nt Name John Smith Date Of Birth ( age of patient) 12/12/1969 567 Mills Lane Palmdale, CA 93550 Date Prescribed 2/11/2016 RX: DISP: □1 –24 Escitalopram 10 mg □25–49 □ 50–74 □ 75–100 Sig: Take one (1) tablet po daily for anxiety x 2 months Refill: 0-‐1 -‐2-‐3-‐4-‐5 -‐PRN Disp: Dispense # 60 (sixty) Refills ø Signature of Provider Disnse as written DEA # MJ/ NPI 2 Provider Address: Signature of Provider Generic substitution per...