 STOP: 09/22/17-1659 SOFT STOP: 0
08/23/17 1421 - VERIFIED by EBALILO
Items Dispensed: 15 Doses Dispensed: 5
For: 08/23/17 - 1700
For: 08/24/17 - 1700
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/25/17 1259 - DISCONTINUE by JHILL Eff: 08/25/17 1251
Items Auto Credited: 15 Doses Auto Credited: 5
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
For: 08/28/17 - 1700
For: 08/29/17 - 1700
EDIT DOCTOR: HILL,JUSTIN M.D.
08/25/17 1318 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by JHILL Eff: 08/25/17 1259
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 135
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 1,000 MG (3.3333333 CAPSULES)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/25/17-1300 Stop Date 09/08/17 1259 DC: 08/25/17-1318
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540031

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Maximum Daily Dose is 1,800 MG/DAY. Ordered dose of 3,000 MG/DAY
exceeds the Maximum Daily Dose.

History
08/25/17 1259 - POM COPY AND EDIT by JHILL
FROM: Rx #01539287
Result of Frequency/Schedule Edit
Ordering Doctor: HILL,JUSTIN M.D.
Last Scheduled Administration Time: 08/24/17 - 1300
Last Actual Administration Time: 08/24/17 - 1318
Old Freq/Sch: DAILY@1300 (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/25/17 - 1251
New Order Start: 08/25/17 - 1300
New Order Stop: 09/08/17 - 1259
08/25/17 1318 - DISCONTINUE by AADEGBAMIG Eff: 08/25/17 1318
EDIT DOCTOR: HILL,JUSTIN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/25/17 1318 - REVIEW PROVIDER ACTIVITY by SYSTEM
Freq/Sch Edit by JHILL Eff: 08/25/17 1259
Ordering Doctor: HILL,JUSTIN M.D.
Last Scheduled Administration Time: 08/24/17 - 1300
Last Actual Administration Time: 08/24/17 - 1318
Old Freq/Sch: DAILY@1300 (SCH)
New Freq/Sch: 3 TIMES A DAY (SCH)
Old Order Stop: 08/25/17 - 1251
New Order Start: 08/25/17 - 1300
New Order Stop: 09/08/17 - 1259
08/25/17 1318 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 136
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 05/23/17-2200 Stop Date 06/22/17 2159 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 37 Total Costs $0.00 Total Charges $343.36
Rx Number 01514951

Discontinued Comments DC'd by Discharge

History
05/23/17 1432 - POM ORDER by GGARRISON
05/23/17 1514 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 8
For: 05/23/17 - 2200
For: 05/24/17 - 0600
For: 05/24/17 - 1400
For: 05/24/17 - 2200
For: 05/25/17 - 0600
For: 05/25/17 - 1400
For: 05/25/17 - 2200
For: 05/26/17 - 0600
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 05/26/17 - 1400
For: 05/26/17 - 2200
For: 05/27/17 - 0600
For: 05/27/17 - 1400
For: 05/27/17 - 2200
For: 05/28/17 - 0600
For: 05/28/17 - 1400
For: 05/28/17 - 2200
For: 05/29/17 - 0600
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/29/17 - 1400
For: 05/29/17 - 2200
For: 05/30/17 - 0600
For: 05/30/17 - 1400
For: 05/30/17 - 2200
For: 05/31/17 - 0600
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 05/31/17 - 1400
For: 05/31/17 - 2200
For: 06/01/17 - 0600
For: 06/01/17 - 1400
For: 06/01/17 - 2200
For: 06/02/17 - 0600
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 06/02/17 - 1400
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 137
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 06/02/17 - 2200

For: 06/03/17 - 0600
For: 06/03/17 - 1400
For: 06/03/17 - 2200
For: 06/04/17 - 0600
For: 06/04/17 - 1400
For: 06/04/17 - 2200
For: 06/05/17 - 0600
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/05/17 - 1400
For: 06/05/17 - 2200
For: 06/06/17 - 0600
For: 06/06/17 - 1400
For: 06/06/17 - 2200
For: 06/07/17 - 0600
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
Items Auto Credited: 7 Doses Auto Credited: 7
For: 06/05/17 - 0600
For: 06/05/17 - 1400
For: 06/05/17 - 2200
For: 06/06/17 - 0600
For: 06/06/17 - 1400
For: 06/06/17 - 2200
For: 06/07/17 - 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 138
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 06/06/17-2200 Stop Date 07/06/17 2159 DC: 07/05/17-1238
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 86 Total Costs $0.00 Total Charges $788.80
Rx Number 01518253

History
06/06/17 1432 - POM ORDER by GGARRISON
06/06/17 1436 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 8
For: 06/06/17 - 2200
For: 06/07/17 - 0600
For: 06/07/17 - 1400
For: 06/07/17 - 2200
For: 06/08/17 - 0600
For: 06/08/17 - 1400
For: 06/08/17 - 2200
For: 06/09/17 - 0600
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 06/09/17 - 1400
For: 06/09/17 - 2200
For: 06/10/17 - 0600
For: 06/10/17 - 1400
For: 06/10/17 - 2200
For: 06/11/17 - 0600
For: 06/11/17 - 1400
For: 06/11/17 - 2200
For: 06/12/17 - 0600
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 6 Doses Dispensed: 6
For: 06/12/17 - 1400
For: 06/12/17 - 2200
For: 06/13/17 - 0600
For: 06/13/17 - 1400
For: 06/13/17 - 2200
For: 06/14/17 - 0600
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/14/17 - 1400
For: 06/14/17 - 2200
For: 06/15/17 - 0600
For: 06/15/17 - 1400
For: 06/15/17 - 2200
For: 06/16/17 - 0600
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 06/16/17 - 1400
For: 06/16/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 139
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 06/17/17 - 0600

For: 06/17/17 - 1400
For: 06/17/17 - 2200
For: 06/18/17 - 0600
For: 06/18/17 - 1400
For: 06/18/17 - 2200
For: 06/19/17 - 0600
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 6 Doses Dispensed: 6
For: 06/19/17 - 1400
For: 06/19/17 - 2200
For: 06/20/17 - 0600
For: 06/20/17 - 1400
For: 06/20/17 - 2200
For: 06/21/17 - 0600
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 06/21/17 - 1400
For: 06/21/17 - 2200
For: 06/22/17 - 0600
For: 06/22/17 - 1400
For: 06/22/17 - 2200
For: 06/23/17 - 0600
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 06/23/17 - 1400
For: 06/23/17 - 2200
For: 06/24/17 - 0600
For: 06/24/17 - 1400
For: 06/24/17 - 2200
For: 06/25/17 - 0600
For: 06/25/17 - 1400
For: 06/25/17 - 2200
For: 06/26/17 - 0600
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 6 Doses Dispensed: 6
For: 06/26/17 - 1400
For: 06/26/17 - 2200
For: 06/27/17 - 0600
For: 06/27/17 - 1400
For: 06/27/17 - 2200
For: 06/28/17 - 0600
06/26/17 0829 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 06/28/17 - 1400
For: 06/28/17 - 2200
For: 06/29/17 - 0600
For: 06/29/17 - 1400
For: 06/29/17 - 2200
For: 06/30/17 - 0600
06/28/17 0818 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 06/30/17 - 1400
For: 06/30/17 - 2200
For: 07/01/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 140
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 07/01/17 - 1400

For: 07/01/17 - 2200
For: 07/02/17 - 0600
For: 07/02/17 - 1400
For: 07/02/17 - 2200
For: 07/03/17 - 0600
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/03/17 - 1400
For: 07/03/17 - 2200
For: 07/04/17 - 0600
For: 07/04/17 - 1400
For: 07/04/17 - 2200
For: 07/05/17 - 0600
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 07/05/17 - 1400
For: 07/05/17 - 2200
For: 07/06/17 - 0600
For: 07/06/17 - 1400
07/05/17 1238 - DISCONTINUE by JHILL Eff: 07/05/17 1238
Items Auto Credited: 4 Doses Auto Credited: 4
For: 07/05/17 - 1400
For: 07/05/17 - 2200
For: 07/06/17 - 0600
For: 07/06/17 - 1400
EDIT DOCTOR: HILL,JUSTIN M.D.
07/05/17 1238 - POM COPY AND EDIT by JHILL
TO: Rx #U01412746
07/05/17 1241 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JHILL Eff: 07/05/17 1238
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 141
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 07/05/17-1400 Stop Date 08/04/17 1359 DC: 08/01/17-1007
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 81 Total Costs $0.00 Total Charges $751.68
Rx Number 01526076

History
07/05/17 1238 - POM COPY AND EDIT by JHILL
FROM: Rx #01518253
07/05/17 1241 - VERIFIED by AMACCA
Items Dispensed: 15 Doses Dispensed: 15
For: 07/05/17 - 1400
For: 07/05/17 - 2200
For: 07/06/17 - 0600
For: 07/06/17 - 1400
For: 07/06/17 - 2200
For: 07/07/17 - 0600
For: 07/07/17 - 1400
For: 07/07/17 - 2200
For: 07/08/17 - 0600
For: 07/08/17 - 1400
For: 07/08/17 - 2200
For: 07/09/17 - 0600
For: 07/09/17 - 1400
For: 07/09/17 - 2200
For: 07/10/17 - 0600
07/06/17 1206 - EDIT by AMOLINARI
EDIT DOCTOR: HILL,JUSTIN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/05/17-1400 STOP: 08/04/17 SOFT STOP:
TO:
START: 07/05/17-1400 STOP: 08/04/17-1359 SOFT STOP: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/10/17 - 1400
For: 07/10/17 - 2200
For: 07/11/17 - 0600
For: 07/11/17 - 1400
For: 07/11/17 - 2200
For: 07/12/17 - 0600
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/12/17 - 1400
For: 07/12/17 - 2200
For: 07/13/17 - 0600
For: 07/13/17 - 1400
For: 07/13/17 - 2200
For: 07/14/17 - 0600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 142
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

07/12/17 0840 - FILL by AMOLINARI

Items Dispensed: 9 Doses Dispensed: 9
For: 07/14/17 - 1400
For: 07/14/17 - 2200
For: 07/15/17 - 0600
For: 07/15/17 - 1400
For: 07/15/17 - 2200
For: 07/16/17 - 0600
For: 07/16/17 - 1400
For: 07/16/17 - 2200
For: 07/17/17 - 0600
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/17/17 - 1400
For: 07/17/17 - 2200
For: 07/18/17 - 0600
For: 07/18/17 - 1400
For: 07/18/17 - 2200
For: 07/19/17 - 0600
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/19/17 - 1400
For: 07/19/17 - 2200
For: 07/20/17 - 0600
For: 07/20/17 - 1400
For: 07/20/17 - 2200
For: 07/21/17 - 0600
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 07/21/17 - 1400
For: 07/21/17 - 2200
For: 07/22/17 - 0600
For: 07/22/17 - 1400
For: 07/22/17 - 2200
For: 07/23/17 - 0600
For: 07/23/17 - 1400
For: 07/23/17 - 2200
For: 07/24/17 - 0600
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 07/24/17 - 1400
For: 07/24/17 - 2200
For: 07/25/17 - 0600
For: 07/25/17 - 1400
For: 07/25/17 - 2200
For: 07/26/17 - 0600
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/26/17 - 1400
For: 07/26/17 - 2200
For: 07/27/17 - 0600
For: 07/27/17 - 1400
For: 07/27/17 - 2200
For: 07/28/17 - 0600
07/26/17 0823 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 143
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Items Dispensed: 9 Doses Dispensed: 9

For: 07/28/17 - 1400
For: 07/28/17 - 2200
For: 07/29/17 - 0600
For: 07/29/17 - 1400
For: 07/29/17 - 2200
For: 07/30/17 - 0600
For: 07/30/17 - 1400
For: 07/30/17 - 2200
For: 07/31/17 - 0600
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 07/31/17 - 1400
For: 07/31/17 - 2200
For: 08/01/17 - 0600
For: 08/01/17 - 1400
For: 08/01/17 - 2200
For: 08/02/17 - 0600
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/02/17 - 1400
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
08/01/17 1007 - DISCONTINUE by JRUSSO Eff: 08/01/17 1007
Items Auto Credited: 9 Doses Auto Credited: 9
For: 08/01/17 - 1400
For: 08/01/17 - 2200
For: 08/02/17 - 0600
For: 08/02/17 - 1400
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/01/17 1007 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01419732
08/02/17 1049 - REVIEW PROVIDER ACTIVITY by JDIMARCO
Discontinue by JRUSSO Eff: 08/01/17 1007
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 144
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/01/17-1400 Stop Date 08/31/17 1359 DC: 08/04/17-1612
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 10 Total Costs $0.00 Total Charges $92.80
Rx Number 01533331

History
08/01/17 1007 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01526076
08/01/17 1021 - EDIT by AADEGBAMIG
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/01/17-1400 STOP: 08/31/17 SOFT STOP:
TO:
START: 08/01/17-1400 STOP: 08/31/17-1359 SOFT STOP:
08/01/17 1021 - VERIFIED by AADEGBAMIG
Items Dispensed: 9 Doses Dispensed: 9
For: 08/01/17 - 1400
For: 08/01/17 - 2200
For: 08/02/17 - 0600
For: 08/02/17 - 1400
For: 08/02/17 - 2200
For: 08/03/17 - 0600
For: 08/03/17 - 1400
For: 08/03/17 - 2200
For: 08/04/17 - 0600
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/04/17 - 1400
For: 08/04/17 - 2200
For: 08/05/17 - 0600
For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
For: 08/09/17 - 0600
08/04/17 1613 - DISCONTINUE by JRUSSO Eff: 08/04/17 1612
Items Auto Credited: 14 Doses Auto Credited: 14
For: 08/04/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 145
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 08/05/17 - 0600

For: 08/05/17 - 1400
For: 08/05/17 - 2200
For: 08/06/17 - 0600
For: 08/06/17 - 1400
For: 08/06/17 - 2200
For: 08/07/17 - 0600
For: 08/07/17 - 1400
For: 08/07/17 - 2200
For: 08/08/17 - 0600
For: 08/08/17 - 1400
For: 08/08/17 - 2200
For: 08/09/17 - 0600
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/09/17 1140 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/04/17 1613

LORA2VIA3 - LORAZEPAM 2 MG/ML

Dose 2 MG (1 ML)
Admin Route INTRAMUSC.
Frequency ONETIME (ONE)
Start Date 06/24/17-2200 Stop Date 06/24/17 2201 DC: 06/24/17-2201
Ordering Doctor BARRY,STEVEN
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01523557

Discontinued Comments Reached Stop Date

History
06/24/17 2201 - POM ORDER by SBARRY
06/25/17 0954 - REVIEW PROVIDER ACTIVITY by AMACCA
Administration of Unverified Order by SANTONY Eff: 06/24/17 2206
06/25/17 0954 - VERIFIED by AMACCA
06/25/17 0954 - DISCONTINUE by PHABKGJOB Eff: 06/24/17 2201
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 146
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

LORA2VIA3 - LORAZEPAM 2 MG/ML

Dose 2 MG (1 ML)
Admin Route INTRAMUSC.
Frequency NONE (STA)
Start Date 07/04/17-2120 Stop Date 07/04/17 2121 DC: 07/04/17-2121
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01525949

Discontinued Comments Reached Stop Date

History
07/04/17 2122 - POM ORDER by YIVANOV
07/05/17 0735 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by BYOHANNAN Eff: 07/04/17 2136
07/05/17 0735 - VERIFIED by AMOLINARI
07/05/17 0736 - DISCONTINUE by PHABKGJOB Eff: 07/04/17 2121
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

LORA2VIA3 - LORAZEPAM 2 MG/ML

Dose 1 MG (0.5 ML)

Admin Route INTRAMUSC.
Frequency ONETIME (ONE)
Start Date 08/25/17-2145 Stop Date 08/25/17 2146 DC: 08/25/17-2146
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540260

Discontinued Comments Reached Stop Date

History
08/25/17 2144 - POM ORDER by SDAS
08/25/17 2146 - VERIFIED by AADEGBAMIG
08/25/17 2146 - DISCONTINUE by PHABKGJOB Eff: 08/25/17 2146
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 147
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

LORA2VIA3 - LORAZEPAM 2 MG/ML

Dose 2 MG (1 ML)
Admin Route INTRAMUSC.
Frequency NOW (STA)
Start Date 08/27/17-2158 Stop Date 08/27/17 2159 DC: 08/27/17-2159
Ordering Doctor IVANOV,YURIY MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01540511

Discontinued Comments Reached Stop Date

History
08/27/17 2200 - POM ORDER by YIVANOV
08/28/17 0723 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by RKURUMUNDA Eff: 08/27/17 2209
08/28/17 0723 - VERIFIED by AMOLINARI
08/28/17 0724 - DISCONTINUE by PHABKGJOB Eff: 08/27/17 2159
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

LORA2VIA3 - LORAZEPAM 2 MG/ML

Dose 1 MG (0.5 ML)

Admin Route INTRAMUSC.
Frequency NOW (STA)
Start Date 08/29/17-1414 Stop Date 08/29/17 1415 DC: 08/29/17-1415
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540995

Discontinued Comments Reached Stop Date

History
08/29/17 1415 - POM ORDER by JRUSSO
08/29/17 1416 - VERIFIED by AMACCA
08/29/17 1416 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 1415
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 148
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

LORA2VIA3 - LORAZEPAM 2 MG/ML

Dose 1 MG (0.5 ML)

Admin Route INTRAMUSC.
Frequency ONETIME (ONE)
Start Date 08/31/17-0130 Stop Date 08/31/17 0131 DC: 08/31/17-0131
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01541493

Discontinued Comments Reached Stop Date

History
08/31/17 0121 - POM ORDER by SDAS
08/31/17 0732 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by BYOHANNAN Eff: 08/31/17 0125
08/31/17 0732 - VERIFIED by AMOLINARI
08/31/17 0732 - DISCONTINUE by PHABKGJOB Eff: 08/31/17 0131
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 149
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route PEG TUBE
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 05/23/17-1245 Stop Date 06/22/17 1244 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01514813

Discontinued Comments DC'd by Discharge

History
05/23/17 1246 - POM ORDER by GGARRISON
05/23/17 1250 - VERIFIED by AMACCA
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 150
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route PEG TUBE
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 06/06/17-1430 Stop Date 07/06/17 1429 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01518250

History
06/06/17 1432 - POM ORDER by GGARRISON
06/06/17 1435 - VERIFIED by EBALILO
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 0 Doses Dispensed: 0
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
For: 06/12/17 - 1700
For: 06/13/17 - 0900
For: 06/13/17 - 1700
For: 06/14/17 - 0900
For: 06/14/17 - 1700
For: 06/15/17 - 0900
For: 06/15/17 - 1700
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407021
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 151
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 06/12/17-1615 Stop Date 07/12/17 1614 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01520156

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518250
06/12/17 1615 - VERIFIED by AMACCA
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 0 Doses Dispensed: 0
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 0 Doses Dispensed: 0
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
For: 07/11/17 - 1700
For: 07/12/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414212
07/11/17 1020 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/11/17 1012
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 152
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 07/11/17-1015 Stop Date 08/10/17 1014 DC: 08/04/17-1021
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01527585

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520156
07/11/17 1021 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/11/17-1015 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/11/17-1015 STOP: 08/10/17-1014 SOFT STOP:
07/11/17 1021 - VERIFIED by AMACCA
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 1022 - DISCONTINUE by JRUSSO Eff: 08/04/17 1021
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/09/17 1140 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/04/17 1022
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 153
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route PEG TUBE
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 05/23/17-1245 Stop Date 06/22/17 1244 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01514812

Discontinued Comments DC'd by Discharge

History
05/23/17 1246 - POM ORDER by GGARRISON
05/23/17 1249 - VERIFIED by AMACCA
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 154
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route PEG TUBE
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 06/06/17-1430 Stop Date 07/06/17 1429 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01518251

History
06/06/17 1432 - POM ORDER by GGARRISON
06/06/17 1435 - VERIFIED by EBALILO
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 0 Doses Dispensed: 0
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
For: 06/12/17 - 1700
For: 06/13/17 - 0900
For: 06/13/17 - 1700
For: 06/14/17 - 0900
For: 06/14/17 - 1700
For: 06/15/17 - 0900
For: 06/15/17 - 1700
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407022
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 155
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 06/12/17-1615 Stop Date 07/12/17 1614 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01520158

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518251
06/12/17 1615 - VERIFIED by AMACCA
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 0 Doses Dispensed: 0
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 0 Doses Dispensed: 0
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/05/17 0834 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
For: 07/11/17 - 1700
For: 07/12/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414213
07/11/17 1020 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/11/17 1012
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 156
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 07/11/17-1015 Stop Date 08/10/17 1014 DC: 08/07/17-1045
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01527586

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520158
07/11/17 1021 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/11/17-1015 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/11/17-1015 STOP: 08/10/17-1014 SOFT STOP:
07/11/17 1021 - VERIFIED by AMACCA
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/07/17 1045 - DISCONTINUE by JRUSSO Eff: 08/07/17 1045
For: 08/07/17 - 2100
For: 08/08/17 - 2100
For: 08/09/17 - 2100
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/07/17 1045 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01421137
08/07/17 1203 - REVIEW PROVIDER ACTIVITY by EBALILO
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 157
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Discontinue by JRUSSO Eff: 08/07/17 1045

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 05/24/17-0900 Stop Date 06/23/17 0859 DC: 06/04/17-2255
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01514827

Discontinued Comments DC'd by Discharge

History
05/23/17 1310 - POM ORDER by GGARRISON
05/23/17 1312 - VERIFIED by EBALILO
05/24/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 05/26/17 - 0900
For: 05/27/17 - 0900
For: 05/28/17 - 0900
05/26/17 0805 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/29/17 - 0900
For: 05/30/17 - 0900
05/29/17 0903 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 05/31/17 - 0900
For: 06/01/17 - 0900
05/31/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/02/17 - 0900
For: 06/03/17 - 0900
For: 06/04/17 - 0900
06/02/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/05/17 - 0900
For: 06/06/17 - 0900
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
For: 06/05/17 - 0900
For: 06/06/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
06/04/17 2351 - EDIT by SYSTEM
TOTAL DOSE ADMIN DATA INITIATED
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 158
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 06/07/17-0900 Stop Date 07/07/17 0859 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01518252

History
06/06/17 1432 - POM ORDER by GGARRISON
06/06/17 1435 - VERIFIED by EBALILO
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/09/17 - 0900
For: 06/10/17 - 0900
For: 06/11/17 - 0900
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 2 Doses Dispensed: 2
For: 06/12/17 - 0900
For: 06/13/17 - 0900
06/12/17 0834 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/14/17 - 0900
For: 06/15/17 - 0900
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
For: 06/12/17 - 1700
For: 06/13/17 - 0900
For: 06/13/17 - 1700
For: 06/14/17 - 0900
For: 06/14/17 - 1700
For: 06/15/17 - 0900
For: 06/15/17 - 1700
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407023
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 159
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/13/17-0900 Stop Date 07/13/17 0859 DC: 07/11/17-1011
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 0 Total Costs $0.00 Total Charges $7.00
Rx Number 01520159

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518252
06/12/17 1615 - VERIFIED by AMACCA
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/16/17 - 0900
For: 06/17/17 - 0900
For: 06/18/17 - 0900
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 2 Doses Dispensed: 2
For: 06/19/17 - 0900
For: 06/20/17 - 0900
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 06/21/17 - 0900
For: 06/22/17 - 0900
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/26/17 - 0900
For: 06/27/17 - 0900
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 06/28/17 - 0900
For: 06/29/17 - 0900
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 06/30/17 - 0900
For: 07/01/17 - 0900
For: 07/02/17 - 0900
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/03/17 - 0900
For: 07/04/17 - 0900
07/03/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/05/17 - 0900
For: 07/06/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 160
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MALONEY,PATRICK F W00001215850 (Continued)

07/05/17 0834 - FILL by AMOLINARI

Items Dispensed: 3 Doses Dispensed: 3
For: 07/07/17 - 0900
For: 07/08/17 - 0900
For: 07/09/17 - 0900
07/07/17 0827 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/10/17 - 0900
For: 07/11/17 - 0900
07/10/17 0836 - FILL by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 07/12/17 - 0900
07/11/17 1012 - DISCONTINUE by JRUSSO Eff: 07/11/17 1011
For: 07/11/17 - 1700
For: 07/12/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01414214
07/11/17 1020 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 07/11/17 1012
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 161
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/12/17-0900 Stop Date 08/10/17 0859 DC: 08/07/17-1045
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $6.75
Rx Number 01527588

History
07/11/17 1012 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01520159
07/11/17 1021 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 07/12/17-0900 STOP: 08/10/17 SOFT STOP:
TO:
START: 07/12/17-0900 STOP: 08/10/17-0859 SOFT STOP:
07/11/17 1021 - VERIFIED by AMACCA
07/12/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 07/14/17 - 0900
For: 07/15/17 - 0900
For: 07/16/17 - 0900
07/14/17 0818 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/17/17 - 0900
For: 07/18/17 - 0900
07/17/17 0819 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/19/17 - 0900
For: 07/20/17 - 0900
07/19/17 0817 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/21/17 - 0900
For: 07/22/17 - 0900
For: 07/23/17 - 0900
07/21/17 0816 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 07/24/17 - 0900
For: 07/25/17 - 0900
07/24/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/26/17 - 0900
For: 07/27/17 - 0900
07/26/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 07/28/17 - 0900
For: 07/29/17 - 0900
For: 07/30/17 - 0900
07/28/17 0815 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 162
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 07/31/17 - 0900
For: 08/01/17 - 0900
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 0900
For: 08/03/17 - 0900
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 0900
For: 08/05/17 - 0900
For: 08/06/17 - 0900
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 0900
For: 08/08/17 - 0900
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 0900
08/07/17 1045 - DISCONTINUE by JRUSSO Eff: 08/07/17 1045
For: 08/07/17 - 2100
For: 08/08/17 - 2100
For: 08/09/17 - 2100
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/07/17 1045 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01421138
08/07/17 1203 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by JRUSSO Eff: 08/07/17 1045
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 163
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

MVT - MULTIVITAMINS TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/08/17-0900 Stop Date 09/05/17 0859 DC: 09/03/17-0842
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $6.25
Rx Number 01534806

History
08/07/17 1045 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01527588
08/07/17 1200 - EDIT by EBALILO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/08/17-0900 STOP: 09/05/17 SOFT STOP:
TO:
START: 08/08/17-0900 STOP: 09/05/17-0859 SOFT STOP: 0
08/07/17 1200 - VERIFIED by EBALILO
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0831 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0839 - FILL by AMOLINARI
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 164
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MALONEY,PATRICK F W00001215850 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 1 Doses Dispensed: 1
For: 09/04/17 - 0900
09/03/17 0843 - DISCONTINUE by JRUSSO Eff: 09/03/17 0842
For: 09/03/17 - 0900
For: 09/04/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
09/03/17 0843 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01428330
09/03/17 1038 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by JRUSSO Eff: 09/03/17 0843
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 165
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MALONEY,PATRICK F W00001215850 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 1 EA (0 EACHS)
Dose Instructions Acuity AZ (Multivitamin)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/14/17-1206
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01536156

History
08/11/17 1537 - POM ORDER by JRUSSO
08/11/17 1636 - EDIT by AMACCA
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
LABEL COMMENTS:
TO:
LABEL COMMENTS:
DOCUMENT MANUALLY- ACUITY AZ- EXP 11/2017 LOT:2710612

SEND BOTTLE BACK TO FLOOR

08/11/17 1636 - VERIFIED by AMACCA
08/14/17 0814 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/14/17 1206 - COPY AND EDIT by AMOLINARI
TO: Rx #01536514
08/14/17 1206 - DISCONTINUE by AMOLINARI Eff: 08/14/17 1206
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 166
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 06/23/17-0900 Stop Date 06/24/17 1117 DC: 06/24/17-1117
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 5 Total Costs $0.00 Total Charges $19.46
Rx Number 01522913

History
06/22/17 1525 - POM ORDER by GGARRISON
06/22/17 1526 - VERIFIED by AADEGBAMIG
Items Dispensed: 3 Doses Dispensed: 3
For: 06/23/17 - 0900
For: 06/24/17 - 0900
For: 06/25/17 - 0900
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 06/26/17 - 0900
For: 06/27/17 - 0900
06/24/17 1118 - EDIT by MELASHVI
EDIT DOCTOR: ELASHVILI, MERY
FROM:
START: 06/23/17-0900 STOP: 07/23/17 0859 SOFT STOP: 0
TO:
START: 06/23/17-0900 STOP: 06/24/17-1117 SOFT STOP:
06/24/17 1118 - DISCONTINUE by MELASHVI Eff: 06/24/17 1117
EDIT DOCTOR: ELASHVILI, MERY
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
06/24/17 1118 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01410225
06/24/17 1213 - REVIEW PROVIDER ACTIVITY by AMACCA
Edit by MELASHVI Eff: 06/24/17 1118
Discontinue by MELASHVI Eff: 06/24/17 1118
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 167
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@0700,2000 (SCH)
Start Date 06/24/17-2000 Stop Date 07/23/17 0859 DC: 06/27/17-1225
Ordering Doctor ELASHVILI, MERY
Total Dispensed 6 Total Costs $0.00 Total Charges $58.38
Rx Number 01523444

History
06/24/17 1118 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01522913
Result of Frequency/Schedule Edit
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 06/24/17 - 0900
Last Actual Administration Time: 06/24/17 - 0855
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@0700,2000 (SCH)
Old Order Stop: 06/24/17 - 1117
New Order Start: 06/24/17 - 2000
New Order Stop: 07/23/17 - 0859
06/24/17 1213 - REVIEW PROVIDER ACTIVITY by AMACCA
Freq/Sch Edit by MELASHVI Eff: 06/24/17 1118
Ordering Doctor: ELASHVILI, MERY
Last Scheduled Administration Time: 06/24/17 - 0900
Last Actual Administration Time: 06/24/17 - 0855
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: DAILY@0700,2000 (SCH)
Old Order Stop: 06/24/17 - 1117
New Order Start: 06/24/17 - 2000
New Order Stop: 07/23/17 - 0859
06/24/17 1213 - VERIFIED by AMACCA
Items Dispensed: 8 Doses Dispensed: 8
For: 06/24/17 - 2000
For: 06/25/17 - 0700
For: 06/25/17 - 2000
For: 06/26/17 - 0700
For: 06/26/17 - 2000
For: 06/27/17 - 0700
For: 06/27/17 - 2000
For: 06/28/17 - 0700
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 06/28/17 - 2000
For: 06/29/17 - 0700
For: 06/29/17 - 2000
For: 06/30/17 - 0700
06/27/17 1226 - DISCONTINUE by GGARRISON Eff: 06/27/17 1225
Items Auto Credited: 6 Doses Auto Credited: 6
For: 06/27/17 - 2000
For: 06/28/17 - 0700
For: 06/28/17 - 2000
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 168
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

For: 06/29/17 - 0700

For: 06/29/17 - 2000
For: 06/30/17 - 0700
EDIT DOCTOR: GARRISON,GRAHAM MD FELLOW
06/27/17 1226 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01410803
06/27/17 1231 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by GGARRISON Eff: 06/27/17 1226
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 169
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 25 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY@0700,2000 (SCH)
Start Date 06/27/17-2000 Stop Date 07/27/17 1959 DC: 06/29/17-1645
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 4 Total Costs $0.00 Total Charges $38.92
Rx Number 01524038

History
06/27/17 1226 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01523444
06/27/17 1231 - VERIFIED by EBALILO
Items Dispensed: 6 Doses Dispensed: 6
For: 06/27/17 - 2000
For: 06/28/17 - 0700
For: 06/28/17 - 2000
For: 06/29/17 - 0700
For: 06/29/17 - 2000
For: 06/30/17 - 0700
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 06/30/17 - 2000
For: 07/01/17 - 0700
For: 07/01/17 - 2000
For: 07/02/17 - 0700
For: 07/02/17 - 2000
For: 07/03/17 - 0700
06/29/17 1340 - HOLD by GGARRISON Eff: 06/29/17 1339
EDIT DOCTOR: GARRISON,GRAHAM MD FELLOW
Items Auto Credited: 8 Doses Auto Credited: 8
For: 06/29/17 - 2000
For: 06/30/17 - 0700
For: 06/30/17 - 2000
For: 07/01/17 - 0700
For: 07/01/17 - 2000
For: 07/02/17 - 0700
For: 07/02/17 - 2000
For: 07/03/17 - 0700
06/29/17 1646 - DISCONTINUE by JHILL Eff: 06/29/17 1645
EDIT DOCTOR: HILL,JUSTIN M.D.
06/30/17 1543 - REVIEW PROVIDER ACTIVITY by AMACCA
Hold/Resume by GGARRISON Eff: 06/29/17 1340
Discontinue by JHILL Eff: 06/29/17 1646
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 170
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@1700 (SCH)
Start Date 07/27/17-1700 Stop Date 07/28/17 1245 DC: 07/28/17-1245
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 6 Total Costs $0.00 Total Charges $9.73
Rx Number 01532263

History
07/27/17 1643 - POM ORDER by JRUSSO
07/27/17 1645 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 07/27/17 - 1700
For: 07/28/17 - 1700
For: 07/29/17 - 1700
For: 07/30/17 - 1700
07/28/17 0815 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 07/31/17 - 1700
For: 08/01/17 - 1700
07/28/17 1245 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 07/27/17-1700 STOP: 08/26/17 1659 SOFT STOP: 0
DISPENSE: 2
TO:
START: 07/27/17-1700 STOP: 07/28/17-1245 SOFT STOP:
DISPENSE: 1
07/28/17 1245 - DISCONTINUE by JRUSSO Eff: 07/28/17 1245
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
07/28/17 1245 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01418864
07/28/17 1330 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by JRUSSO Eff: 07/28/17 1245
Discontinue by JRUSSO Eff: 07/28/17 1245
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 171
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@2000 (SCH)
Start Date 07/28/17-2000 Stop Date 08/26/17 1659 DC: 08/11/17-1108
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 14 Total Costs $0.00 Total Charges $136.22
Rx Number 01532460

History
07/28/17 1245 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01532263
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 07/27/17 - 1700
Last Actual Administration Time: 07/27/17 - 1726
Old Freq/Sch: DAILY@1700 (SCH)
New Freq/Sch: DAILY@2000 (SCH)
Old Order Stop: 07/28/17 - 1245
New Order Start: 07/28/17 - 2000
New Order Stop: 08/26/17 - 1659
07/28/17 1330 - REVIEW PROVIDER ACTIVITY by EBALILO
Freq/Sch Edit by JRUSSO Eff: 07/28/17 1245
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: 07/27/17 - 1700
Last Actual Administration Time: 07/27/17 - 1726
Old Freq/Sch: DAILY@1700 (SCH)
New Freq/Sch: DAILY@2000 (SCH)
Old Order Stop: 07/28/17 - 1245
New Order Start: 07/28/17 - 2000
New Order Stop: 08/26/17 - 1659
07/28/17 1330 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 07/28/17 - 2000
For: 07/29/17 - 2000
For: 07/30/17 - 2000
For: 07/31/17 - 2000
For: 08/01/17 - 2000
07/31/17 0831 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/02/17 - 2000
For: 08/03/17 - 2000
08/02/17 0824 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/04/17 - 2000
For: 08/05/17 - 2000
For: 08/06/17 - 2000
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/07/17 - 2000
For: 08/08/17 - 2000
08/07/17 0822 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 172
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Items Dispensed: 2 Doses Dispensed: 2

For: 08/09/17 - 2000
For: 08/10/17 - 2000
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 2000
For: 08/12/17 - 2000
For: 08/13/17 - 2000
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 2000
For: 08/15/17 - 2000
08/11/17 1109 - DISCONTINUE by JRUSSO Eff: 08/11/17 1108
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/11/17 - 2000
For: 08/12/17 - 2000
For: 08/13/17 - 2000
For: 08/14/17 - 2000
For: 08/15/17 - 2000
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/11/17 1139 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by JRUSSO Eff: 08/11/17 1109

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NOW (STA)
Start Date 08/29/17-1516 Stop Date 08/29/17 1517 DC: 08/29/17-1517
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $9.73
Rx Number 01541049

Discontinued Comments Reached Stop Date

History
08/29/17 1517 - POM ORDER by JRUSSO
08/29/17 1518 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 1516
08/29/17 1518 - DISCONTINUE by PHABKGJOB Eff: 08/29/17 1517
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 173
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

RNT150T - RANITIDINE HCL 150 MG TAB

Dose 150 MG (1 TABLET)

Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/03/17-1700 Stop Date 09/02/17 1659 DC: 08/30/17-0921
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 54 Total Costs $0.00 Total Charges $18.90
Rx Number 01533866

History
08/03/17 1025 - ENTER by AMOLINARI
Items Dispensed: 7 Doses Dispensed: 7
For: 08/03/17 - 1700
For: 08/04/17 - 0900
For: 08/04/17 - 1700
For: 08/05/17 - 0900
For: 08/05/17 - 1700
For: 08/06/17 - 0900
For: 08/06/17 - 1700
08/04/17 0830 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/07/17 - 0900
For: 08/07/17 - 1700
For: 08/08/17 - 0900
For: 08/08/17 - 1700
08/07/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0823 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0814 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1700
08/16/17 0830 - FILL by BGIRLING
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 174
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

Items Dispensed: 6 Doses Dispensed: 6

For: 08/18/17 - 0900
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0839 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
08/30/17 0921 - DISCONTINUE by JRUSSO Eff: 08/30/17 0921
Items Auto Credited: 6 Doses Auto Credited: 6
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/30/17 0921 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01427323
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 175
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

08/30/17 1111 - REVIEW PROVIDER ACTIVITY by JDIMARCO

Discontinue by JRUSSO Eff: 08/30/17 0921

RISP0.25 - RISPERIDONE 0.25 MG TAB

Dose 0.125 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: AGITATION - for Agitation
Start Date 08/25/17-1300 Stop Date 08/28/17 1250 DC: 08/28/17-1250
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed 2 Total Costs $0.00 Total Charges $21.08
Rx Number 01540029

History
08/25/17 1304 - POM ORDER by JHILL
08/25/17 1315 - VERIFIED by AADEGBAMIG
Items Dispensed: 2 Doses Dispensed: 2
For: 08/25/17 - 1300
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 1251 - DISCONTINUE by JRUSSO Eff: 08/28/17 1250
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
TO:
RX COMMENTS:
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
Order filed UNV:
Allergies/Duplicates/Interactions differ from order entry
08/28/17 1251 - EDIT by JRUSSO
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
FROM:
START: 08/25/17-1300 STOP: 09/24/17 1259 SOFT STOP: 0
DISPENSE: 0
TO:
START: 08/25/17-1300 STOP: 08/28/17-1250 SOFT STOP:
DISPENSE: 3
08/28/17 1252 - POM COPY AND EDIT by JRUSSO
TO: Rx #U01426812
08/28/17 1445 - REVIEW PROVIDER ACTIVITY by YLEE
Edit by JRUSSO Eff: 08/28/17 1251
Discontinue by JRUSSO Eff: 08/28/17 1251
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 176
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

RISP0.25 - RISPERIDONE 0.25 MG TAB

Dose 0.25 MG (1 TABLET)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/27/17-2230 Stop Date 08/27/17 2231 DC: 08/27/17-2309
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540507

Warnings
Type: BURKE
Range: RISPERIDONE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.5 MG/DAY - 6 MG/DAY. Ordered dose of 0.25 MG/DAY is
below the Low Daily Dose.

History
08/27/17 2222 - POM ORDER by RMINASSIAN
08/27/17 2309 - VERIFIED by SYSTEM
Verified in order to DC
08/27/17 2309 - DISCONTINUE by RMINASSIAN Eff: 08/27/17 2309
EDIT DOCTOR: MINASSIAN,RAIA MD PGY-3
08/28/17 0723 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 08/27/17 2309
Discontinue by RMINASSIAN Eff: 08/27/17 2309
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 177
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

RISP0.25 - RISPERIDONE 0.25 MG TAB

Dose 0.125 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/29/17-0900 Stop Date 09/24/17 1259 DC: 08/29/17-1415
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $21.08
Rx Number 01540732

Warnings
Type: BURKE
Range: RISPERIDONE
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 0.5 MG/DAY - 6 MG/DAY. Ordered dose of 0.125 MG/DAY is
below the Low Daily Dose.

History
08/28/17 1252 - POM COPY AND EDIT by JRUSSO
FROM: Rx #01540029
Result of Frequency/Schedule Edit
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/27/17 - 1107
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/28/17 - 1250
New Order Start: 08/29/17 - 0900
New Order Stop: 09/24/17 - 1259
08/28/17 1446 - REVIEW PROVIDER ACTIVITY by YLEE
Freq/Sch Edit by JRUSSO Eff: 08/28/17 1252
Ordering Doctor: RUSSO,JENNIFER MD PGY-2
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/27/17 - 1107
Old Freq/Sch: DAILY (PRN)
New Freq/Sch: DAILY (SCH)
Old Order Stop: 08/28/17 - 1250
New Order Start: 08/29/17 - 0900
New Order Stop: 09/24/17 - 1259
08/28/17 1446 - VERIFIED by YLEE
Items Dispensed: 3 Doses Dispensed: 3
For: 08/29/17 - 0900
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/29/17 1416 - DISCONTINUE by JRUSSO Eff: 08/29/17 1415
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
08/29/17 1417 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JRUSSO Eff: 08/29/17 1416
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 178
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 25 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (ONE)
Start Date 05/27/17-2100 Stop Date 05/27/17 2101 DC: 05/27/17-2100
Ordering Doctor AZIZI,HANA MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01516035

History
05/27/17 1058 - POM ORDER by HAZIZI
05/27/17 1117 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 05/27/17 - 2100
05/27/17 1117 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01516036
05/27/17 1117 - DISCONTINUE by AADEGBAMIG Eff: 05/27/17 2100
Items Auto Credited: 1 Doses Auto Credited: 1
For: 05/27/17 - 2100
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 179
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 25 MG (0.5 TABLETS)

Admin Route PEG TUBE
Frequency NIGHTLY (ONE)
Start Date 05/27/17-2100 Stop Date 05/27/17 2101 DC: 05/27/17-2101
Ordering Doctor AZIZI,HANA MD
Total Dispensed 1 Total Costs $0.00 Total Charges $0.23
Rx Number 01516036

Discontinued Comments Reached Stop Date

History
05/27/17 1117 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01516035
05/27/17 1117 - ENTER by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 05/27/17 - 2100
05/27/17 1117 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: AZIZI,HANA MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
05/27/17 2101 - DISCONTINUE by PHABKGJOB Eff: 05/27/17 2101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 180
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route PEG TUBE
Frequency NIGHTLY (PRN) PRN REASON: AGITATION - for Agitation
Start Date 06/02/17-2230 Stop Date 07/02/17 2229 DC: 06/04/17-2255
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01517485

Discontinued Comments DC'd by Discharge

History
06/02/17 2229 - POM ORDER by GSYRKIN
06/03/17 0949 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 06/02/17 - 2230
06/04/17 2351 - DISCONTINUE by DISCHARGE Eff: 06/04/17 2255
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route PEG TUBE
Frequency NIGHTLY (PRN) PRN REASON: AGITATION - for Agitation
Start Date 06/06/17-1430 Stop Date 07/06/17 1429 DC: 06/12/17-1606
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 1 Total Costs $0.00 Total Charges $0.92
Rx Number 01518261

History
06/06/17 1432 - POM ORDER by GGARRISON
06/06/17 1441 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 06/06/17 - 1430
06/07/17 0809 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/09/17 0821 - FILL by BNDIKUM
Items Dispensed: 0 Doses Dispensed: 0
06/12/17 0835 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/12/17 1609 - DISCONTINUE by GGARRISON Eff: 06/12/17 1606
EDIT DOCTOR: GARRISON,GRAHAM MD
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01407024
06/12/17 1613 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by GGARRISON Eff: 06/12/17 1609
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 181
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

TRAZ50TA20 - TRAZODONE HCL 50 MG TAB

Dose 50 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: AGITATION - for Agitation
Start Date 06/12/17-1615 Stop Date 07/12/17 1614 DC: 06/30/17-1536
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed 2 Total Costs $0.00 Total Charges $2.76
Rx Number 01520160

History
06/12/17 1609 - POM COPY AND EDIT by GGARRISON
FROM: Rx #01518261
06/12/17 1615 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 06/12/17 - 1615
06/14/17 0902 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/16/17 0831 - FILL by EBALILO
Items Dispensed: 0 Doses Dispensed: 0
06/19/17 0841 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/21/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
06/23/17 0822 - FILL by AADEGBAMIG
Items Dispensed: 0 Doses Dispensed: 0
06/26/17 0830 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/28/17 0819 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 0839 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
06/30/17 1541 - DISCONTINUE by JHILL Eff: 06/30/17 1536
EDIT DOCTOR: HILL,JUSTIN M.D.
06/30/17 1543 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by JHILL Eff: 06/30/17 1541
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 182
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions ear abrasion
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 06/06/17-2100 Stop Date 06/06/17 2100 CAN: 06/06/17-1446
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed Total Costs $ Total Charges $
Rx Number U01405152

History
06/06/17 1431 - POM ORDER by GGARRISON
06/06/17 1444 - EDIT by GGARRISON
EDIT DOCTOR: GARRISON,GRAHAM MD
FROM:
START: 06/06/17-2100 STOP: None SOFT STOP:
TO:
START: 06/06/17-2100 STOP: 06/06/17-2100 SOFT STOP:
06/06/17 1444 - POM COPY AND EDIT by GGARRISON
TO: Rx #U01405163
06/06/17 1446 - CANCEL by EBALILO
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
DUPLICATE ORDER
06/06/17 1447 - REVIEW PROVIDER ACTIVITY by EBALILO
Edit by GGARRISON Eff: 06/06/17 1444
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 183
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 06/07/17-0900 Stop Date 07/07/17 0859 CAN: 06/06/17-1438
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed Total Costs $ Total Charges $
Rx Number U01405148

History
06/06/17 1431 - POM ORDER by GGARRISON
06/06/17 1438 - CANCEL by EBALILO
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
DUPLICATE ORDER

AML5T - AMLODIPINE BESYLATE 5 MG TAB

Dose 2.5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 07/04/17-0900 Stop Date 08/03/17 0859 CAN: 07/03/17-1629
Ordering Doctor HILL,JUSTIN M.D.
Total Dispensed Total Costs $ Total Charges $
Rx Number U01412443

History
07/03/17 1614 - POM COPY AND EDIT by JHILL
FROM: Rx #01520150
07/03/17 1629 - CANCEL by EBALILO
EDIT DOCTOR: HILL,JUSTIN M.D.
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 2.5MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 184
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 40 MG (0.5 TABLETS)

Admin Route PEG TUBE
Frequency NIGHTLY (SCH)
Start Date 05/23/17-2100 Stop Date 06/22/17 2059 CAN: 05/23/17-1313
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed Total Costs $ Total Charges $
Rx Number U01401822

History
05/23/17 1309 - POM ORDER by GGARRISON
05/23/17 1313 - CANCEL by EBALILO
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
CANCELLATION COMMENTS:
CHANGED TO USE 20MG TAB

CRV25T - CARVEDILOL 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route XX
Frequency EVERY 12 HOURS (SCH)
Start Date 05/23/17-2100 Stop Date 06/22/17 2059 CAN: 05/23/17-1316
Ordering Doctor GARRISON,GRAHAM MD FELLOW
Total Dispensed Total Costs $ Total Charges $
Rx Number U01401823

History
05/23/17 1309 - POM ORDER by GGARRISON
05/23/17 1316 - CANCEL by EBALILO
EDIT DOCTOR: GARRISON,GRAHAM MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
CANCELLATION COMMENTS:
CHANGED TO USE 6.25MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 185
Run Time 1513 PHA Profile

MALONEY,PATRICK F W00001215850 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 150 EA (0 EACHS)

Dose Instructions RANITIDINE
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/03/17-1700 Stop Date 09/02/17 1659 CAN: 08/03/17-1025
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Total Dispensed Total Costs $ Total Charges $
Rx Number U01420259

History
08/03/17 1018 - POM ORDER by JRUSSO
08/03/17 1025 - CANCEL by AMOLINARI
EDIT DOCTOR: RUSSO,JENNIFER MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO NF ENTRY
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient MANUELE,MICHAEL Responsible Doctor ELASHVILI, MERY

Account Number W00001219025 Location B2EA Unit Number M000209117
Age/Sex 57/M Room 208 Registered Date 08/17/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 10 in 177.8 cm Body Surface Area 1.91 m2

Weight 161 lb 11.2 oz 73.346 kg
Hem-Onc No

Drug Allergies ampicillin, sulbactam

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis:
Secondary Diagnosis:

FLUO20SO8 - FLUOXETINE HCL 20 MG/5 ML 120 ML ML

Dose 5 ML (5 MLS)
Admin Route PEG TUBE
Frequency DAILY@1800 (SCH)
Start Date 08/28/17-1800 Stop Date 09/27/17 1759
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01540819

History
08/28/17 1710 - ENTER by MHAIMOWITZ
Items Dispensed: 120 Doses Dispensed: 1
For: 08/28/17 - 1800
08/28/17 1712 - CREDIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

LEVA0.63 - LEVALBUTEROL HCL 0.63 MG/3 ML VIAL

Dose 0.63 MG (3 ML)

Admin Route NEBULIZER
Frequency EVERY 8 HOURS (SCH)
Start Date 08/21/17-1400 Stop Date 09/20/17 1359
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 36 Total Costs $0.00 Total Charges $667.44
Rx Number 01538559

History
08/21/17 1230 - POM ORDER by YCHO
08/21/17 1322 - VERIFIED by MHAIMOWITZ
Items Dispensed: 12 Doses Dispensed: 1
For: 08/21/17 - 1400
08/26/17 1009 - DEBIT by AADEGBAMIG
ITEMS: 1
09/01/17 0745 - DEBIT by AMOLINARI
ITEMS: 1

LYTE240S - LYTES/YERBA SANTA 59 ML BTL

Dose 1 APPLIC (1 SOLUTION APPLICATION)

Admin Route MUCUS MEMB
Frequency EVERY 4 HRS W/AWAKE (SCH)
Start Date 08/17/17-2100 Stop Date 09/16/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 2 Total Costs $0.00 Total Charges $59.94
Rx Number 01537771

History
08/17/17 1811 - POM ORDER by MELASHVI
08/17/17 1812 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 2100
09/01/17 1921 - DEBIT by MHAIMOWITZ
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route XX
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/17/17-1700 Stop Date 09/16/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01537716

History
08/17/17 1700 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01537672
08/17/17 1704 - VERIFIED by AMACCA
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 19 Total Costs $0.00 Total Charges $10.71
Rx Number 01537720

History
08/17/17 1701 - POM ORDER by MELASHVI
08/17/17 1705 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 19 Total Costs $0.00 Total Charges $1.70
Rx Number 01537721

History
08/17/17 1701 - POM ORDER by MELASHVI
08/17/17 1705 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route PEG TUBE
Frequency NIGHTLY (SCH)
Start Date 08/17/17-2100 Stop Date 09/16/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 20 Total Costs $0.00 Total Charges $12.75
Rx Number 01537722

History
08/17/17 1701 - POM ORDER by MELASHVI
08/17/17 1706 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/17/17 - 2100
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions peg tube
Admin Route XX
Frequency NIGHTLY (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 13 Total Costs $0.00 Total Charges $7.50
Rx Number 01539544

History
08/24/17 1142 - POM ORDER by YCHO
08/24/17 1150 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/24/17 - 2100
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/17/17-1630 Stop Date 09/16/17 1629
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537673

History
08/17/17 1618 - POM ORDER by YCHO
08/17/17 1625 - VERIFIED by AMACCA
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

ENXP40I.4 - ENOXAPARIN 40 MG/0.4 ML SYR

Dose 40 MG (0.4 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 19 Total Costs $0.00 Total Charges $1448.91
Rx Number 01537726

Warnings
Type: BURKE
Range: LOVENOX
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 1 MG/KG/DAY - 2 MG/KG/DAY. Ordered dose of 0.55
MG/KG/DAY is below the Low Daily Dose.

History
08/17/17 1701 - POM ORDER by MELASHVI
08/17/17 1706 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

For: 09/04/17 - 0900

For: 09/05/17 - 0900

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/18/17-0900 Stop Date 09/17/17 0859
Ordering Doctor ELASHVILI, MERY
Total Dispensed 19 Total Costs $0.00 Total Charges $5.95
Rx Number 01537725

History
08/17/17 1701 - POM ORDER by MELASHVI
08/17/17 1706 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

FERR300L - FERROUS SULFATE 300 MG/5 ML UDC

Dose 300 MG (5 ML)

Admin Route PEG TUBE
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/27/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $3.00
Rx Number 01540729

History
08/28/17 1256 - POM ORDER by MELASHVI
08/28/17 1434 - VERIFIED by MHAIMOWITZ
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route PEG TUBE
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/17/17-1700 Stop Date 09/16/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537717

History
08/17/17 1701 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01537675
08/17/17 1705 - VERIFIED by AMACCA
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route PEG TUBE
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/17/17-1700 Stop Date 09/16/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01537718

History
08/17/17 1701 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01537674
08/17/17 1705 - VERIFIED by AMACCA
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 75 MG (3 TABLETS)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route PEG TUBE
Frequency EVERY 12 HOURS (SCH)
Start Date 08/17/17-2100 Stop Date 09/16/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 117 Total Costs $0.00 Total Charges $25.50
Rx Number 01537733

History
08/17/17 1709 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01537723
08/17/17 1715 - VERIFIED by AMACCA
Items Dispensed: 21 Doses Dispensed: 7
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 18 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
For: 08/26/17 - 0900
For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 12 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

For: 08/31/17 - 0900

For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 18 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Admin Route PEG TUBE
Frequency NIGHTLY (SCH)
Start Date 08/17/17-2100 Stop Date 09/18/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $0.00 Total Charges $4.00
Rx Number 01537724

History
08/17/17 1701 - POM ORDER by MELASHVI
08/17/17 1706 - VERIFIED by AMACCA
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route PEG TUBE
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/17/17-1700 Stop Date 09/16/17 1659
Ordering Doctor ELASHVILI, MERY
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01537719

History
08/17/17 1701 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01537676
08/17/17 1705 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 08/17/17 - 1700
08/18/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0833 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0841 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0817 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

VITA1CAP19 - VITAMIN B COMPLEX W/VIT B-12 1 EA TAB

Dose 1 EA (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor ELASHVILI, MERY
Total Dispensed 12 Total Costs $0.00 Total Charges $0.64
Rx Number 01540006

History
08/25/17 1204 - POM ORDER by MELASHVI
08/25/17 1246 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0821 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0823 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

FLUO20SO8 - FLUOXETINE HCL 20 MG/5 ML 120 ML ML

Dose 2.5 ML (2.5 MLS)

Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/21/17-1800 Stop Date 09/20/17 1759 DC: 08/21/17-1800
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 120 Total Costs $0.00 Total Charges $370.80
Rx Number 01538740

Warnings
Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DAY (Dose Units).

Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DOSE (Dose Units).

Type: BURKE
Range: FLUOXETINE HCL
Condition: ALL COMMON INDICATIONS
Warnings FLUO20SO8: Unable to check dose ranges for MG/DAY (Dose Units).

History
08/21/17 1758 - ENTER by AADEGBAMIG
Items Dispensed: 120 Doses Dispensed: 1
For: 08/21/17 - 1800
08/21/17 1759 - COPY AND EDIT by AADEGBAMIG
TO: Rx #01538742
08/21/17 1759 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 1800
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

FLUO20SO8 - FLUOXETINE HCL 20 MG/5 ML 120 ML ML

Dose 2.5 ML (2.5 MLS)

Admin Route PEG TUBE
Frequency DAILY@1800 (SCH)
Start Date 08/21/17-1800 Stop Date 09/20/17 1759 DC: 08/28/17-1251
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 120 Total Costs $0.00 Total Charges $370.80
Rx Number 01538742

History
08/21/17 1759 - COPY AND EDIT by AADEGBAMIG
FROM: Rx #01538740
08/21/17 1759 - ENTER by AADEGBAMIG
Items Dispensed: 120 Doses Dispensed: 1
For: 08/21/17 - 1800
08/21/17 1759 - SYSTEM COPY AND EDIT by AADEGBAMIG
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ROUTE: ORAL
TO:
ROUTE: PEG TUBE
08/28/17 1256 - DISCONTINUE by MELASHVI Eff: 08/28/17 1251
EDIT DOCTOR: ELASHVILI, MERY
08/28/17 1256 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01426816
08/28/17 1710 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by MELASHVI Eff: 08/28/17 1256

MTC5B473 - METOCLOPRAMIDE HCL 5 MG/5 ML 473 ML ML

Dose 5 ML (5 MLS)
Admin Route PEG TUBE
Frequency EVERY 6 HOURS (SCH)
Start Date 08/18/17-1800 Stop Date 09/17/17 1759 DC: 08/24/17-1534
Ordering Doctor ELASHVILI, MERY
Total Dispensed 90 Total Costs $0.00 Total Charges $5.40
Rx Number 01538037

History
08/18/17 1323 - ENTER by AMACCA
Items Dispensed: 90 Doses Dispensed: 18
For: 08/18/17 - 1800
08/24/17 1536 - DISCONTINUE by MELASHVI Eff: 08/24/17 1534
EDIT DOCTOR: ELASHVILI, MERY
08/28/17 1601 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by MELASHVI Eff: 08/24/17 1536
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/17/17-1630 Stop Date 09/16/17 1629 DC: 08/17/17-1646
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537672

History
08/17/17 1618 - POM ORDER by YCHO
08/17/17 1625 - VERIFIED by AMACCA
08/17/17 1700 - DISCONTINUE by MELASHVI Eff: 08/17/17 1646
EDIT DOCTOR: ELASHVILI, MERY
08/17/17 1700 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01423964
08/17/17 1704 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 08/17/17 1700

FLX10C - FLUOXETINE HCL 10 MG CAP

Dose 10 MG (1 CAPSULE)
Admin Route ORAL
Frequency DAILY@1800 (SCH)
Start Date 08/21/17-1800 Stop Date 09/20/17 1759 DC: 08/21/17-1800
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538741

History
08/21/17 1744 - POM ORDER by YCHO
08/21/17 1759 - DISCONTINUE by AADEGBAMIG Eff: 08/21/17 1800
EDIT DOCTOR: CHO,YUSIK MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/21/17 1759 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/17/17-1630 Stop Date 09/16/17 1629 DC: 08/17/17-1646
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537675

History
08/17/17 1618 - POM ORDER by YCHO
08/17/17 1625 - VERIFIED by AMACCA
08/17/17 1700 - DISCONTINUE by MELASHVI Eff: 08/17/17 1646
EDIT DOCTOR: ELASHVILI, MERY
08/17/17 1701 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01423965
08/17/17 1704 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 08/17/17 1700

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/17/17-1630 Stop Date 09/16/17 1629 DC: 08/17/17-1646
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537674

History
08/17/17 1618 - POM ORDER by YCHO
08/17/17 1625 - VERIFIED by AMACCA
08/17/17 1700 - DISCONTINUE by MELASHVI Eff: 08/17/17 1646
EDIT DOCTOR: ELASHVILI, MERY
08/17/17 1701 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01423966
08/17/17 1704 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 08/17/17 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

METO5SOL5 - METOCLOPRAMIDE HCL 10 MG/10 ML UDC

Dose 5 MG (5 ML)
Admin Route PEG TUBE
Frequency EVERY 6 HOURS (SCH)
Start Date 08/18/17-1800 Stop Date 09/17/17 1759 DC: 08/18/17-1800
Ordering Doctor ELASHVILI, MERY
Total Dispensed 19 Total Costs $0.00 Total Charges $25.65
Rx Number 01538036

History
08/18/17 1315 - POM ORDER by MELASHVI
08/18/17 1318 - VERIFIED by AMACCA
Items Dispensed: 19 Doses Dispensed: 19
For: 08/18/17 - 1800
For: 08/19/17 - 0000
For: 08/19/17 - 0600
For: 08/19/17 - 1200
For: 08/19/17 - 1800
For: 08/20/17 - 0000
For: 08/20/17 - 0600
For: 08/20/17 - 1200
For: 08/20/17 - 1800
For: 08/21/17 - 0000
For: 08/21/17 - 0600
For: 08/21/17 - 1200
For: 08/21/17 - 1800
For: 08/22/17 - 0000
For: 08/22/17 - 0600
For: 08/22/17 - 1200
For: 08/22/17 - 1800
For: 08/23/17 - 0000
For: 08/23/17 - 0600
08/18/17 1321 - DEBIT by AMACCA
ITEMS: 19 DOSES: 19
08/18/17 1321 - DISCONTINUE by AMACCA Eff: 08/18/17 1800
Items Auto Credited: 19 Doses Auto Credited: 19
For: 08/18/17 - 1800
For: 08/19/17 - 0000
For: 08/19/17 - 0600
For: 08/19/17 - 1200
For: 08/19/17 - 1800
For: 08/20/17 - 0000
For: 08/20/17 - 0600
For: 08/20/17 - 1200
For: 08/20/17 - 1800
For: 08/21/17 - 0000
For: 08/21/17 - 0600
For: 08/21/17 - 1200
For: 08/21/17 - 1800
For: 08/22/17 - 0000
For: 08/22/17 - 0600
For: 08/22/17 - 1200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

For: 08/22/17 - 1800

For: 08/23/17 - 0000
For: 08/23/17 - 0600
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE

METO25TA4 - METOPROLOL TARTRATE 25 MG TAB

Dose 25 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route PEG TUBE
Frequency EVERY 12 HOURS (SCH)
Start Date 08/17/17-2100 Stop Date 09/16/17 2059 DC: 08/17/17-2100
Ordering Doctor ELASHVILI, MERY
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01537723

History
08/17/17 1701 - POM ORDER by MELASHVI
08/17/17 1706 - VERIFIED by AMACCA
Items Dispensed: 7 Doses Dispensed: 7
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/17/17 1709 - DISCONTINUE by MELASHVI Eff: 08/17/17 2100
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/17/17 - 2100
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
EDIT DOCTOR: ELASHVILI, MERY
08/17/17 1709 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01424008
08/17/17 1715 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 08/17/17 1709
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

MANUELE,MICHAEL W00001219025 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/17/17-1630 Stop Date 09/16/17 1629 DC: 08/17/17-1646
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 2 Total Costs $ Total Charges $
Rx Number 01537676

History
08/17/17 1618 - POM ORDER by YCHO
08/17/17 1626 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 1
For: 08/17/17 - 1630
08/17/17 1700 - DISCONTINUE by MELASHVI Eff: 08/17/17 1646
EDIT DOCTOR: ELASHVILI, MERY
08/17/17 1701 - POM COPY AND EDIT by MELASHVI
TO: Rx #U01423967
08/17/17 1704 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by MELASHVI Eff: 08/17/17 1700

FLUO20SO8 - FLUOXETINE HCL 20 MG/5 ML 120 ML ML

Dose 20 ML (20 MLS)

Admin Route PEG TUBE
Frequency DAILY@1800 (SCH)
Start Date 08/28/17-1800 Stop Date 09/27/17 1759 CAN: 08/28/17-1709
Ordering Doctor ELASHVILI, MERY
Total Dispensed Total Costs $ Total Charges $
Rx Number U01426816

History
08/28/17 1256 - POM COPY AND EDIT by MELASHVI
FROM: Rx #01538742
08/28/17 1709 - CANCEL by MHAIMOWITZ
EDIT DOCTOR: ELASHVILI, MERY
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGE TO 20MG
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient MARTINEZ MAISONET,CARMEN Responsible Doctor DOHLE,CAROLIN MD

Account Number W00001219306 Location B2EA Unit Number M000208709
Age/Sex 79/F Room 218 Registered Date 08/18/17
Status ADM IN Bed 02 Discharged Date

Height 5 ft 0.98 in 154.9 cm Body Surface Area 1.54 m2

Weight 124 lb 6.4 oz 56.427 kg
Hem-Onc No

Drug Allergies No Known Allergies

ADRS NO ADR'S ENTERED

Clinical Interventions
Start Date-Time Intervention Type Status
08/18/17-1648 DRUG - DRUG INTERACTION COMPLETE

Med Allergies:
Food Allergies:
Primary Diagnosis: CVA
Secondary Diagnosis:

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 325 MG (10.16 ML)

Admin Route PEG TUBE
Frequency EVERY 6 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/23/17-1645 Stop Date 09/22/17 1644
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539381

History
08/23/17 1641 - ENTER by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions around PEG tube
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Clinical Indication POST-OP
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541939

History
09/01/17 1232 - POM COPY AND EDIT by SDAS
FROM: Rx #01540554
09/01/17 1312 - EDIT by AADEGBAMIG
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
DOSE INSTRUCTIONS:
aroun PEG tube
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP:
DOSE INSTRUCTIONS:
around PEG tube
09/01/17 1312 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
09/01/17 1312 - CREDIT by AADEGBAMIG
ITEMS: 1

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 14 UNIT (0.14 ML)

Admin Route SUBCUTAN.
Frequency EVERY BEDTIME (SCH)
Start Date 08/29/17-2100 Stop Date 09/28/17 2059
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541124

History
08/29/17 1638 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01539747
08/29/17 1640 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/29/17 - 2100
08/29/17 1641 - CREDIT by AADEGBAMIG
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 4 UNIT (0.04 ML)

Admin Route SUBCUTAN.
Frequency DAILY (SCH)
Start Date 08/31/17-0900 Stop Date 09/30/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541379

History
08/30/17 1617 - POM ORDER by TKOUTZEVA
08/30/17 1625 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/31/17 - 0900
08/30/17 1625 - CREDIT by AMACCA
ITEMS: 1

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency EVERY 6 HOURS (SCH)
Start Date 08/18/17-1800 Stop Date 09/17/17 1759
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01538137

History
08/18/17 1558 - POM ORDER by TKOUTZEVA
08/18/17 1600 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 1800
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions to left ankle
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/23/17-0900 Stop Date 09/22/17 0859
Ordering Doctor MINASSIAN,RAIA MD PGY-3
Total Dispensed 25 Total Costs $0.00 Total Charges $551.25
Rx Number 01539073

History
08/22/17 1704 - POM ORDER by RMINASSIAN
08/22/17 1704 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 1
For: 08/23/17 - 0900
08/24/17 1357 - DEBIT by MHAIMOWITZ
ITEMS: 2
09/03/17 1230 - DEBIT by MHAIMOWITZ
ITEMS: 2

LIDO30AD - LIDOCAINE 5% 1 EA PATCH

Dose 1 EA (1 PATCH)
Dose Instructions apply to neck
Admin Route TOPICALLY
Frequency DAILY (SCH)
Start Date 08/24/17-0900 Stop Date 09/23/17 0859
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 10 Total Costs $0.00 Total Charges $220.50
Rx Number 01539520

History
08/24/17 0853 - POM ORDER by CDOHLE
08/24/17 0912 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 1
For: 08/24/17 - 0900
08/31/17 1118 - DEBIT by AMACCA
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LYTE240S - LYTES/YERBA SANTA 59 ML BTL

Dose 1 APPLIC (1 SOLUTION APPLICATION)

Admin Route MUCUS MEMB
Frequency 3 TIMES A DAY (SCH)
Start Date 08/18/17-1700 Stop Date 09/17/17 1659
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 2 Total Costs $0.00 Total Charges $59.94
Rx Number 01538145

History
08/18/17 1610 - POM ORDER by TKOUTZEVA
08/18/17 1614 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 1700
08/25/17 1044 - DEBIT by AMOLINARI
ITEMS: 1

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions inguinal,buttocks area
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 09/01/17-2100 Stop Date 09/08/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01541940

History
09/01/17 1232 - POM COPY AND EDIT by SDAS
FROM: Rx #01540555
09/01/17 1312 - EDIT by AADEGBAMIG
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 09/01/17-2100 STOP: 09/08/17 SOFT STOP:
TO:
START: 09/01/17-2100 STOP: 09/08/17-2059 SOFT STOP:
09/01/17 1312 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 09/01/17 - 2100
09/01/17 1313 - CREDIT by AADEGBAMIG
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions PRN PAIN/FEVER
Admin Route ORAL
Frequency 4 TIMES A DAY (PRN) PRN REASON: FEVER - Fever
Start Date 08/25/17-2100 Stop Date 09/24/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01540244

History
08/25/17 2051 - POM ORDER by SDAS
08/25/17 2055 - VERIFIED by AADEGBAMIG
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Admin Route PEG TUBE
Frequency DAILY@0700 (SCH)
Start Date 08/23/17-0700 Stop Date 09/17/17 1559
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $3.25
Rx Number 01538952

History
08/22/17 1138 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538119
Result of Frequency/Schedule Edit
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/22/17 - 0721
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: DAILY@0700 (SCH)
Old Order Stop: 08/23/17 - 0900
New Order Start: 08/23/17 - 0700
New Order Stop: 09/17/17 - 1559
08/22/17 1149 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Freq/Sch Edit by TKOUTZEVA Eff: 08/22/17 1138
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: As Needed
Last Actual Administration Time: 08/22/17 - 0721
Old Freq/Sch: EVERY 4 HOURS (PRN)
New Freq/Sch: DAILY@0700 (SCH)
Old Order Stop: 08/23/17 - 0900
New Order Start: 08/23/17 - 0700
New Order Stop: 09/17/17 - 1559
08/22/17 1149 - VERIFIED by AMOLINARI
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/26/17 - 0700
For: 08/27/17 - 0700
For: 08/28/17 - 0700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/29/17 - 0700
For: 08/30/17 - 0700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/31/17 - 0700
For: 09/01/17 - 0700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/02/17 - 0700
For: 09/03/17 - 0700
For: 09/04/17 - 0700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

For: 09/05/17 - 0700

For: 09/06/17 - 0700

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 18 Total Costs $0.00 Total Charges $9.45
Rx Number 01538129

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1557 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $4.00
Rx Number 01538141

History
08/18/17 1601 - POM ORDER by TKOUTZEVA
08/18/17 1603 - VERIFIED by EBALILO
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY EVENING (SCH)
Start Date 08/19/17-1700 Stop Date 09/18/17 1659
Ordering Doctor DOHLE,CAROLIN
Total Dispensed 18 Total Costs $0.00 Total Charges $11.25
Rx Number 01538214

History
08/18/17 1757 - ENTER by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 1700
For: 08/20/17 - 1700
For: 08/21/17 - 1700
For: 08/22/17 - 1700
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 1700
For: 08/24/17 - 1700
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 1700
For: 08/26/17 - 1700
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 1700
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1700
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1700
For: 09/02/17 - 1700
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1700
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

BCL10T - BACLOFEN 10 MG TAB

Dose 5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 09/01/17-1300 Stop Date 10/01/17 1259
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 14 Total Costs $0.00 Total Charges $5.25
Rx Number 01541883

History
09/01/17 1130 - POM ORDER by SDAS
09/01/17 1136 - VERIFIED by AMOLINARI
Items Dispensed: 14 Doses Dispensed: 14
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/18/17-1545 Stop Date 09/17/17 1544
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01538105

History
08/18/17 1543 - POM ORDER by TKOUTZEVA
08/18/17 1544 - VERIFIED by EBALILO
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

CRV3.125T - CARVEDILOL 3.125 MG TAB

Dose 3.125 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route XX
Frequency 2 TIMES A DAY (SCH)
Start Date 08/18/17-1700 Stop Date 09/17/17 1659
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 37 Total Costs $0.00 Total Charges $7.26
Rx Number 01538131

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1557 - VERIFIED by EBALILO
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1700
For: 08/21/17 - 0900
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1700
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1700
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

For: 09/01/17 - 1700

For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route XX
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 18 Total Costs $0.00 Total Charges $258.08
Rx Number 01538167

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1647 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route PEG TUBE
Frequency 3 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $10.50
Rx Number 01538109

History
08/18/17 1549 - ENTER by EBALILO
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
For: 08/26/17 - 0900
For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

For: 09/02/17 - 1300

For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route PEG TUBE
Frequency 2 TIMES A DAY (SCH)
Start Date 08/30/17-1700 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 13 Total Costs $0.00 Total Charges $2.80
Rx Number 01541301

History
08/30/17 1314 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538128
Result of Frequency/Schedule Edit
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: 08/30/17 - 0900
Last Actual Administration Time: 08/30/17 - 0950
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/30/17 - 1313
New Order Start: 08/30/17 - 1700
New Order Stop: 09/18/17 - 0859
08/30/17 1316 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by TKOUTZEVA Eff: 08/30/17 1314
Ordering Doctor: Koutzeva,Totka MD PGY-4
Last Scheduled Administration Time: 08/30/17 - 0900
Last Actual Administration Time: 08/30/17 - 0950
Old Freq/Sch: DAILY (SCH)
New Freq/Sch: 2 TIMES A DAY (SCH)
Old Order Stop: 08/30/17 - 1313
New Order Start: 08/30/17 - 1700
New Order Stop: 09/18/17 - 0859
08/30/17 1316 - VERIFIED by MHAIMOWITZ
Items Dispensed: 9 Doses Dispensed: 9
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1700
For: 09/01/17 - 0900
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1700
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

FENO145T - FENOFIBRATE,MICRONIZED 145 MG TAB

Dose 145 MG (1 TABLET)

Admin Route XX
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 18 Total Costs $0.00 Total Charges $41.28
Rx Number 01538132

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1558 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 36 Total Costs $0.00 Total Charges $6.40
Rx Number 01538168

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1647 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 36 Total Costs $0.00 Total Charges $0.75
Rx Number 01538139

History
08/18/17 1600 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538134
08/18/17 1602 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route PEG TUBE
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/18/17-1545 Stop Date 09/17/17 1544
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538106

History
08/18/17 1543 - POM ORDER by TKOUTZEVA
08/18/17 1544 - VERIFIED by EBALILO
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route PEG TUBE
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/18/17-1545 Stop Date 09/17/17 1544
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538107

History
08/18/17 1543 - POM ORDER by TKOUTZEVA
08/18/17 1544 - VERIFIED by EBALILO
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

MEMA5TAB2 - MEMANTINE HCL 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 36 Total Costs $0.00 Total Charges $416.80
Rx Number 01538140

History
08/18/17 1600 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538135
08/18/17 1602 - VERIFIED by EBALILO
Items Dispensed: 8 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

PIOG30TA2 - PIOGLITAZONE HCL 30 MG TAB

Dose 30 MG (1 TABLET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 18 Total Costs $0.00 Total Charges $791.68
Rx Number 01538166

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1646 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route PEG TUBE
Frequency NIGHTLY (SCH)
Start Date 08/18/17-2100 Stop Date 09/17/17 2059
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 38 Total Costs $0.00 Total Charges $3.20
Rx Number 01538108

History
08/18/17 1543 - POM ORDER by TKOUTZEVA
08/18/17 1545 - VERIFIED by EBALILO
Items Dispensed: 10 Doses Dispensed: 5
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0822 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ART3.5OO - ARTIFICIAL TEARS OP OINT 3.5 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Admin Route OPHTHALMIC
Frequency 3 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $2.37
Rx Number 01535285

Discontinued Comments DC'd by Discharge

History
08/08/17 2143 - ENTER by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions aroun PEG tube
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/18/17-2100 Stop Date 08/25/17 2059 DC: 08/23/17-0915
Ordering Doctor Koutzeva,Totka MD PGY-4
Clinical Indication POST-OP
Total Dispensed 1 Total Costs $0.00 Total Charges $32.40
Rx Number 01538138

History
08/18/17 1558 - POM ORDER by TKOUTZEVA
08/18/17 1601 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 2100
08/23/17 0915 - DISCONTINUE by TKOUTZEVA Eff: 08/23/17 0915
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/23/17 0915 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01425407
08/23/17 1216 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/23/17 0915
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions aroun PEG tube
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/23/17-2100 Stop Date 08/30/17 2059 DC: 08/28/17-0920
Ordering Doctor Koutzeva,Totka MD PGY-4
Clinical Indication POST-OP
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539243

History
08/23/17 0915 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538138
08/23/17 1216 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/23/17-2100 STOP: 08/30/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/23/17-2100 STOP: 08/30/17-2059 SOFT STOP: 0
DISPENSE: 0
08/23/17 1216 - VERIFIED by AMOLINARI
08/28/17 0920 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0920
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0921 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426697
08/28/17 1027 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0920
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

BACI30OI4 - BACITRACIN/POLYMYXIN B SULFATE 30 GM TUBE

Dose 1 APPLIC (1 OINT. APPLICATION)

Dose Instructions aroun PEG tube
Admin Route TOPICALLY
Frequency EVERY 12 HOURS (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-1231
Ordering Doctor Koutzeva,Totka MD PGY-4
Clinical Indication POST-OP
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540554

History
08/28/17 0921 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01539243
08/28/17 1026 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/04/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/28/17-2100 STOP: 09/04/17-2059 SOFT STOP: 0
DISPENSE: 0
08/28/17 1026 - VERIFIED by MHAIMOWITZ
09/01/17 1232 - DISCONTINUE by SDAS Eff: 09/01/17 1231
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
09/01/17 1232 - POM COPY AND EDIT by SDAS
TO: Rx #U01427969
09/01/17 1312 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 09/01/17 1232
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

DICL100G16 - DICLOFENAC SODIUM 1% GEL 100 GM TUBE

Dose 2 GM (2 GEL APPLICATIONS)

Admin Route TOPICALLY
Frequency DAILY@0900,2100 (SCH)
Start Date 08/10/17-0900 Stop Date 09/09/17 0859 DC: 08/10/17-1058
Ordering Doctor CHO,YUSIK MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01535549

History
08/09/17 2153 - POM ORDER by YCHO
08/10/17 0736 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/10/17 - 0900
08/10/17 1059 - DISCONTINUE by TKOUTZEVA Eff: 08/10/17 1058
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/10/17 1149 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/10/17 1059
08/10/17 1411 - CREDIT by BGIRLING
ITEMS: 1

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 6 UNIT (0.06 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/09/17-2100 Stop Date 09/08/17 2059 DC: 08/09/17-2100
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 1 Total Costs $0.00 Total Charges $322.41
Rx Number 01535270

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2138 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 2100
08/08/17 2215 - DISCONTINUE by SMOHAMED Eff: 08/09/17 2100
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
08/08/17 2215 - POM COPY AND EDIT by SMOHAMED
TO: Rx #U01421623
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SMOHAMED Eff: 08/08/17 2215
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 6 UNIT (0.06 ML)

Admin Route SUBCUTAN.
Frequency NIGHTLY (SCH)
Start Date 08/09/17-2100 Stop Date 09/08/17 2059 DC: 08/13/17-1615
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01535308

Discontinued Comments DC'd by Discharge

History
08/08/17 2215 - POM COPY AND EDIT by SMOHAMED
FROM: Rx #01535270
08/09/17 0800 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 2100
08/09/17 0801 - CREDIT by AMOLINARI
ITEMS: 1
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 6 UNIT (0.06 ML)

Admin Route SUBCUTAN.
Frequency 2134 (ONE)
Start Date 08/08/17-2134 Stop Date 08/08/17 2135 DC: 08/08/17-2135
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01535309

Discontinued Comments Reached Stop Date

History
08/08/17 2215 - POM ORDER by SMOHAMED
08/09/17 0800 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by ACABELLO Eff: 08/08/17 2307
08/09/17 0800 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/08/17 - 2134
08/09/17 0800 - DISCONTINUE by PHABKGJOB Eff: 08/08/17 2135
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
08/09/17 0802 - CREDIT by AMOLINARI
ITEMS: 1

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 6 UNIT (0.06 ML)

Admin Route SUBCUTAN.
Frequency EVERY BEDTIME (SCH)
Start Date 08/18/17-2100 Stop Date 09/17/17 2059 DC: 08/21/17-1518
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $322.41
Rx Number 01538136

History
08/18/17 1558 - POM ORDER by TKOUTZEVA
08/18/17 1559 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 2100
08/21/17 1521 - DISCONTINUE by CDOHLE Eff: 08/21/17 1518
EDIT DOCTOR: DOHLE,CAROLIN MD
08/21/17 1521 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01424874
08/21/17 1544 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by CDOHLE Eff: 08/21/17 1521
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 8 UNIT (0.08 ML)

Admin Route SUBCUTAN.
Frequency EVERY BEDTIME (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059 DC: 08/23/17-1440
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01538666

History
08/21/17 1521 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01538136
08/21/17 1543 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/21/17 - 2100
08/21/17 1544 - CREDIT by EBALILO
ITEMS: 1
08/23/17 1441 - DISCONTINUE by CDOHLE Eff: 08/23/17 1440
EDIT DOCTOR: DOHLE,CAROLIN MD
08/23/17 1441 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01425471
08/23/17 1636 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by CDOHLE Eff: 08/23/17 1441

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 10 UNIT (0.1 ML)

Admin Route SUBCUTAN.
Frequency EVERY BEDTIME (SCH)
Start Date 08/23/17-2100 Stop Date 09/22/17 2059 DC: 08/24/17-1631
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $322.41
Rx Number 01539296

History
08/23/17 1441 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01538666
08/23/17 1441 - VERIFIED by AADEGBAMIG
Items Dispensed: 1 Doses Dispensed: 1
For: 08/23/17 - 2100
08/24/17 1631 - DISCONTINUE by TKOUTZEVA Eff: 08/24/17 1631
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/24/17 1631 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01425932
08/24/17 1636 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/24/17 1631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 12 UNIT (0.12 ML)

Admin Route SUBCUTAN.
Frequency EVERY BEDTIME (SCH)
Start Date 08/24/17-2100 Stop Date 09/23/17 2059 DC: 08/29/17-1636
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.00
Rx Number 01539747

History
08/24/17 1631 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01539296
08/24/17 1636 - VERIFIED by MHAIMOWITZ
Items Dispensed: 1 Doses Dispensed: 1
For: 08/24/17 - 2100
08/24/17 1712 - CREDIT by MHAIMOWITZ
ITEMS: 1
08/29/17 1638 - DISCONTINUE by CDOHLE Eff: 08/29/17 1636
EDIT DOCTOR: DOHLE,CAROLIN MD
08/29/17 1638 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01427212
08/29/17 1640 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by CDOHLE Eff: 08/29/17 1638
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 35
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
> 300 = 8 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency EVERY 6 HOURS (SCH)
Start Date 08/09/17-1800 Stop Date 09/08/17 1759 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01535453

Discontinued Comments DC'd by Discharge

History
08/09/17 1553 - POM ORDER by CDOHLE
08/09/17 1559 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 1800
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route ORAL
Frequency NOW (ONE)
Start Date 08/09/17-1445 Stop Date 08/09/17 1446 DC: 08/09/17-1446
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01535443

Discontinued Comments Reached Stop Date

History
08/09/17 1442 - POM ORDER by TKOUTZEVA
08/09/17 1445 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 1445
08/09/17 1446 - DISCONTINUE by PHABKGJOB Eff: 08/09/17 1446
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 36
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

SODI15OR2 - SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML BTL

Dose 15 GM (60 ML)

Admin Route PEG TUBE
Frequency ONETIME (ONE)
Start Date 08/11/17-1615 Stop Date 08/11/17 1616 DC: 08/11/17-1616
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $17.58
Rx Number 01536135

Discontinued Comments Reached Stop Date

History
08/11/17 1606 - POM ORDER by CDOHLE
08/11/17 1607 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 1615
08/11/17 1617 - DISCONTINUE by PHABKGJOB Eff: 08/11/17 1616
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions inguinal,buttocks area
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/18/17-2100 Stop Date 08/25/17 2059 DC: 08/23/17-0915
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01538144

History
08/18/17 1613 - POM ORDER by TKOUTZEVA
08/18/17 1614 - VERIFIED by EBALILO
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 2100
08/23/17 0915 - DISCONTINUE by TKOUTZEVA Eff: 08/23/17 0915
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/23/17 0915 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01425408
08/23/17 1216 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/23/17 0915
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 37
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions inguinal,buttocks area
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/23/17-2100 Stop Date 08/30/17 2059 DC: 08/28/17-0920
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $54.09
Rx Number 01539244

History
08/23/17 0915 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01538144
08/23/17 1216 - EDIT by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/23/17-2100 STOP: 08/30/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/23/17-2100 STOP: 08/30/17-2059 SOFT STOP: 0
DISPENSE: 0
08/23/17 1216 - VERIFIED by AMOLINARI
08/25/17 0731 - DEBIT by AMOLINARI
ITEMS: 1
08/28/17 0921 - DISCONTINUE by TKOUTZEVA Eff: 08/28/17 0920
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/28/17 0921 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01426698
08/28/17 1027 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by TKOUTZEVA Eff: 08/28/17 0921
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 38
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

TRPLCREAM - ZINC OXIDE/HYDROCORTISONE 2.5%CR/NYSTATIN CR. (TRIPLE CREAM) 300GM J

Dose 1 APPLIC (1 CREAM APPLICATION)

Dose Instructions inguinal,buttocks area
Admin Route TOPICALLY
Frequency DAILY@06,21 (SCH)
Start Date 08/28/17-2100 Stop Date 09/04/17 2059 DC: 09/01/17-1231
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540555

History
08/28/17 0921 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01539244
08/28/17 1026 - EDIT by MHAIMOWITZ
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/28/17-2100 STOP: 09/04/17 SOFT STOP:
DISPENSE: 1
TO:
START: 08/28/17-2100 STOP: 09/04/17-2059 SOFT STOP: 0
DISPENSE: 0
08/28/17 1026 - VERIFIED by MHAIMOWITZ
09/01/17 1232 - DISCONTINUE by SDAS Eff: 09/01/17 1231
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
09/01/17 1232 - POM COPY AND EDIT by SDAS
TO: Rx #U01427970
09/01/17 1312 - REVIEW PROVIDER ACTIVITY by AADEGBAMIG
Discontinue by SDAS Eff: 09/01/17 1232

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Dose Instructions by gastrostomy tube while awake
Admin Route ORAL
Frequency EVERY 6 HOURS (SCH)
Start Date 08/09/17-0000 Stop Date 09/08/17 0000 DC: 08/09/17-0625
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01535267

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2138 - VERIFIED by AMACCA
08/09/17 0630 - DISCONTINUE by CDOHLE Eff: 08/09/17 0625
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0630
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 39
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency EVERY 6 HOURS (PRN) PRN REASON: PAIN - FOR PAIN
Start Date 08/23/17-1645 Stop Date 09/22/17 1644 DC: 08/23/17-1645
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01539380

Discontinued Comments PT PEG-SPOKE TO MD- CHANGE TO LIQ EQUIVALENT AND "FOR MILD
PAIN"

History
08/23/17 1635 - POM ORDER by TKOUTZEVA
08/23/17 1639 - DISCONTINUE by AMACCA Eff: 08/23/17 1645
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
PT PEG-SPOKE TO MD- CHANGE TO LIQ EQUIVALENT AND "FOR MILD
PAIN"
08/23/17 1639 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 40
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Dose Instructions FOR MILD PAIN OR FEVER
Admin Route PEG TUBE
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/09/17-0630 Stop Date 09/08/17 0629 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.75
Rx Number 01535298

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM ORDER by CDOHLE
08/09/17 0757 - VERIFIED by AMOLINARI
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 41
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Admin Route PEG TUBE
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/18/17-1600 Stop Date 08/23/17 0900 DC: 08/23/17-0900
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.50
Rx Number 01538119

Discontinued Comments Reached Stop Date

History
08/18/17 1553 - ENTER by EBALILO
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/22/17 1138 - EDIT by TKOUTZEVA
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
START: 08/18/17-1600 STOP: 09/17/17 1559 SOFT STOP: 0
TO:
START: 08/18/17-1600 STOP: 08/23/17-0900 SOFT STOP:
08/22/17 1138 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01425143
08/22/17 1151 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by TKOUTZEVA Eff: 08/22/17 1138
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0900 - DISCONTINUE by PHABKGJOB Eff: 08/23/17 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 42
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Admin Route PEG TUBE
Frequency DAILY@1230 (SCH)
Start Date 08/22/17-1230 Stop Date 09/21/17 1229 DC: 08/25/17-2050
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01538953

History
08/22/17 1150 - ENTER by AMOLINARI
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 1230
For: 08/26/17 - 1230
For: 08/27/17 - 1230
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 1230
For: 08/29/17 - 1230
08/25/17 2051 - DISCONTINUE by SDAS Eff: 08/25/17 2050
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
08/28/17 1454 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by SDAS Eff: 08/25/17 2051

AC160U20 - ACETAMINOPHEN ELIX 160 MG/5 ML 20.3 ML UDC

Dose 650 MG (20.31 ML)

Admin Route ORAL
Frequency ONETIME (ONE)
Start Date 08/24/17-2130 Stop Date 08/24/17 2131 DC: 08/24/17-2131
Ordering Doctor Spunberg,Daniel MD PGY-2
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01539842

Discontinued Comments Reached Stop Date

History
08/24/17 2121 - POM ORDER by DSPUNBERG
08/25/17 0725 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by ACABELLO Eff: 08/24/17 2228
08/25/17 0725 - VERIFIED by AMOLINARI
08/25/17 0725 - DISCONTINUE by PHABKGJOB Eff: 08/24/17 2131
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 43
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535268

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2138 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0630 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421631
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0630
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 44
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

AML10T - AMLODIPINE BESYLATE 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $3.15
Rx Number 01535297

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535268
08/09/17 0757 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 45
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535273

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2139 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/08/17 2231 - DISCONTINUE by RSHARMA Eff: 08/09/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/08/17 2231 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01421625
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by RSHARMA Eff: 08/08/17 2231
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 46
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ASPI81TA2 - ASPIRIN 81 MG TABEC

Dose 81 MG (1 TABLET, ENTERIC COATED)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 08/11/17 0900 DC: 08/11/17-0900
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535287

History
08/08/17 2231 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01535273
08/09/17 0631 - EDIT by CDOHLE
EDIT DOCTOR: DOHLE,CAROLIN MD
FROM:
START: 08/11/17-0900 STOP: 09/10/17 0859 SOFT STOP: 0
TO:
START: 08/11/17-0900 STOP: 08/11/17-0900 SOFT STOP:
08/09/17 0631 - VERIFIED by SYSTEM
Verified in order to DC
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/11/17 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by CDOHLE Eff: 08/09/17 0631
Edit by SYSTEM Eff: 08/09/17 0631
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 47
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $0.50
Rx Number 01535299

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM ORDER by CDOHLE
08/09/17 0757 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 48
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535280

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2140 - DISCONTINUE by AMACCA Eff: 08/09/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/08/17 2140 - VERIFIED by SYSTEM
Verified in order to DC

ATR20T - ATORVASTATIN 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route PEG TUBE
Frequency EVERY EVENING (SCH)
Start Date 08/18/17-1700 Stop Date 09/17/17 1659 DC: 08/18/17-1755
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $ Total Charges $
Rx Number 01538130

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1557 - VERIFIED by EBALILO
Items Dispensed: 5 Doses Dispensed: 5
For: 08/18/17 - 1700
For: 08/19/17 - 1700
For: 08/20/17 - 1700
For: 08/21/17 - 1700
For: 08/22/17 - 1700
08/18/17 1756 - DISCONTINUE by CDOHLE Eff: 08/18/17 1755
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 1700
For: 08/20/17 - 1700
For: 08/21/17 - 1700
For: 08/22/17 - 1700
EDIT DOCTOR: DOHLE,CAROLIN MD
08/18/17 1756 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01424440
08/18/17 1756 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by CDOHLE Eff: 08/18/17 1756
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 49
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ATR20T - ATORVASTATIN 20 MG TAB

Dose 80 MG (4 TABLETS)
Admin Route PEG TUBE
Frequency EVERY EVENING (SCH)
Start Date 08/19/17-1700 Stop Date 09/18/17 1659 DC: 08/19/17-1700
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538213

History
08/18/17 1756 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01538130
08/18/17 1757 - DISCONTINUE by AMACCA Eff: 08/19/17 1700
EDIT DOCTOR: DOHLE,CAROLIN MD
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/18/17 1757 - VERIFIED by SYSTEM
Verified in order to DC

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535281

History
08/08/17 2140 - ENTER by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421632
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 50
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ATOR80TA13 - ATORVASTATIN CALCIUM 80 MG TABLET

Dose 80 MG (1 TABLET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $3.75
Rx Number 01535302

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535281
08/09/17 0758 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 51
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Dose Instructions PRN CONSTIPATION
Admin Route RECTALLY
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/08/17-2245 Stop Date 09/07/17 2244 DC: 08/13/17-1615
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01535300

Discontinued Comments DC'd by Discharge

History
08/08/17 2258 - POM ORDER by RSHARMA
08/09/17 0758 - VERIFIED by AMOLINARI
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 52
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

CRV3.125T - CARVEDILOL 3.125 MG TAB

Dose 3.125 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535274

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2139 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421633
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 53
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

CRV3.125T - CARVEDILOL 3.125 MG TAB

Dose 3.125 MG (1 TABLET)

Dose Instructions HOLD FOR SBP < 110 AND/OR PULSE < 60
Admin Route XX
Frequency 2 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 9 Total Costs $0.00 Total Charges $2.97
Rx Number 01535303

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535274
08/09/17 0758 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/13/17 - 1700
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 54
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535275

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2139 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421634
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 55
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

CLOP75TA - CLOPIDOGREL BISULFATE 75 MG TAB

Dose 75 MG (1 TABLET)
Admin Route XX
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $80.65
Rx Number 01535304

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535275
08/09/17 0759 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 56
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535269

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2138 - VERIFIED by AMACCA
08/09/17 0630 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421635
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0630

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 08/09/17 0900 DC: 08/09/17-0900
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535290

History
08/08/17 2258 - POM ORDER by RSHARMA
08/09/17 0631 - EDIT by CDOHLE
EDIT DOCTOR: DOHLE,CAROLIN MD
FROM:
START: 08/09/17-0900 STOP: 09/08/17 0859 SOFT STOP: 0
TO:
START: 08/09/17-0900 STOP: 08/09/17-0900 SOFT STOP:
08/09/17 0631 - VERIFIED by SYSTEM
Verified in order to DC
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by CDOHLE Eff: 08/09/17 0631
Edit by SYSTEM Eff: 08/09/17 0631
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 57
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

DOCU150L - DOCUSATE SODIUM 100 MG/10 ML UDC

Dose 100 MG (10 ML)

Admin Route PEG TUBE
Frequency 3 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $0.00 Total Charges $3.50
Rx Number 01535301

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535269
08/09/17 0758 - VERIFIED by AMOLINARI
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 0900
For: 08/11/17 - 1300
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1300
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1300
For: 08/13/17 - 1700
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 0900
For: 08/14/17 - 1300
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1300
For: 08/15/17 - 1700
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 58
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535276

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2139 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421636
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631

FMT20T - FAMOTIDINE 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535266

Discontinued Comments DUPLICATE ORDER

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2136 - DISCONTINUE by AMACCA Eff: 08/09/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DUPLICATE ORDER
08/08/17 2136 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 59
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 40 MG (2 TABLETS)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 10 Total Costs $0.00 Total Charges $3.50
Rx Number 01535305

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535276
08/09/17 0759 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 60
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 08/30/17 1313 DC: 08/30/17-1313
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 16 Total Costs $0.00 Total Charges $4.20
Rx Number 01538128

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1556 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0831 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0825 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0837 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0816 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0820 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
08/30/17 1314 - EDIT by TKOUTZEVA
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
FROM:
START: 08/19/17-0900 STOP: 09/18/17 0859 SOFT STOP: 0
DISPENSE: 3
TO:
START: 08/19/17-0900 STOP: 08/30/17-1313 SOFT STOP:
DISPENSE: 12
08/30/17 1314 - DISCONTINUE by TKOUTZEVA Eff: 08/30/17 1313
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/30/17 1314 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01427391
08/30/17 1316 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 61
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

Edit by TKOUTZEVA Eff: 08/30/17 1314

Discontinue by TKOUTZEVA Eff: 08/30/17 1314

FENO145T - FENOFIBRATE,MICRONIZED 145 MG TAB

Dose 145 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535277

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2139 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421637
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 62
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MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

FENO145T - FENOFIBRATE,MICRONIZED 145 MG TAB

Dose 145 MG (1 TABLET)

Admin Route XX
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $12.90
Rx Number 01535306

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535277
08/09/17 0759 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 63
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

GBPN400C - GABAPENTIN 400 MG CAP

Dose 600 MG (1.5 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535282

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2141 - DISCONTINUE by AMACCA Eff: 08/09/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/08/17 2141 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 64
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535283

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 600 MG/DAY
is below the Low Daily Dose.

History
08/08/17 2142 - ENTER by AMACCA
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421638
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 65
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

GBPN300C - GABAPENTIN 300 MG CAP

Dose 600 MG (2 CAPSULES)

Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 10 Total Costs $0.00 Total Charges $2.00
Rx Number 01535307

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535283
08/09/17 0759 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 66
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

HDRL10T - HYDRALAZINE HCL 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency NOW (ONE)
Start Date 08/09/17-1100 Stop Date 08/09/17 1101 DC: 08/09/17-1101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 1 Total Costs $0.00 Total Charges $0.48
Rx Number 01535329

Discontinued Comments Reached Stop Date

History
08/09/17 1057 - POM ORDER by TKOUTZEVA
08/09/17 1106 - VERIFIED by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/09/17 - 1100
08/09/17 1117 - DISCONTINUE by PHABKGJOB Eff: 08/09/17 1101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 67
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

HDRL10T - HYDRALAZINE HCL 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency EVERY 8 HOURS (SCH)
Start Date 08/09/17-2200 Stop Date 09/08/17 2159 DC: 08/13/17-1615
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 12 Total Costs $0.00 Total Charges $5.28
Rx Number 01535482

Discontinued Comments DC'd by Discharge

History
08/09/17 1700 - POM ORDER by TKOUTZEVA
08/09/17 1702 - VERIFIED by EBALILO
Items Dispensed: 14 Doses Dispensed: 14
For: 08/09/17 - 2200
For: 08/10/17 - 0600
For: 08/10/17 - 1400
For: 08/10/17 - 2200
For: 08/11/17 - 0600
For: 08/11/17 - 1400
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 8 Doses Auto Credited: 8
For: 08/13/17 - 2200
For: 08/14/17 - 0600
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 68
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

HDRL10T - HYDRALAZINE HCL 10 MG TAB

Dose 10 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency EVERY 8 HOURS (SCH)
Start Date 08/18/17-2200 Stop Date 09/17/17 2159 DC: 08/22/17-2252
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 13 Total Costs $0.00 Total Charges $5.28
Rx Number 01538133

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1558 - VERIFIED by EBALILO
Items Dispensed: 14 Doses Dispensed: 14
For: 08/18/17 - 2200
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
For: 08/21/17 - 0600
For: 08/21/17 - 1400
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
For: 08/22/17 - 2200
For: 08/23/17 - 0600
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/22/17 2253 - DISCONTINUE by CDOHLE Eff: 08/22/17 2252
Items Auto Credited: 7 Doses Auto Credited: 7
For: 08/23/17 - 0600
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
EDIT DOCTOR: DOHLE,CAROLIN MD
08/23/17 1216 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/22/17 2253
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 69
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535278

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2139 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421639
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 70
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535310

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535278
08/09/17 0801 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/09/17 0856 - DISCONTINUE by TKOUTZEVA Eff: 08/09/17 0900
Items Auto Credited: 5 Doses Auto Credited: 5
For: 08/09/17 - 0900
For: 08/10/17 - 0900
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/09/17 0856 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01421656
08/09/17 1221 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/09/17 0856
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 71
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-1103
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $0.00 Total Charges $0.05
Rx Number 01535328

History
08/09/17 0856 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01535310
08/09/17 1104 - DISCONTINUE by TKOUTZEVA Eff: 08/09/17 1103
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/09/17 1104 - VERIFIED by SYSTEM
Verified in order to DC
08/09/17 1104 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01421712
08/09/17 1221 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by JDWARKA Eff: 08/09/17 0927
Edit by SYSTEM Eff: 08/09/17 1104
Discontinue by TKOUTZEVA Eff: 08/09/17 1104

LSNP5T - LISINOPRIL 5 MG TAB

Dose 10 MG (2 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency NOW (ONE)
Start Date 08/09/17-1100 Stop Date 08/09/17 1101 DC: 08/09/17-1101
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 2 Total Costs $0.00 Total Charges $0.05
Rx Number 01535330

Discontinued Comments Reached Stop Date

History
08/09/17 1055 - POM ORDER by TKOUTZEVA
08/09/17 1106 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 1
For: 08/09/17 - 1100
08/09/17 1117 - DISCONTINUE by PHABKGJOB Eff: 08/09/17 1101
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 72
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/10/17-0900 Stop Date 09/09/17 0859 DC: 08/12/17-1447
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 3 Total Costs $0.00 Total Charges $0.90
Rx Number 01535400

History
08/09/17 1221 - ENTER by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/10/17 - 0900
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/12/17 1451 - DISCONTINUE by EGITLER Eff: 08/12/17 1447
Items Auto Credited: 3 Doses Auto Credited: 3
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
EDIT DOCTOR: GITLER, ELLEN M.D.
08/12/17 1451 - POM COPY AND EDIT by EGITLER
TO: Rx #U01422658
08/12/17 1502 - REVIEW PROVIDER ACTIVITY by AMACCA
Discontinue by EGITLER Eff: 08/12/17 1451
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 73
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 10 MG (0.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/13/17-0900 Stop Date 09/12/17 0859 DC: 08/13/17-1615
Ordering Doctor GITLER, ELLEN M.D.
Total Dispensed 1 Total Costs $0.00 Total Charges $0.30
Rx Number 01536349

Discontinued Comments DC'd by Discharge

History
08/12/17 1451 - POM COPY AND EDIT by EGITLER
FROM: Rx #01535400
08/12/17 1502 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 74
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LSNP5T - LISINOPRIL 5 MG TAB

Dose 5 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 DC: 08/19/17-0900
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538134

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1558 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/18/17 1600 - DISCONTINUE by TKOUTZEVA Eff: 08/19/17 0900
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/18/17 1600 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01424371
08/18/17 1602 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by TKOUTZEVA Eff: 08/18/17 1600
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 75
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LRT10T - LORATADINE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535279

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2139 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421640
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 76
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

LRT10T - LORATADINE 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route XX
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-1056
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 1 Total Costs $0.00 Total Charges $1.03
Rx Number 01535311

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535279
08/09/17 0802 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/09/17 1056 - DISCONTINUE by TKOUTZEVA Eff: 08/09/17 1056
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/10/17 - 0900
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/09/17 1221 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by TKOUTZEVA Eff: 08/09/17 1056
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 77
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

MEMA5TAB2 - MEMANTINE HCL 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route ORAL
Frequency 2 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535288

History
08/08/17 2242 - POM ORDER by RSHARMA
08/09/17 0631 - VERIFIED by SYSTEM
Verified in order to DC
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421641
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by SYSTEM Eff: 08/09/17 0631
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 78
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

MEMA5TAB2 - MEMANTINE HCL 5 MG TAB

Dose 10 MG (2 TABLETS)
Admin Route PEG TUBE
Frequency 2 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 18 Total Costs $0.00 Total Charges $234.45
Rx Number 01535312

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535288
08/09/17 0802 - VERIFIED by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/09/17 - 0900
For: 08/09/17 - 1700
For: 08/10/17 - 0900
For: 08/10/17 - 1700
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 12 Doses Dispensed: 6
For: 08/11/17 - 0900
For: 08/11/17 - 1700
For: 08/12/17 - 0900
For: 08/12/17 - 1700
For: 08/13/17 - 0900
For: 08/13/17 - 1700
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 8 Doses Dispensed: 4
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 10 Doses Auto Credited: 5
For: 08/13/17 - 1700
For: 08/14/17 - 0900
For: 08/14/17 - 1700
For: 08/15/17 - 0900
For: 08/15/17 - 1700
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 79
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

MEMA5TAB2 - MEMANTINE HCL 5 MG TAB

Dose 5 MG (1 TABLET)
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 DC: 08/19/17-0900
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538135

History
08/18/17 1553 - POM ORDER by TKOUTZEVA
08/18/17 1558 - VERIFIED by EBALILO
Items Dispensed: 4 Doses Dispensed: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/18/17 1600 - DISCONTINUE by TKOUTZEVA Eff: 08/19/17 0900
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 0900
For: 08/20/17 - 0900
For: 08/21/17 - 0900
For: 08/22/17 - 0900
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
08/18/17 1600 - POM COPY AND EDIT by TKOUTZEVA
TO: Rx #U01424372
08/18/17 1602 - REVIEW PROVIDER ACTIVITY by EBALILO
Discontinue by TKOUTZEVA Eff: 08/18/17 1600

NF-MED - NON FORMULARY MEDICATION

Dose Instructions white petrolatum-mineral oil 83-15% ointment

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535284

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2142 - DISCONTINUE by AMACCA Eff: 08/09/17 0900
EDIT DOCTOR: MOHAMED,SALAH ELDIN MD PGY-2
EDIT SOURCE: PHARMACY WRITTEN CHANGE
08/08/17 2142 - VERIFIED by SYSTEM
Verified in order to DC
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 80
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

PIOG30TA2 - PIOGLITAZONE HCL 30 MG TAB

Dose 30 MG (1 TABLET)
Dose Instructions by gastrostomy tube
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535271

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2138 - VERIFIED by AMACCA
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421642
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 81
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

PIOG30TA2 - PIOGLITAZONE HCL 30 MG TAB

Dose 30 MG (1 TABLET)
Dose Instructions by gastrostomy tube
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 5 Total Costs $0.00 Total Charges $247.40
Rx Number 01535313

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535271
08/09/17 0802 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 2 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 82
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions by gastrostomy tube
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/09/17-0900
Ordering Doctor MOHAMED,SALAH ELDIN MD PGY-2
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535272

History
08/08/17 2131 - POM ORDER by SMOHAMED
08/08/17 2139 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
TO: Rx #U01421643
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 83
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 1 EACH (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 08/09/17 0900 DC: 08/09/17-0900
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01535289

History
08/08/17 2258 - POM ORDER by RSHARMA
08/09/17 0631 - DISCONTINUE by CDOHLE Eff: 08/09/17 0900
EDIT DOCTOR: DOHLE,CAROLIN MD
08/09/17 0631 - EDIT by CDOHLE
EDIT DOCTOR: DOHLE,CAROLIN MD
FROM:
START: 08/09/17-0900 STOP: 09/08/17 0859 SOFT STOP: 0
DISPENSE: 2
TO:
START: 08/09/17-0900 STOP: 08/09/17-0900 SOFT STOP:
DISPENSE: 0
08/09/17 0631 - VERIFIED by SYSTEM
Verified in order to DC
08/09/17 0802 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Edit by CDOHLE Eff: 08/09/17 0631
Edit by SYSTEM Eff: 08/09/17 0631
Discontinue by CDOHLE Eff: 08/09/17 0631
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 84
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Dose Instructions by gastrostomy tube
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/09/17-0900 Stop Date 09/08/17 0859 DC: 08/13/17-1615
Ordering Doctor DOHLE,CAROLIN MD
Total Dispensed 10 Total Costs $0.00 Total Charges $0.80
Rx Number 01535314

Discontinued Comments DC'd by Discharge

History
08/09/17 0631 - POM COPY AND EDIT by CDOHLE
FROM: Rx #01535272
08/09/17 0802 - VERIFIED by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/09/17 - 0900
For: 08/10/17 - 0900
08/09/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/11/17 - 0900
For: 08/12/17 - 0900
For: 08/13/17 - 0900
08/11/17 0813 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/13/17 2006 - DISCONTINUE by DISCHARGE Eff: 08/13/17 1615
Items Auto Credited: 4 Doses Auto Credited: 2
For: 08/14/17 - 0900
For: 08/15/17 - 0900
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
DC'd by Discharge
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 85
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route XX
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/18/17-1545 Stop Date 09/17/17 1544 CAN: 08/18/17-1550
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424334

History
08/18/17 1543 - POM ORDER by TKOUTZEVA
08/18/17 1550 - CANCEL by EBALILO
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO LIQUID FORM

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route XX
Frequency DAILY@1230 (SCH)
Start Date 08/22/17-1230 Stop Date 09/21/17 1229 CAN: 08/22/17-1150
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01425144

History
08/22/17 1139 - POM ORDER by TKOUTZEVA
08/22/17 1150 - CANCEL by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO LIQUID
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 86
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

ASPI-542 - ASPIRIN 81 MG CHEW

Dose 81 MG (1 TABLET CHEWABLE)

Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/11/17-0900 Stop Date 09/10/17 0859 CAN: 08/10/17-1149
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01421911

History
08/10/17 1128 - POM ORDER by TKOUTZEVA
08/10/17 1149 - CANCEL by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
duplicate order

ASPI325T27 - ASPIRIN 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 CAN: 08/18/17-1603
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424374

History
08/18/17 1601 - POM ORDER by TKOUTZEVA
08/18/17 1603 - CANCEL by EBALILO
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
DUPLICATE ORDER
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 87
Run Time 1513 PHA Profile

MARTINEZ MAISONET,CARMEN W00001219306 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route XX
Frequency 3 TIMES A DAY (SCH)
Start Date 08/19/17-0900 Stop Date 09/18/17 0859 CAN: 08/18/17-1547
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01424339

History
08/18/17 1543 - POM ORDER by TKOUTZEVA
08/18/17 1547 - CANCEL by EBALILO
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO LIQUID FORM

LSNP5T - LISINOPRIL 5 MG TAB

Dose 20 MG (4 TABLETS)
Dose Instructions HOLD FOR SBP < 110
Admin Route PEG TUBE
Frequency DAILY (SCH)
Start Date 08/10/17-0900 Stop Date 09/09/17 0859 CAN: 08/09/17-1220
Ordering Doctor Koutzeva,Totka MD PGY-4
Total Dispensed Total Costs $ Total Charges $
Rx Number U01421712

History
08/09/17 1104 - POM COPY AND EDIT by TKOUTZEVA
FROM: Rx #01535328
08/09/17 1220 - CANCEL by AMOLINARI
EDIT DOCTOR: Koutzeva,Totka MD PGY-4
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
CANCEL COMMENTS:
TO:
CANCEL COMMENTS:
CHANGED TO USE 20MG TAB
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 1
Run Time 1513 PHA Profile

Patient MARTONE JR,RALPH Responsible Doctor AMBROSE,ANNE MD

Account Number W00001219134 Location B2WEII Unit Number M000180939
Age/Sex 76/M Room 254 Registered Date 08/11/17
Status ADM IN Bed 01 Discharged Date

Height 5 ft 7.01 in 170.2 cm Body Surface Area 2.07 m2

Weight 210 lb 8 oz 95.481 kg
Hem-Onc No

Drug Allergies Benzodiazepines, haloperidol (From Haldol)

ADRS NO ADR'S ENTERED

Med Allergies:
Food Allergies:
Primary Diagnosis: HYDROCEPHALUS S/P VP SHUNT
Secondary Diagnosis:

BRIM5DRO2 - BRIMONIDINE TARTRATE/TIMOLOL 5 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Admin Route OPHTHALMIC
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 2 Total Costs $0.00 Total Charges $539.28
Rx Number 01536287

History
08/11/17 1932 - POM ORDER by GSYRKIN
08/11/17 1934 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 2100
08/27/17 1017 - DEBIT by AADEGBAMIG
ITEMS: 1
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 2
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

DORZ10DR6 - DORZOLAMIDE HCL 2% 10 ML BTL

Dose 1 DROP (1 DROP APPLICATION)

Admin Route OPHTHALMIC
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 2 Total Costs $0.00 Total Charges $400.80
Rx Number 01536302

History
08/11/17 2009 - POM ORDER by GSYRKIN
08/11/17 2016 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 2100
08/27/17 1017 - DEBIT by AADEGBAMIG
ITEMS: 1

INSU100V31 - INSULIN DETEMIR 100 UNIT/ML VIAL

Dose 15 UNIT (0.15 ML)

Admin Route SUBCUTAN.
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 1 Total Costs $0.00 Total Charges $322.41
Rx Number 01536300

History
08/11/17 1939 - POM ORDER by GSYRKIN
08/11/17 1940 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 3
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 2 UNITS SUBCUT.
201 TO 250 = 4 UNITS SUBCUT.
251 TO 300 = 6 UNITS SUBCUT.
301 TO 350 = 8 UNITS SUBCUT.
> 350 = 10 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency WITH MEALS (SCH)
Start Date 08/12/17-0800 Stop Date 09/11/17 0759
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01536295

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1935 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/12/17 - 0800

SSHUMALOG3 - INSULIN LISPRO 100 UNIT/ML 3ML VIAL

Dose Instructions 100 TO 150 = 0 UNITS SUBCUT.

151 TO 200 = 0 UNITS SUBCUT.
201 TO 250 = 0 UNITS SUBCUT.
251 TO 300 = 2 UNITS SUBCUT.
301 TO 350 = 4 UNITS SUBCUT.
> 350 = 6 UNITS SUBCUT. & NOTIFY PHYSCIAN
Admin Route SUBCUTAN.
Frequency EVERY BEDTIME (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 1 Total Costs $0.00 Total Charges $247.23
Rx Number 01536296

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1935 - VERIFIED by AMACCA
Items Dispensed: 1 Doses Dispensed: 1
For: 08/11/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 4
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 250 EA (0 EACHS)

Dose Instructions water 250 cc
Admin Route ORAL
Frequency 4 TIMES A DAY (SCH)
Start Date 08/29/17-1300 Stop Date 09/28/17 1259
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01540945

History
08/29/17 1216 - POM ORDER by SDAS
08/29/17 1217 - EDIT by AMACCA
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
RX ID: NON FORMULARY MEDICATION
LABEL COMMENTS:
TO:
ORDER TYPE: BULK - BULK ORDER
RX ID: NON FORMULARY MEDICATION water 250 cc
LABEL COMMENTS:
water 250 cc
08/29/17 1217 - VERIFIED by AMACCA
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 5
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/20/17-0830 Stop Date 09/19/17 0829
Ordering Doctor SHARMA,RAMAN MD PGY-3
Total Dispensed 0 Total Costs $0.00 Total Charges $1.00
Rx Number 01538367

History
08/20/17 0823 - POM COPY AND EDIT by RSHARMA
FROM: Rx #01536281
08/20/17 1003 - EDIT by AADEGBAMIG
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
START: 08/20/17-0830 STOP: 09/19/17 SOFT STOP:
TO:
START: 08/20/17-0830 STOP: 09/19/17-0829 SOFT STOP:
08/20/17 1003 - VERIFIED by AADEGBAMIG
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 6
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

BSC10SU - BISACODYL 10 MG SUPP

Dose 10 MG (1 SUPPOSITORY)
Admin Route RECTALLY
Frequency EVERY 12 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/11/17-1930 Stop Date 09/10/17 1929
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536282

History
08/11/17 1926 - POM ORDER by GSYRKIN
08/11/17 1928 - VERIFIED by AMACCA
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 7
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

BISA5TAB8 - BISACODYL 5 MG TABEC

Dose 5 MG (1 TABLET, ENTERIC COATED)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency EVERY 12 HOURS (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/11/17-1930 Stop Date 09/10/17 1929
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536286

History
08/11/17 1932 - POM ORDER by GSYRKIN
08/11/17 1933 - VERIFIED by AMACCA
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 8
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

CHOL100026 - CHOLECALCIFEROL 1,000 UNIT CAP

Dose 1,000 UNIT (1 CAPSULE)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 25 Total Costs $0.00 Total Charges $2.99
Rx Number 01536299

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1935 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 9
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

09/01/17 0824 - FILL by BGIRLING

Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 10
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

DOCU100C2 - DOCUSATE SODIUM CAP 100 MG

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency 3 TIMES A DAY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $0.00 Total Charges $15.25
Rx Number 01536289

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1934 - VERIFIED by AMACCA
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 0900
For: 08/16/17 - 1300
For: 08/16/17 - 1700
For: 08/17/17 - 0900
For: 08/17/17 - 1300
For: 08/17/17 - 1700
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 0900
For: 08/18/17 - 1300
For: 08/18/17 - 1700
For: 08/19/17 - 0900
For: 08/19/17 - 1300
For: 08/19/17 - 1700
For: 08/20/17 - 0900
For: 08/20/17 - 1300
For: 08/20/17 - 1700
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 0900
For: 08/21/17 - 1300
For: 08/21/17 - 1700
For: 08/22/17 - 0900
For: 08/22/17 - 1300
For: 08/22/17 - 1700
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 0900
For: 08/23/17 - 1300
For: 08/23/17 - 1700
For: 08/24/17 - 0900
For: 08/24/17 - 1300
For: 08/24/17 - 1700
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 0900
For: 08/25/17 - 1300
For: 08/25/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 11
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

For: 08/26/17 - 0900

For: 08/26/17 - 1300
For: 08/26/17 - 1700
For: 08/27/17 - 0900
For: 08/27/17 - 1300
For: 08/27/17 - 1700
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 0900
For: 08/28/17 - 1300
For: 08/28/17 - 1700
For: 08/29/17 - 0900
For: 08/29/17 - 1300
For: 08/29/17 - 1700
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 0900
For: 08/30/17 - 1300
For: 08/30/17 - 1700
For: 08/31/17 - 0900
For: 08/31/17 - 1300
For: 08/31/17 - 1700
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 0900
For: 09/01/17 - 1300
For: 09/01/17 - 1700
For: 09/02/17 - 0900
For: 09/02/17 - 1300
For: 09/02/17 - 1700
For: 09/03/17 - 0900
For: 09/03/17 - 1300
For: 09/03/17 - 1700
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 0900
For: 09/04/17 - 1300
For: 09/04/17 - 1700
For: 09/05/17 - 0900
For: 09/05/17 - 1300
For: 09/05/17 - 1700
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 12
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

ESCI10TA - ESCITALOPRAM OXALATE 10 MG TAB

Dose 20 MG (2 TABLETS)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 52 Total Costs $0.00 Total Charges $875.15
Rx Number 01536290

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1934 - VERIFIED by AMACCA
Items Dispensed: 10 Doses Dispensed: 5
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 13
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

For: 09/03/17 - 2100

09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 14
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

FMT20T - FAMOTIDINE 20 MG TAB

Dose 20 MG (1 TABLET)
Admin Route ORAL
Frequency EVERY 12 HOURS (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 51 Total Costs $0.00 Total Charges $16.10
Rx Number 01536291

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1934 - VERIFIED by AMACCA
Items Dispensed: 9 Doses Dispensed: 9
For: 08/11/17 - 2100
For: 08/12/17 - 0900
For: 08/12/17 - 2100
For: 08/13/17 - 0900
For: 08/13/17 - 2100
For: 08/14/17 - 0900
For: 08/14/17 - 2100
For: 08/15/17 - 0900
For: 08/15/17 - 2100
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/16/17 - 0900
For: 08/16/17 - 2100
For: 08/17/17 - 0900
For: 08/17/17 - 2100
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/18/17 - 0900
For: 08/18/17 - 2100
For: 08/19/17 - 0900
For: 08/19/17 - 2100
For: 08/20/17 - 0900
For: 08/20/17 - 2100
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 0900
For: 08/21/17 - 2100
For: 08/22/17 - 0900
For: 08/22/17 - 2100
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/23/17 - 0900
For: 08/23/17 - 2100
For: 08/24/17 - 0900
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/25/17 - 0900
For: 08/25/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 15
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

For: 08/26/17 - 0900

For: 08/26/17 - 2100
For: 08/27/17 - 0900
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 4 Doses Dispensed: 4
For: 08/28/17 - 0900
For: 08/28/17 - 2100
For: 08/29/17 - 0900
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 08/30/17 - 0900
For: 08/30/17 - 2100
For: 08/31/17 - 0900
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/01/17 - 0900
For: 09/01/17 - 2100
For: 09/02/17 - 0900
For: 09/02/17 - 2100
For: 09/03/17 - 0900
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 4 Doses Dispensed: 4
For: 09/04/17 - 0900
For: 09/04/17 - 2100
For: 09/05/17 - 0900
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 16
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

FERR325T - FERROUS SULFATE 325 MG TAB

Dose 325 MG (1 TABLET)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $0.00 Total Charges $5.75
Rx Number 01536292

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1935 - VERIFIED by AMACCA
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 0900
For: 08/24/17 - 0900
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 0900
For: 08/26/17 - 0900
For: 08/27/17 - 0900
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 0900
For: 08/29/17 - 0900
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 0900
For: 08/31/17 - 0900
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 17
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

GBPN100C - GABAPENTIN 100 MG CAP

Dose 100 MG (1 CAPSULE)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 26 Total Costs $0.00 Total Charges $3.45
Rx Number 01536293

Warnings
Type: BURKE
Range: GABAPENTIN
Condition: ALL COMMON INDICATIONS
Daily Dose Dosing range is 900 MG/DAY - 1,800 MG/DAY. Ordered dose of 100 MG/DAY
is below the Low Daily Dose.

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1935 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 18
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

08/28/17 0818 - FILL by BGIRLING

Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 19
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

HP5KV - HEPARIN SOD (PORCINE) 5,000 UNIT/ML VIAL

Dose 5,000 UNIT (1 ML)

Admin Route SUBCUTAN.
Frequency EVERY 8 HOURS (SCH)
Start Date 08/11/17-2200 Stop Date 09/10/17 2159
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 77 Total Costs $0.00 Total Charges $631.04
Rx Number 01536294

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1935 - VERIFIED by AMACCA
Items Dispensed: 14 Doses Dispensed: 14
For: 08/11/17 - 2200
For: 08/12/17 - 0600
For: 08/12/17 - 1400
For: 08/12/17 - 2200
For: 08/13/17 - 0600
For: 08/13/17 - 1400
For: 08/13/17 - 2200
For: 08/14/17 - 0600
For: 08/14/17 - 1400
For: 08/14/17 - 2200
For: 08/15/17 - 0600
For: 08/15/17 - 1400
For: 08/15/17 - 2200
For: 08/16/17 - 0600
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/16/17 - 1400
For: 08/16/17 - 2200
For: 08/17/17 - 0600
For: 08/17/17 - 1400
For: 08/17/17 - 2200
For: 08/18/17 - 0600
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 08/18/17 - 1400
For: 08/18/17 - 2200
For: 08/19/17 - 0600
For: 08/19/17 - 1400
For: 08/19/17 - 2200
For: 08/20/17 - 0600
For: 08/20/17 - 1400
For: 08/20/17 - 2200
For: 08/21/17 - 0600
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 1400
For: 08/21/17 - 2200
For: 08/22/17 - 0600
For: 08/22/17 - 1400
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 20
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

For: 08/22/17 - 2200

For: 08/23/17 - 0600
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/23/17 - 1400
For: 08/23/17 - 2200
For: 08/24/17 - 0600
For: 08/24/17 - 1400
For: 08/24/17 - 2200
For: 08/25/17 - 0600
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 9 Doses Dispensed: 9
For: 08/25/17 - 1400
For: 08/25/17 - 2200
For: 08/26/17 - 0600
For: 08/26/17 - 1400
For: 08/26/17 - 2200
For: 08/27/17 - 0600
For: 08/27/17 - 1400
For: 08/27/17 - 2200
For: 08/28/17 - 0600
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 6 Doses Dispensed: 6
For: 08/28/17 - 1400
For: 08/28/17 - 2200
For: 08/29/17 - 0600
For: 08/29/17 - 1400
For: 08/29/17 - 2200
For: 08/30/17 - 0600
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 08/30/17 - 1400
For: 08/30/17 - 2200
For: 08/31/17 - 0600
For: 08/31/17 - 1400
For: 08/31/17 - 2200
For: 09/01/17 - 0600
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 9 Doses Dispensed: 9
For: 09/01/17 - 1400
For: 09/01/17 - 2200
For: 09/02/17 - 0600
For: 09/02/17 - 1400
For: 09/02/17 - 2200
For: 09/03/17 - 0600
For: 09/03/17 - 1400
For: 09/03/17 - 2200
For: 09/04/17 - 0600
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 6 Doses Dispensed: 6
For: 09/04/17 - 1400
For: 09/04/17 - 2200
For: 09/05/17 - 0600
For: 09/05/17 - 1400
For: 09/05/17 - 2200
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 21
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

For: 09/06/17 - 0600

MAG30ORA3 - MAG HYDROX/AL HYDROX/SIMETH 30 ML UDC

Dose 30 ML (1 UNIT DOSE CUP)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: DISP/INDI - FOR DYSPEPSIA/INDIGESTION
Start Date 08/11/17-1930 Stop Date 09/10/17 1929
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.25
Rx Number 01536284

History
08/11/17 1926 - POM ORDER by GSYRKIN
08/11/17 1928 - VERIFIED by AMACCA
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 22
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

MAGN400O3 - MAGNESIUM HYDROXIDE 400MG/5ML 30 ML SUSP

Dose 30 ML (1 SUSPENSION)
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/11/17-1930 Stop Date 09/10/17 1929
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $0.00 Total Charges $0.50
Rx Number 01536283

History
08/11/17 1926 - POM ORDER by GSYRKIN
08/11/17 1928 - VERIFIED by AMACCA
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 23
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

POLY17PO4 - POLYETHYLENE GLYCOL 3350 17 GM PACK

Dose 17 GM (1 POWDER, PACKET)

Dose Instructions PRN CONSTIPATION
Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/11/17-1930 Stop Date 09/12/17 1929
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01536298

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1935 - VERIFIED by AMACCA
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 24
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency EVERY 8 HOURS (PRN) PRN REASON: agitation
Start Date 08/21/17-1400 Stop Date 09/15/17 1029
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 6 Total Costs $0.00 Total Charges $19.46
Rx Number 01538501

History
08/21/17 1151 - POM COPY AND EDIT by SDAS
FROM: Rx #01537167
Result of Frequency/Schedule Edit
Ordering Doctor: DAS,SOUMABHA MD PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 8 HOURS (PRN)
New Freq/Sch: EVERY 8 HOURS (PRN)
Old Order Stop: 08/21/17 - 1149
New Order Start: 08/21/17 - 1400
New Order Stop: 09/15/17 - 1029
08/21/17 1201 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Freq/Sch Edit by SDAS Eff: 08/21/17 1151
Ordering Doctor: DAS,SOUMABHA MD PGY-3
Last Scheduled Administration Time: As Needed
Last Actual Administration Time:
Old Freq/Sch: EVERY 8 HOURS (PRN)
New Freq/Sch: EVERY 8 HOURS (PRN)
Old Order Stop: 08/21/17 - 1149
New Order Start: 08/21/17 - 1400
New Order Stop: 09/15/17 - 1029
08/21/17 1201 - VERIFIED by MHAIMOWITZ
Items Dispensed: 6 Doses Dispensed: 6
For: 08/21/17 - 1400
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 25
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/21/17-2100 Stop Date 09/20/17 2059
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 16 Total Costs $0.00 Total Charges $126.49
Rx Number 01538500

History
08/21/17 1151 - POM ORDER by SDAS
08/21/17 1201 - VERIFIED by MHAIMOWITZ
Items Dispensed: 4 Doses Dispensed: 4
For: 08/21/17 - 2100
For: 08/22/17 - 2100
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
For: 09/03/17 - 2100
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 26
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY@1400 (SCH)
Start Date 08/25/17-1400 Stop Date 09/24/17 1359
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 12 Total Costs $0.00 Total Charges $97.30
Rx Number 01539981

History
08/25/17 1150 - POM ORDER by SDAS
08/25/17 1237 - VERIFIED by AMOLINARI
Items Dispensed: 5 Doses Dispensed: 5
For: 08/25/17 - 1400
For: 08/26/17 - 1400
For: 08/27/17 - 1400
For: 08/28/17 - 1400
For: 08/29/17 - 1400
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 1400
For: 08/31/17 - 1400
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 1400
For: 09/02/17 - 1400
For: 09/03/17 - 1400
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 1400
For: 09/05/17 - 1400
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 27
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

QTP25T - QUETIAPINE FUMARATE 25 MG TAB

Dose 12.5 MG (0.5 TABLETS)

Admin Route ORAL
Frequency DAILY (SCH)
Start Date 09/01/17-0900 Stop Date 10/01/17 0859
Ordering Doctor LEE,YOUNGHOON MD, PGY-3
Total Dispensed 5 Total Costs $0.00 Total Charges $29.19
Rx Number 01541783

History
08/31/17 1635 - POM ORDER by YOLEE
08/31/17 1643 - VERIFIED by AMACCA
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 0900
For: 09/02/17 - 0900
For: 09/03/17 - 0900
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 0900
For: 09/05/17 - 0900
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 28
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

ROSU10TA - ROSUVASTATIN CALCIUM 10 MG TAB

Dose 10 MG (1 TABLET)
Admin Route ORAL
Frequency NIGHTLY (SCH)
Start Date 08/11/17-2100 Stop Date 09/10/17 2059
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 26 Total Costs $0.00 Total Charges $500.25
Rx Number 01536288

History
08/11/17 1932 - POM ORDER by GSYRKIN
08/11/17 1934 - VERIFIED by AMACCA
Items Dispensed: 5 Doses Dispensed: 5
For: 08/11/17 - 2100
For: 08/12/17 - 2100
For: 08/13/17 - 2100
For: 08/14/17 - 2100
For: 08/15/17 - 2100
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 2100
For: 08/17/17 - 2100
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 2100
For: 08/19/17 - 2100
For: 08/20/17 - 2100
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 2100
For: 08/22/17 - 2100
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/23/17 - 2100
For: 08/24/17 - 2100
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 3 Doses Dispensed: 3
For: 08/25/17 - 2100
For: 08/26/17 - 2100
For: 08/27/17 - 2100
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 2
For: 08/28/17 - 2100
For: 08/29/17 - 2100
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/30/17 - 2100
For: 08/31/17 - 2100
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 09/01/17 - 2100
For: 09/02/17 - 2100
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 29
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

For: 09/03/17 - 2100

09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 09/04/17 - 2100
For: 09/05/17 - 2100

SNN187T - SENNA 187 MG = 8.6MG SENNOSIDES TABLET

Dose 2 EACH (2 TABLETS)

Admin Route ORAL
Frequency DAILY (PRN) PRN REASON: CONSTIP - FOR CONSTIPATION
Start Date 08/11/17-1930 Stop Date 09/10/17 1929
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 4 Total Costs $0.00 Total Charges $0.40
Rx Number 01536285

History
08/11/17 1926 - POM ORDER by GSYRKIN
08/11/17 1928 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 2
For: 08/11/17 - 1930
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/21/17 0832 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/23/17 0840 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/25/17 0838 - FILL by AMOLINARI
Items Dispensed: 0 Doses Dispensed: 0
08/28/17 0818 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/30/17 0822 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
09/01/17 0824 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 30
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

NF-MED - NON FORMULARY MEDICATION

Dose 250 EA (0 EACHS)

Dose Instructions Water 250 cc q 4
Admin Route ORAL
Frequency EVERY 4 HOURS (SCH)
Start Date 08/18/17-1300 Stop Date 09/17/17 1259 DC: 08/29/17-1219
Ordering Doctor DAS,SOUMABHA MD PGY-3
Total Dispensed 0 Total Costs $ Total Charges $
Rx Number 01538011

Discontinued Comments SPOKE TO MD- DUPLICATE ORDER- DC q4H CHANGES TO QID

History
08/18/17 1302 - POM ORDER by SDAS
08/18/17 1303 - EDIT by AMACCA
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
ORDER TYPE: MED - MEDICATION ORDER TYPE
LABEL COMMENTS:
TO:
ORDER TYPE: BULK - BULK ORDER
LABEL COMMENTS:
Water 250 cc q 4
08/18/17 1303 - VERIFIED by AMACCA
08/29/17 1219 - DISCONTINUE by AMACCA Eff: 08/29/17 1219
EDIT DOCTOR: DAS,SOUMABHA MD PGY-3
EDIT SOURCE: PHARMACY WRITTEN CHANGE
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
SPOKE TO MD- DUPLICATE ORDER- DC q4H CHANGES TO QID
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 31
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 500 MLS/HR Duration 1 HR
Frequency .Q1H (SCH)
Start Date 08/17/17-1045 Stop Date 08/17/17 1144 DC: 08/17/17-1144
Ordering Doctor RUSSO,JENNIFER MD PGY-2
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $15.75
Rx Number 01537531

Discontinued Comments Reached Stop Date

History
08/17/17 1042 - ENTER by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/17/17 - 1045
08/17/17 1144 - DISCONTINUE by PHABKGJOB Eff: 08/17/17 1144
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date

SODI500I3 - SODIUM CHLORIDE 0.9% BAG 500 ML - 500 ML

Site
Total Volume 500 MLS Rate 500 MLS/HR Duration 1 HR
Frequency .Q1H (SCH)
Start Date 08/18/17-1115 Stop Date 08/18/17 1214 DC: 08/18/17-1214
Ordering Doctor DAS,SOUMABHA MD PGY-3
Last Bag 1
Total Dispensed 1 Total Costs $0.00 Total Charges $15.75
Rx Number 01537885

Discontinued Comments Reached Stop Date

History
08/18/17 1112 - ENTER by AMOLINARI
Items Dispensed: 1 Doses Dispensed: 1
For: 08/18/17 - 1115
08/18/17 1214 - DISCONTINUE by PHABKGJOB Eff: 08/18/17 1214
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 32
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

AC325T - ACETAMINOPHEN 325 MG TAB

Dose 650 MG (2 TABLETS)

Admin Route ORAL
Frequency EVERY 4 HOURS (PRN) PRN REASON: MILD - FOR MILD PAIN (PAIN SCALE 1-3)
Start Date 08/11/17-1930 Stop Date 09/10/17 1929 DC: 08/20/17-0822
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 0 Total Costs $0.00 Total Charges $1.25
Rx Number 01536281

History
08/11/17 1926 - POM ORDER by GSYRKIN
08/11/17 1928 - VERIFIED by AMACCA
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 0 Doses Dispensed: 0
08/20/17 0823 - DISCONTINUE by RSHARMA Eff: 08/20/17 0822
EDIT DOCTOR: SHARMA,RAMAN MD PGY-3
08/20/17 0823 - POM COPY AND EDIT by RSHARMA
TO: Rx #U01424579
08/21/17 1202 - REVIEW PROVIDER ACTIVITY by MHAIMOWITZ
Discontinue by RSHARMA Eff: 08/20/17 0823
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 33
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

HDRL10T - HYDRALAZINE HCL 10 MG TAB

Dose 15 MG (1.5 TABLETS)

Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency NOW (ONE)
Start Date 08/13/17-2030 Stop Date 08/13/17 2031 DC: 08/13/17-2031
Ordering Doctor CHANDEL,NEEL MD
Total Dispensed 2 Total Costs $0.00 Total Charges $0.95
Rx Number 01536424

Discontinued Comments Reached Stop Date

History
08/13/17 2025 - POM ORDER by NCHANDEL
08/14/17 0738 - REVIEW PROVIDER ACTIVITY by AMOLINARI
Administration of Unverified Order by MGEORGE Eff: 08/13/17 2136
08/14/17 0738 - VERIFIED by AMOLINARI
Items Dispensed: 2 Doses Dispensed: 1
For: 08/13/17 - 2030
08/14/17 0738 - DISCONTINUE by PHABKGJOB Eff: 08/13/17 2031
FROM:
DC COMMENTS:
TO:
DC COMMENTS:
Reached Stop Date
Run Date 09/03/17 The Burke Rehab. Hosp. PHA **LIVE** Page 34
Run Time 1513 PHA Profile

MARTONE JR,RALPH W00001219134 (Continued)

LSNP20T - LISINOPRIL 20 MG TAB

Dose 20 MG (1 TABLET)
Dose Instructions HOLD FOR SBP < 110
Admin Route ORAL
Frequency DAILY (SCH)
Start Date 08/12/17-0900 Stop Date 09/11/17 0859 DC: 08/18/17-1146
Ordering Doctor SYRKIN,GRIGORY MD
Total Dispensed 7 Total Costs $0.00 Total Charges $2.10
Rx Number 01536297

History
08/11/17 1933 - POM ORDER by GSYRKIN
08/11/17 1935 - VERIFIED by AMACCA
Items Dispensed: 4 Doses Dispensed: 4
For: 08/12/17 - 0900
For: 08/13/17 - 0900
For: 08/14/17 - 0900
For: 08/15/17 - 0900
08/14/17 0813 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/16/17 - 0900
For: 08/17/17 - 0900
08/16/17 0829 - FILL by BGIRLING
Items Dispensed: 3 Doses Dispensed: 3
For: 08/18/17 - 0900
For: 08/19/17 - 0900
For: 08/20/17 - 0900
08/18/17 0821 - FILL by BGIRLING
Items Dispensed: 2 Doses Dispensed: 2
For: 08/21/17 - 0900
For: 08/22/17 - 0900
08/18/17 1147 - DISCONTINUE by SDAS Eff: 08/18/17 1146
Items Auto Credited: 4 Doses Auto Credited: 4
For: 08/19/17 - 0900
For