Documents tagged "Prescription"
Found 3 documents with this tag
DOJ-OGR-00026767.jpg
The image displays a document titled "U.S. Department of Health and Human Services Medicare Prescription Drug Coverage Enrollment Form". The form appears to be related to healthcare insurance for prescriptions in the United States. It contains sections that are typically found on official documents, such as fields for personal information, checkboxes, and places to fill out answers or responses. There's also a pink stripe running down the middle of the document, which is often used to separate different sections or to add emphasis. The text "Medicare Prescription Drug Coverage" is prominently displayed at the top.
DOJ-OGR-00026234.jpg
The image is a scanned document titled "Bureau of Prisons" at the top left corner. The document appears to be an administrative note or form with sections labeled "Administrative Data Entry," "Medication Administration Record," and "Prescription Orders." There are fields for patient information such as name and identification number, and specific medication details including dosage forms and dates. Some text is redacted in the areas where personal identifying information might be present. The document seems to be a standard form used by medical staff within a prison facility to record and manage patients' medications.
DOJ-OGR-00026154.jpg
The image shows a document titled "Department of Corrections Medication Request" at the top left corner. It is a form that includes several checkboxes and lines for information entry. There are two visible sections with checkmarks: one labeled "New Prescription" and another labeled "Change in Dosage/Frequency." At the bottom right, there's a signature within a box labeled "Signature of Patient or Legal Guardian." The form also includes spaces for date and time, but these are not filled out. There is no text indicating people or locations, and the document itself appears to be a standard office paper with visible creases and folds.