mailto:9922222.ncpdp@surescripts.com mailto:1572564792001.spi@surescripts.com b58592aa6f9d45e0b7aa1be7bf907fc7 2008-02-20T16:10:34.0Z

RxRef-814407P451 0OG085VV762N 9922222 UD75G7314W47U365 ZZZZZZ QA SureScripts Test 4.20 Pharmacist last name Pharmacist First name Pharmacist Middle Junior iii Pharmacist Pharmacist agent Last name Pharmacist agent First name Pharmacist agent Middle name Junior iii Pharmacist

123 Main St Pharmacy AddressLine 2 Alexandria VA 22315

Pharmacistagent@pharmacy.com 7035556677 TE 5555555555 FX 1572564792001 1234567890  Prescriber ZZZ The prescribers Clinic Gentry 4.20 Waldo Middle Junior iii Prescriber AM OCC Prescriber agent Last Prescriber agent First Prescriber agent middle name Junior iii Nurse12345

6344 S.R. 90 Prescriber address line 2 Philadelphia PA 19102

prescriber@prescriber.com 2158520098 TE 2158520098 FX 1572564792001 R52FQB6KAJL7320BX8E3D KK416IH02WE6 This is the supervisors clinic Supervisor Last name Supervisor First Name Supervisor Middle Name Suffix 123 Supervisor AM OTR  Supervisor agent Last name Supervisor agent First name Supervisor agent middle name Junior iii Supervisor

Supervisor address line 1 Supervisor address line 2 Supervisor city name VA 803695432

Supervisor@emailaddress.com 01141222123456789x1234567 HP 7032224441x1231 NP U801OQG2PQ7X3L3QO6VQDHT328E15W17DS4 patient zz 000 Pt Last Name First Name Middle Name Junior iii Patient II F 19840101

Patient address line 1 Patient address line 2 Patient city name CO 803615977

patientemailaddress@email.com 57192121221234567890x4444 NP AVANDAMET 2MG/1000MG TABLET(ROSIGLITAZONE/METFOR MIN Hydrochloride tablet manufactured by GLAXOSMITHKLINE)  104 Drug Strength Drug Strength Drug Strength Drug Stren gth Drug Strengthh DJ 062IU65A08J35KT2BCF0L058Y2MD42MQOPM MC U2 123456789.12345 501 Take one tablet by mouth in the morning after you wake up ********and before you have any breakfast or any other diet or anything to drink THIS IS A TEST MESSAGE PLEASE DISREGARD. Acid reflux is a c ondition caused by hyper secretion of the acid in your stomach, the most freq uent manifestation is heartburn. You should take frequent meals bland diet R 101 0 20070101 PrescriberSupplied ICD-9 303EV41V31Q52WU6S ICD-9 456HC48O73A13HS8Y PrescriberSupplied ICD-9 146DO81O08M03FL0R ICD-9 688JL30F24W70IH2B