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Cpe-71-67-128-96.woh.res.rr.com

Prescription claims (Jan 01, 2007 - Dec 31, 2007)
The claims below include only those prescriptions that have been processed to date.
2007 Prescription claims
Patient: Ingrid Richmond
Plan paid
Rx Number: 0393037
Date of service: 01/03/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 01/08/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0428295
Date of service: 01/11/07
Drug information: Doxycycline Hycl Caps 50mg
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 01/30/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0393037
Date of service: 01/30/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 03/02/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0393037
Date of service: 03/02/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 03/28/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 04/06/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Patient: Ingrid Richmond
Plan paid
Rx Number: 0448160
Date of service: 04/28/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0453612
Date of service: 05/01/07
Drug information: Vexol Drops 5ml 1%
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 05/05/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 05/29/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 05/29/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0453612
Date of service: 06/13/07
Drug information: Vexol Drops 5ml 1%
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 06/24/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 06/30/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 07/22/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 07/31/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 08/21/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 08/26/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Patient: Ingrid Richmond
Plan paid
Rx Number: 0448160
Date of service: 09/18/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 09/20/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 10/18/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 10/28/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0484871
Date of service: 11/13/07
Drug information: Propoxyphene Napsylate/apap Tabs 100/650
Filled at: CVS PHARMACY #4401
Rx Number: 0484872
Date of service: 11/13/07
Drug information: Amoxicillin Caps 500mg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 11/28/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 12/10/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Subtotal:
Patient: Mark Richmond
Plan paid
Rx Number: 062470363407
Date of service: 02/14/07
Drug information: Lipitor Tabs 10mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 070452567307
Date of service: 02/15/07
Drug information: Fluticasone Prop Nasal Spray 50mcg
Filled at: MEDCO HEALTH WILLINGBORO
Patient: Mark Richmond
Plan paid
Rx Number: 063422857607
Date of service: 02/17/07
Drug information: Nexium Caps 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 063422857707
Date of service: 02/17/07
Drug information: Zyrtec Tabs 10mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 062470363407
Date of service: 05/21/07
Drug information: Lipitor Tabs 10mg
Filled at: MEDCO HEALTH LAS VEGAS
Rx Number: 0458296
Date of service: 05/30/07
Drug information: Lisinopril Tabs 10mg
Filled at: CVS PHARMACY #4401
Rx Number: 0460834
Date of service: 06/14/07
Drug information: Diltiazem Xt(cartia Xt)cap 180mg
Filled at: CVS PHARMACY #4401
Rx Number: 0460834
Date of service: 07/02/07
Drug information: Diltiazem Xt(cartia Xt)cap 180mg
Filled at: CVS PHARMACY #4401
Rx Number: 063422857607
Date of service: 07/05/07
Drug information: Nexium Caps 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 0460834
Date of service: 07/23/07
Drug information: Diltiazem Xt(cartia Xt)cap 180mg
Filled at: CVS PHARMACY #4401
Rx Number: 072072032407
Date of service: 07/26/07
Drug information: Diltiazem Xt(cartia Xt)cap 240mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 0469191
Date of service: 08/07/07
Drug information: Sonata Caps 10mg
Filled at: CVS PHARMACY #4401
Rx Number: 070452567307
Date of service: 09/06/07
Drug information: Fluticasone Prop Nasal Spray 50mcg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 072493590907
Date of service: 09/07/07
Drug information: Lipitor Tabs 10mg
Filled at: MEDCO HEALTH LAS VEGAS
Patient: Mark Richmond
Plan paid
Rx Number: 0475201
Date of service: 09/14/07
Drug information: Triamcinolone Cream 15gm 0.1%
Filled at: CVS PHARMACY #4401
Rx Number: 0476338
Date of service: 09/21/07
Drug information: Micardis Tabs 40mg
Filled at: CVS PHARMACY #4401
Rx Number: 063422857607
Date of service: 10/14/07
Drug information: Nexium Caps 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 072950402807
Date of service: 10/22/07
Drug information: Micardis Tabs 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 072493590907
Date of service: 11/13/07
Drug information: Lipitor Tabs 10mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 0475201
Date of service: 12/09/07
Drug information: Triamcinolone Cream 15gm 0.1%
Filled at: CVS PHARMACY #4401
Rx Number: 070452567307
Date of service: 12/20/07
Drug information: Fluticasone Prop Nasal Spray 50mcg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 073543322207
Date of service: 12/21/07
Drug information: Nexium Caps 40mg
Filled at: MEDCO HEALTH LAS VEGAS
Rx Number: 072950402807
Date of service: 12/28/07
Drug information: Micardis Tabs 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Subtotal:
$2588.14
Household Total for 2007:
$2815.38

Source: ftp://cpe-71-67-128-96.woh.res.rr.com/My%20Passport/Mark_Personal/Aloha-HP/Memeo/Aloha-HP/C_/Users/Public/Documents/Medical%20Data/2007%20Medical%20Claims.pdf

Appendix 316

HEAD LICE COUNSELLING GUIDELINES 1. Head lice do not spread any diseases but do cause emotional distress. They affect anyone, regardless of personal cleanliness. Children are affected more than adults because of the amount of time spent in close conditions. 2. Lice require warmth and human blood to survive. Transmission is person-to-person, spread by direct contact. Sharing of hats, coats,

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DIRECTIONS FOR USE Restraints: Do not use less than 14 days before slaughter for human consumption. Do not use in sheep that are producing or may in future produce milk or milk products for human consumption. Precautions and Contraindications: KEEP OUT OF REACH OF CHILDREN Not to be used at the same time as any other selenium treatments such as v accines, drenches and fe

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