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PROFILE:5
Name: Mike, Ursal Address: 911 Ginseng St.
Height: 5’ 11" Age: 55 Weight: 181 lbs. Sex: Male Allergy: NK
Primary Diagnosis: 1. Ulcerative colitis
2. Constipation
3. CHF
4. Diabetes
Secondary diagnosis:
Lab Results Values Date
RX No Drug Name Prescriber Qty Date Refills
11056 Ery-tab 500mg 1/ po b.i.d. Kerlan 20 09/30/2025 0
11066 Hycodan syrup 15cc po b.i.d. Kerlan 240 09/30/2025 0
11076 Lozol 1.25mg 1/ po/q.d. Kerlan 30 09/30/2025 5
11089 Lanoxin 0.25 1/ po/q.d. Kerlan 30 09/30/2025 5
11095 Lomotil ii/po/prn/Q6h Kerlan 10 10/05/2025 0
11100 Tagamet 400mg 1/ po/q.i.d. Kerlan 120 10/06/2025 5
11112 Asacol 400mg 1/ po/q.i.d. Kerlan 120 11/05/2025 2
11122 Colace 100mg 1/ po/hs Kerlan 30 11/05/2025 5
11134 Serax 15mg 1/ po/hs Kerlan 10 11/14/2025 0
11146 Actifed 1/ po/tid Kerlan 10 11/30/2025 0
Pharmacist Notes:
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