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[checkbox memo="Weight" name="Wt-Dose" value="" memo_color="blue"][conditional field="Wt-Dose" condition="(Wt-Dose).is('')"]Dosing Wt: [text name="kg" size="4"] kgs[/conditional][checkbox memo="Blank Drug" name="Blank" memo_color="yellow" value=""][conditional field="Blank" condition="(Blank).is('')"]
--[text name="med_1" size="15"] ([text name="med_strength_1" size="5"] [select name="med_unitstrength_1" value="mg|mcg|G"]), Take [text name="med_dose_1" size="5"] [select name="med_unit_1" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_1" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_1" default="30" size="2"]days, disp: [text name="med_disp_1" size="4"] [var name="med_unit_1" name="unit"], refill(s) [select name="med_refill_1" value="0|1|2|3|4|5|6"][/conditional][checkbox memo="Blank Drug" name="Blank_2" memo_color="yellow" value=""][conditional field="Blank_2" condition="(Blank_2).is('')"]
--[text name="med_2" size="15"] ([text name="med_strength_2" size="5"] [select name="med_unitstrength_2" value="mg|mcg|G"]), Take [text name="med_dose_2" size="5"] [select name="med_unit_2" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_2" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_2" default="30" size="2"]days, disp: [text name="med_disp_2" size="4"] [var name="med_unit_2" name="unit"], refill(s) [select name="med_refill_2" value="0|1|2|3|4|5|6"][/conditional][checkbox memo="Blank Drug" memo_color="yellow" name="Blank_3" value=""][conditional field="Blank_3" condition="(Blank_3).is('')"]
--[text name="med_3" size="15"] ([text name="med_strength_3" size="5"] [select name="med_unitstrength_3" value="mg|mcg|G"]), Take [text name="med_dose_3" size="5"] [select name="med_unit_3" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_3" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_3" default="30" size="2"]days, disp: [text name="med_disp_3" size="4"] [var name="med_unit_3" name="unit"], refill(s) [select name="med_refill_3" value="0|1|2|3|4|5|6"][/conditional][checkbox memo="Blank Drug" name="Blank_4" memo_color="yellow" value=""][conditional field="Blank_4" condition="(Blank_4).is('')"]
--[text name="med_4" size="15"] ([text name="med_strength_4" size="5"] [select name="med_unitstrength_4" value="mg|mcg|G"]), Take [text name="med_dose_4" size="5"] [select name="med_unit_4" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_4" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_4" default="30" size="2"]days, disp: [text name="med_disp_4" size="4"] [var name="med_unit_4" name="unit"], refill(s) [select name="med_refill_4" value="0|1|2|3|4|5|6"][/conditional] [checkbox memo="Blank Drug" memo_color="yellow" name="Blank_5" value=""][conditional field="Blank_5" condition="(Blank_5).is('')"]
--[text name="med_5" size="15"] ([text name="med_strength_5" size="5"] [select name="med_unitstrength_5" value="mg|mcg|G"]), Take [text name="med_dose_5" size="5"] [select name="med_unit_5" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"], [select name="med_freq_5" value="Daily|HS|BID|TID|QID|every 3 hours|every 4 hours|every 6 hours"] for [text name=" med_dur_5" default="30" size="2"]days, disp: [text name="med_disp_5" size="4"] [var name="med_unit_5" name="unit"], refill(s) [select name="med_refill_5" value="0|1|2|3|4|5|6"][/conditional] [checkbox memo="Blank PRN Drug" memo_color="yellow" name="Blank_PRN_1" value=""][conditional field="Blank_PRN_1" condition="(Blank_PRN_1).is('')"]
--[text name="med_PRN_1" size="15"] ([text name="med_strength_PRN_1" size="5"] [select name="med_unitstrength_PRN_1" value="mg|mcg|G"]), Take [text name="med_dose_PRN_1" size="5"] [select name="med_unit_PRN_1" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"] as needed every [select name="med_freq_PRN_1" value="2 hours|3 hours|4 hours|6 hours|day"] for [text name=" med_reason_PRN_1" default="" size="10"], disp: [text name="med_disp_PRN_1" size="4"] [var name="med_unit_PRN_1" name="unit"], refill(s) [select name="med_refill_PRN_1" value="0|1|2|3|4|5|6"][/conditional] [checkbox memo="Blank PRN Drug" memo_color="yellow" name="Blank_PRN_2" value=""][conditional field="Blank_PRN_2" condition="(Blank_PRN_2).is('')"]
--[text name="med_PRN_2" size="15"] ([text name="med_strength_PRN_2" size="5"] [select name="med_unitstrength_PRN_2" value="mg|mcg|G"]), Take [text name="med_dose_PRN_2" size="5"] [select name="med_unit_PRN_2" value="tab(s)|mL|capsule(s)|drop(s)|spray(s)|puff(s)|app(s)|neb"] as needed every [select name="med_freq_PRN_2" value="2 hours|3 hours|4 hours|6 hours|day"] for [text name=" med_reason_PRN_2" default="" size="10"], disp: [text name="med_disp_PRN_2" size="4"] [var name="med_unit_PRN_2" name="unit"], refill(s) [select name="med_refill_PRN_2" value="0|1|2|3|4|5|6"][/conditional][checkbox memo="Acetaminophen (160mg/5mL) (Ped)" name="Acet" value=""][conditional field="Acet" condition="(Acet).is('')"]
--Acetaminophen (160 mg/5 mL) (Ped), [text name="Acet_dose" default="15" memo="10-15" size="3"] mg/kg ([calc memo="dose" value="acetaminophen=(kg)*(Acet_dose)"] mg/dose), Take [calc memo="mL" value="score1=((acetaminophen)*(5/160)).toFixed(1)"] mL by mouth every 6 hours as needed for pain/discomfort/temp >100.4F[/conditional][checkbox memo="Abilify (10 mg)" name="Abil_2565" value=""][conditional field="Abil_2565" condition="(Abil_2565).is('')"]
[text default="--Abilify (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Accupril (Quinapril) (10 mg)" name="Accu_5271" value=""][conditional field="Accu_5271" condition="(Accu_5271).is('')"]
[text default="--Accupril (Quinapril) (10 mg), 1 tab PO BID, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Actonel (35 mg)" name="Acto_6976" value=""][conditional field="Acto_6976" condition="(Acto_6976).is('')"]
[text default="--Actonel (35 mg), 1 tab PO weekly, Disp: 4, RF: 3" size="80"][/conditional][checkbox memo="Actos (Pioglitazone) (15 mg)" name="Acto_739" value=""][conditional field="Acto_739" condition="(Acto_739).is('')"]
[text default="--Actos (Pioglitazone) (15 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Actos (Pioglitazone) (30 mg)" name="Acto_2745" value=""][conditional field="Acto_2745" condition="(Acto_2745).is('')"]
[text default="--Actos (Pioglitazone) (30 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Adderall XR (Amphetamine Salt XR) (10 mg)" name="Adde_7732" value=""][conditional field="Adde_7732" condition="(Adde_7732).is('')"]
[text default="--Adderall XR (Amphetamine Salt XR) (10 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Advair Diskus (250 mcg/50 mcg)" name="Adva_281" value=""][conditional field="Adva_281" condition="(Adva_281).is('')"]
[text default="--Advair Diskus (250 mcg/50 mcg), 1 puff INH daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Allegra (Fexofenadine) (180 mg)" name="Alle_116" value=""][conditional field="Alle_116" condition="(Alle_116).is('')"]
[text default="--Allegra (Fexofenadine) (180 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Altace (Ramipril) (5 mg)" name="Alta_6920" value=""][conditional field="Alta_6920" condition="(Alta_6920).is('')"]
[text default="--Altace (Ramipril) (5 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Amaryl (Glimepiride) (2 mg)" name="Amar_4447" value=""][conditional field="Amar_4447" condition="(Amar_4447).is('')"]
[text default="--Amaryl (Glimepiride) (2 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Ambien (Zolpidem) (10 mg)" name="Ambi_1167" value=""][conditional field="Ambi_1167" condition="(Ambi_1167).is('')"]
[text default="--Ambien (Zolpidem) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Ambien CR (Zolpidem CR) (12.5 mg)" name="Ambi_6983" value=""][conditional field="Ambi_6983" condition="(Ambi_6983).is('')"]
[text default="--Ambien CR (Zolpidem CR) (12.5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Amoxycillin (Q8H) (Ped)" name="Amox" value=""][conditional field="Amox" condition="(Amox).is('')"]
--Amoxycillin (250mg/5mL), [text name="Amox_dose" default="25" memo="25-60" size="2"] mg/kg ([calc memo="dose" value="Amox_dose2=(kg)*(Amox_dose)"] mg), Take [calc memo="mL" value="Amox_mL=((Amox_dose2)*(5/250)).toFixed(1)"] mL every 8 hours for [text name="Amox_dur" default="10" size="2"] days, disp: [calc value="Amox_disp=(Amox_mL)*8*(Amox_dur)"] mL, refill: 0[/conditional][checkbox memo="Amoxil (Amoxicillin) (500 mg)" name="Amox_138" value=""][conditional field="Amox_138" condition="(Amox_138).is('')"]
[text default="--Amoxil (Amoxicillin) (500 mg), 1 cap PO BID for 10 days, Disp: 20, RF: 3" size="80"][/conditional][checkbox memo="Aricept (Donepezil) (5 mg)" name="Aric_9131" value=""][conditional field="Aric_9131" condition="(Aric_9131).is('')"]
[text default="--Aricept (Donepezil) (5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Augmentin (Q12H) (Ped 3+ months)" name="Augm" value=""][conditional field="Augm" condition="(Augm).is('')"]
--Augmentin (200mg/5mL), [text name="Augm_dose" default="45" memo="" size="2"] mg/kg/day ([calc memo="dose" value="Augm_dose2=((kg)*(Augm_dose))/2"] mg/dose), Take [calc memo="mL" value="Augm_mL=((Augm_dose2)*(5/200)).toFixed(1)"] mL every 12 hours for [text name="Augm_dur" default="10" size="2"] days[/conditional][checkbox memo="Augmentin (Amox Tr-K Clv) (875 mg)" name="Augm_7205" value=""][conditional field="Augm_7205" condition="(Augm_7205).is('')"]
[text default="--Augmentin (Amox Tr-K Clv) (875 mg), 1 tab PO BID for 10 days, Disp: 20, RF: 0" size="80"][/conditional][checkbox memo="Avapro (150 mg)" name="Avap_5047" value=""][conditional field="Avap_5047" condition="(Avap_5047).is('')"]
[text default="--Avapro (150 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Avelox (400 mg)" name="Avel_3046" value=""][conditional field="Avel_3046" condition="(Avel_3046).is('')"]
[text default="--Avelox (400 mg), 1 tab PO daily for 7 days, Disp: 7, RF: 0" size="80"][/conditional][checkbox memo="Azithromycin (Ped)" name="Azith" value=""][conditional field="Azith" condition="(Azith).is('')"]
--Azithromycin (200mg/5mL), [text name="Azith_dose" default="5" memo="" size="2"] mg/kg ([calc memo="dose" value="Azith_dose2=(kg)*(Azith_dose)"] mg), Take [calc memo="mL" value="Azith_mL_1=(((Azith_dose2)*(5/200))*2).toFixed(1)"] mL on day 1, and [calc memo="mL" value="Azith_mL_2=((Azith_dose2)*(5/200)).toFixed(1)"] mL on days 2-5[/conditional][checkbox memo="Azithromycin (Adult)" name="Azith_adult" value=""][conditional field="Azith_adult" condition="(Azith_adult).is('')"]
--Azithromycin (250 mg) take 2 tab by mouth on day 1, then 1 tab once daily for 4 days
[/conditional][checkbox memo="Bactrim (Sulfameth/Trimeth)" name="Bact_538" value=""][conditional field="Bact_538" condition="(Bact_538).is('')"]
[text default="--Bactrim (Sulfameth/Trimeth), 1 tab PO BID for 10 days, Disp: 20, RF: 0" size="80"][/conditional][checkbox memo="Bactroban (Mupirocin)" name="Bact_3913" value=""][conditional field="Bact_3913" condition="(Bact_3913).is('')"]
[text default="--Bactroban (Mupirocin), 1 app TOP daily, Disp: 1 Tube, RF: 0" size="80"][/conditional][checkbox memo="Benicar (20 mg)" name="Beni_3836" value=""][conditional field="Beni_3836" condition="(Beni_3836).is('')"]
[text default="--Benicar (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Boric Acid (Vaginal)" name="Bor" value=""][conditional field="Bor" condition="(Bor).is('')"]
--Boric Acid Suppository (1 Supp), PV, HS for 7 days, disp: 7, refill(s) 0[/conditional][checkbox memo="Boniva (150 mg)" name="Boni_2454" value=""][conditional field="Boni_2454" condition="(Boni_2454).is('')"]
[text default="--Boniva (150 mg), 1 tab PO Monthly, Disp: 1, RF: 3" size="80"][/conditional][checkbox memo="Catapres (Clonidine) (0.1 mg)" name="Cata_6671" value=""][conditional field="Cata_6671" condition="(Cata_6671).is('')"]
[text default="--Catapres (Clonidine) (0.1 mg), 1 tab PO TID, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="Celebrex (200 mg)" name="Cele_302" value=""][conditional field="Cele_302" condition="(Cele_302).is('')"]
[text default="--Celebrex (200 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Celexa (Citalopram) (20 mg)" name="Cele_1745" value=""][conditional field="Cele_1745" condition="(Cele_1745).is('')"]
[text default="--Celexa (Citalopram) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Chantix (1 mg)" name="Chan_7799" value=""][conditional field="Chan_7799" condition="(Chan_7799).is('')"]
[text default="--Chantix (1 mg), 1 tab PO daily, Disp: 56, RF: 1, 0.5 mg PO once daily on Days 1 through 3, then 0.5 mg PO twice daily on Days 4 through 7, and finally 1 mg PO twice daily on day 8 until the end of treatment" size="80"][/conditional][checkbox memo="Cialis (5 mg)" name="Cial_9622" value=""][conditional field="Cial_9622" condition="(Cial_9622).is('')"]
[text default="--Cialis (5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Cipro (Ciprofloxacin) (500 mg)" name="Cipr_8618" value=""][conditional field="Cipr_8618" condition="(Cipr_8618).is('')"]
[text default="--Cipro (Ciprofloxacin) (500 mg), 1 tab PO BID for 10 days, Disp: 20, RF: 0" size="80"][/conditional][checkbox memo="Combivent (ipratropium bromide/albuterol) (20 mcg-100 mcg)" name="Comb_9414" value=""][conditional field="Comb_9414" condition="(Comb_9414).is('')"]
[text default="--Combivent (ipratropium bromide/albuterol) (20 mcg-100 mcg), 1 puff INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Coreg (Carvedilol) (6.25 mg)" name="Core_4856" value=""][conditional field="Core_4856" condition="(Core_4856).is('')"]
[text default="--Coreg (Carvedilol) (6.25 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Coumadin (Warfarin) (5 mg)" name="Coum_4630" value=""][conditional field="Coum_4630" condition="(Coum_4630).is('')"]
[text default="--Coumadin (Warfarin) (5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Cozaar (Losartan) (50 mg)" name="Coza_5377" value=""][conditional field="Coza_5377" condition="(Coza_5377).is('')"]
[text default="--Cozaar (Losartan) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Crestor (10 mg)" name="Cres_9611" value=""][conditional field="Cres_9611" condition="(Cres_9611).is('')"]
[text default="--Crestor (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Cymbalta (30 mg)" name="Cymb_3069" value=""][conditional field="Cymb_3069" condition="(Cymb_3069).is('')"]
[text default="--Cymbalta (30 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Depakote (Divalproex) (500 mg)" name="Depa_9580" value=""][conditional field="Depa_9580" condition="(Depa_9580).is('')"]
[text default="--Depakote (Divalproex) (500 mg), 1 tab PO TID, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="Desyrel (Trazodone) (50 mg)" name="Desy_880" value=""][conditional field="Desy_880" condition="(Desy_880).is('')"]
[text default="--Desyrel (Trazodone) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Diflucan (Fluconazole) (400 mg)" name="Difl_299" value=""][conditional field="Difl_299" condition="(Difl_299).is('')"]
[text default="--Diflucan (Fluconazole) (400 mg), 1 tab PO for 10 days, Disp: 10, RF: 0" size="80"][/conditional][checkbox memo="Dilantin (Phenytoin) (100 mg)" name="Dila_3162" value=""][conditional field="Dila_3162" condition="(Dila_3162).is('')"]
[text default="--Dilantin (Phenytoin) (100 mg), 1 cap PO daily, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="Diovan (80 mg)" name="Diov_2362" value=""][conditional field="Diov_2362" condition="(Diov_2362).is('')"]
[text default="--Diovan (80 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Effexor XR (Venlafaxine XR) (75 mg)" name="Effe_3062" value=""][conditional field="Effe_3062" condition="(Effe_3062).is('')"]
[text default="--Effexor XR (Venlafaxine XR) (75 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Evista (60 mg)" name="Evis_3167" value=""][conditional field="Evis_3167" condition="(Evis_3167).is('')"]
[text default="--Evista (60 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Flagyl (Metronidazole) (500 mg)" name="Flag_8700" value=""][conditional field="Flag_8700" condition="(Flag_8700).is('')"]
[text default="--Flagyl (Metronidazole) (500 mg), 1 tab PO BID for 10 days, Disp: 20, RF: 0" size="80"][/conditional][checkbox memo="Flexeril (Cyclobenzaprine) (10 mg)" name="Flex_6049" value=""][conditional field="Flex_6049" condition="(Flex_6049).is('')"]
[text default="--Flexeril (Cyclobenzaprine) (10 mg), 1 tab PO daily, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Flexpen (Novolog 70-30)" name="Flex_709" value=""][conditional field="Flex_709" condition="(Flex_709).is('')"]
[text default="--Flexpen (Novolog 70-30), 1 units SubQ daily, Disp: 1 vial, RF: 3" size="80"][/conditional][checkbox memo="Flomax (Tamsulosin) (0.4 mg)" name="Flom_8044" value=""][conditional field="Flom_8044" condition="(Flom_8044).is('')"]
[text default="--Flomax (Tamsulosin) (0.4 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Flonase (Fluticasone) (50 mcg)" name="Flon_4663" value=""][conditional field="Flon_4663" condition="(Flon_4663).is('')"]
[text default="--Flonase (Fluticasone) (50 mcg), 1 spray Nasal daily, Disp: 1 Bottle, RF: 3" size="80"][/conditional][checkbox memo="Flovent HFA (110 mcg)" name="Flov_3694" value=""][conditional field="Flov_3694" condition="(Flov_3694).is('')"]
[text default="--Flovent HFA (110 mcg), 1 puff INH daily, Disp: 1 Inhaler, RF: 3" size="80"][/conditional][checkbox memo="Fluticasone" name="Flut" value=""][conditional field="Flut" condition="(Flut).is('')"]
--Fluticasone (27.5 mcg/spray), [text name="Flut_dose" default="1" memo="1-2" size="2"] spray(s)/nostril, Spray [var name="Flut_dose" memo="#"] spray(s) in each nostril once daily, disp:1, RF: 3[/conditional][checkbox memo="Folic Acid (1 mg)" name="Foli_9378" value=""][conditional field="Foli_9378" condition="(Foli_9378).is('')"]
[text default="--Folic Acid (1 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Fosamax (Alendronate) (70 mg)" name="Fosa_7294" value=""][conditional field="Fosa_7294" condition="(Fosa_7294).is('')"]
[text default="--Fosamax (Alendronate) (70 mg), 1 tab PO weekly, Disp: 4, RF: 3" size="80"][/conditional][checkbox memo="Glucophage (Metformin HCL) (500 mg)" name="Gluc_2843" value=""][conditional field="Gluc_2843" condition="(Gluc_2843).is('')"]
[text default="--Glucophage (Metformin HCL) (500 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Glucophage (Metformin HCL) (1000 mg)" name="Gluc_2681" value=""][conditional field="Gluc_2681" condition="(Gluc_2681).is('')"]
[text default="--Glucophage (Metformin HCL) (1000 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Glucophage XR (Metformin ER) (500 mg)" name="Gluc_726" value=""][conditional field="Gluc_726" condition="(Gluc_726).is('')"]
[text default="--Glucophage XR (Metformin ER) (500 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Glucotrol XL (Glipizide ER) (5 mg)" name="Gluc_1818" value=""][conditional field="Gluc_1818" condition="(Gluc_1818).is('')"]
[text default="--Glucotrol XL (Glipizide ER) (5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Glucotrol XL (Glipizide ER) (10 mg)" name="Gluc_4071" value=""][conditional field="Gluc_4071" condition="(Gluc_4071).is('')"]
[text default="--Glucotrol XL (Glipizide ER) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Hydrodiuril (Hydrochlorothiazide) (12.5 mg)" name="Hydr_5031" value=""][conditional field="Hydr_5031" condition="(Hydr_5031).is('')"]
[text default="--Hydrodiuril (Hydrochlorothiazide) (12.5 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Hydrodiuril (Hydrochlorothiazide) (25 mg)" name="Hydr_2249" value=""][conditional field="Hydr_2249" condition="(Hydr_2249).is('')"]
[text default="--Hydrodiuril (Hydrochlorothiazide) (25 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Hytone (Hydrocortisone) (2.5 %)" name="Hyto_8661" value=""][conditional field="Hyto_8661" condition="(Hyto_8661).is('')"]
[text default="--Hytone (Hydrocortisone) (2.5 %), 1 app daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Ibuprofen (Ped)" name="Ibup" value=""][conditional field="Ibup" condition="(Ibup).is('')"]
--Ibuprofen (100mg/5mL), [text name="Ibup_dose" default="10" memo="" size="2"] mg/kg ([calc memo="dose" value="Ibup_dose2=(kg)*(Ibup_dose)"] mg/dose), Take [calc memo="mL" value="Ibup_mL=((Ibup_dose2)*(5/100)).toFixed(1)"] mL every 6-8 hours as needed for pain/discomfort/temp >100.4F[/conditional][checkbox memo="Imitrex (Sumatriptan) (100 mg)" name="Imit_3507" value=""][conditional field="Imit_3507" condition="(Imit_3507).is('')"]
[text default="--Imitrex (Sumatriptan) (100 mg), 1 tab PO daily, Disp: 14, RF: 3" size="80"][/conditional][checkbox memo="Januvia (100 mg)" name="Janu_1003" value=""][conditional field="Janu_1003" condition="(Janu_1003).is('')"]
[text default="--Januvia (100 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="K-dur (Potassium) (20 mEq)" name="K-du_6153" value=""][conditional field="K-du_6153" condition="(K-du_6153).is('')"]
[text default="--K-dur (Potassium) (20 mEq), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Keflex (Cephalexin) (500 mg)" name="Kefl_9955" value=""][conditional field="Kefl_9955" condition="(Kefl_9955).is('')"]
[text default="--Keflex (Cephalexin) (500 mg), 1 cap PO QID, Disp: 28, RF: 0" size="80"][/conditional][checkbox memo="Ketoconazole" name="Ketoconazole" value=""][conditional field="Ketoconazole" condition="(Ketoconazole).is('')"]
[text default="--Ketoconazole, 1 app per scalp q3-4 days for 8 weeks, Disp: 1 bottle, RF: 1" size="80"][/conditional][checkbox memo="Klonopin (Clonazepam) (1 mg)" name="Klon_408" value=""][conditional field="Klon_408" condition="(Klon_408).is('')"]
[text default="--Klonopin (Clonazepam) (1 mg), 1 tab PO daily, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="KWIKPEN (Humalog) (75 -25)" name="KWIK_7765" value=""][conditional field="KWIK_7765" condition="(KWIK_7765).is('')"]
[text default="--KWIKPEN (Humalog) (75 -25), 1 units SubQ daily, Disp: 1 vial, RF: 3" size="80"][/conditional][checkbox memo="Lamictal (Lamotrigine) (25 mg)" name="Lami_5964" value=""][conditional field="Lami_5964" condition="(Lami_5964).is('')"]
[text default="--Lamictal (Lamotrigine) (25 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lamisil (Terbinafine) (250 mg)" name="Lami_1807" value=""][conditional field="Lami_1807" condition="(Lami_1807).is('')"]
[text default="--Lamisil (Terbinafine) (250 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lanoxin (Digoxin) (0.125 mg)" name="Lano_670" value=""][conditional field="Lano_670" condition="(Lano_670).is('')"]
[text default="--Lanoxin (Digoxin) (0.125 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lantus" name="Lant_474" value=""][conditional field="Lant_474" condition="(Lant_474).is('')"]
[text default="--Lantus, 1 units SubQ QHS, Disp: 1 vial, RF: 3" size="80"][/conditional][checkbox memo="Lasix (Furosemide) (20 mg)" name="Lasi_3883" value=""][conditional field="Lasi_3883" condition="(Lasi_3883).is('')"]
[text default="--Lasix (Furosemide) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lasix (Furosemide) (40 mg)" name="Lasi_2144" value=""][conditional field="Lasi_2144" condition="(Lasi_2144).is('')"]
[text default="--Lasix (Furosemide) (40 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lexapro (Escitalopram) (10 mg)" name="Lexa_673" value=""][conditional field="Lexa_673" condition="(Lexa_673).is('')"]
[text default="--Lexapro (Escitalopram) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lipitor (Atorvastatin) (10 mg)" name="Lipi_8168" value=""][conditional field="Lipi_8168" condition="(Lipi_8168).is('')"]
[text default="--Lipitor (Atorvastatin) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lipitor (Atorvastatin) (20 mg)" name="Lipi_651" value=""][conditional field="Lipi_651" condition="(Lipi_651).is('')"]
[text default="--Lipitor (Atorvastatin) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Loestrin FE ( )" name="Loes_5773" value=""][conditional field="Loes_5773" condition="(Loes_5773).is('')"]
[text default="--Loestrin FE ( ), 1 tab PO daily, Disp: 28, RF: 3" size="80"][/conditional][checkbox memo="Lopressor (Metoprolol) (50 mg)" name="Lopr_323" value=""][conditional field="Lopr_323" condition="(Lopr_323).is('')"]
[text default="--Lopressor (Metoprolol) (50 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Lotrisone (Clotrimazole/Betam) (1 %-0.05 %)" name="Lotr_1926" value=""][conditional field="Lotr_1926" condition="(Lotr_1926).is('')"]
[text default="--Lotrisone (Clotrimazole/Betam) (1 %-0.05 %), 1 app daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Lyrica (50 mg)" name="Lyri_3546" value=""][conditional field="Lyri_3546" condition="(Lyri_3546).is('')"]
[text default="--Lyrica (50 mg), 1 cap PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Macrobid (Nitrofurantoin) (100 mg)" name="Macr_5663" value=""][conditional field="Macr_5663" condition="(Macr_5663).is('')"]
[text default="--Macrobid (Nitrofurantoin) (100 mg), 1 cap PO BIDfor 7 days, Disp: 14, RF: 0" size="80"][/conditional][checkbox memo="Maxzide (Triamterene/HCTZ) (37.5 mg)" name="Maxz_8806" value=""][conditional field="Maxz_8806" condition="(Maxz_8806).is('')"]
[text default="--Maxzide (Triamterene/HCTZ) (37.5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Mobic (Meloxicam) (7.5 mg)" name="Mobi_9516" value=""][conditional field="Mobi_9516" condition="(Mobi_9516).is('')"]
[text default="--Mobic (Meloxicam) (7.5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Motrin (Ibuprofen) (600 mg)" name="Motr_1521" value=""][conditional field="Motr_1521" condition="(Motr_1521).is('')"]
[text default="--Motrin (Ibuprofen) (600 mg), 1 tab PO daily, Disp: 90, RF: 0" size="80"][/conditional][checkbox memo="Motrin (Ibuprofen) (800 mg)" name="Motr_7929" value=""][conditional field="Motr_7929" condition="(Motr_7929).is('')"]
[text default="--Motrin (Ibuprofen) (800 mg), 1 tab PO daily, Disp: 60, RF: 0" size="80"][/conditional][checkbox memo="Namenda (10 mg)" name="Name_2848" value=""][conditional field="Name_2848" condition="(Name_2848).is('')"]
[text default="--Namenda (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Naprosyn (Naproxen) (500 mg)" name="Napr_1399" value=""][conditional field="Napr_1399" condition="(Napr_1399).is('')"]
[text default="--Naprosyn (Naproxen) (500 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Nasonex (25 mcg)" name="Naso_8238" value=""][conditional field="Naso_8238" condition="(Naso_8238).is('')"]
[text default="--Nasonex (25 mcg), 1 spray Nasal daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Neurotin (Gabapentin) (300 mg)" name="Neur_4621" value=""][conditional field="Neur_4621" condition="(Neur_4621).is('')"]
[text default="--Neurotin (Gabapentin) (300 mg), 1 cap PO daily, Disp: 90, RF: 3" size="80"][/conditional][checkbox memo="Nexium (40 mg)" name="Nexi_3738" value=""][conditional field="Nexi_3738" condition="(Nexi_3738).is('')"]
[text default="--Nexium (40 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Norvasc (Amlodipine) (10 mg)" name="Norv_7362" value=""][conditional field="Norv_7362" condition="(Norv_7362).is('')"]
[text default="--Norvasc (Amlodipine) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Paxil (Paroxetine) (20 mg)" name="Paxi_712" value=""][conditional field="Paxi_712" condition="(Paxi_712).is('')"]
[text default="--Paxil (Paroxetine) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Penicillin-VK (500 mg)" name="Peni_3607" value=""][conditional field="Peni_3607" condition="(Peni_3607).is('')"]
[text default="--Penicillin-VK (500 mg), 1 tab PO QID for 10 days, Disp: 40, RF: 0" size="80"][/conditional][checkbox memo="Percocet (Oxycodone/Acetaminophen) (5 /325 mg)" name="Perc_5054" value=""][conditional field="Perc_5054" condition="(Perc_5054).is('')"]
[text default="--Percocet (Oxycodone/Acetaminophen) (5 /325 mg), 1 tab PO every 6 hours for 5 days, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Plavix (Clopidogrel) (75 mg)" name="Plav_8114" value=""][conditional field="Plav_8114" condition="(Plav_8114).is('')"]
[text default="--Plavix (Clopidogrel) (75 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Pravachol (Pravastatin) (20 mg)" name="Prav_4373" value=""][conditional field="Prav_4373" condition="(Prav_4373).is('')"]
[text default="--Pravachol (Pravastatin) (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Prednisone (5 mg) - 5 Days" name="Pred_332" value=""][conditional field="Pred_332" condition="(Pred_332).is('')"]
[text default="--Prednisone (5 mg), 1 tab PO QAM, Disp: 5, RF: 0" size="80"][/conditional][checkbox memo="Prednisone (20 mg)" name="Pred_1878" value=""][conditional field="Pred_1878" condition="(Pred_1878).is('')"]
[text default="--Prednisone (20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Premarin (0.625 mg)" name="Prem_3208" value=""][conditional field="Prem_3208" condition="(Prem_3208).is('')"]
[text default="--Premarin (0.625 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Prevacid (Lansoprazole) (30 mg)" name="Prev_8724" value=""][conditional field="Prev_8724" condition="(Prev_8724).is('')"]
[text default="--Prevacid (Lansoprazole) (30 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Prilosec (Omeprazole) (20 mg)" name="Pril_5170" value=""][conditional field="Pril_5170" condition="(Pril_5170).is('')"]
[text default="--Prilosec (Omeprazole) (20 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Procardia XL (Nifedipine ER) (30 mg)" name="Proc_7106" value=""][conditional field="Proc_7106" condition="(Proc_7106).is('')"]
[text default="--Procardia XL (Nifedipine ER) (30 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Proscar (Finasteride) (5 mg)" name="Pros_4106" value=""][conditional field="Pros_4106" condition="(Pros_4106).is('')"]
[text default="--Proscar (Finasteride) (5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Protonix (Pantoprazole) (40 mg)" name="Prot_2237" value=""][conditional field="Prot_2237" condition="(Prot_2237).is('')"]
[text default="--Protonix (Pantoprazole) (40 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Proventil (90 mcg)" name="Prov_7658" value=""][conditional field="Prov_7658" condition="(Prov_7658).is('')"]
[text default="--Proventil (90 mcg), 1 puff INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Proventil (Albuterol) (0.08 %)" name="Prov_4348" value=""][conditional field="Prov_4348" condition="(Prov_4348).is('')"]
[text default="--Proventil (Albuterol) (0.08 %), 1 puff INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Pyridium" name="Pyr" value=""][checkbox memo="Pyridium (200 mg)" name="Pyri_5011" value=""][conditional field="Pyri_5011" condition="(Pyri_5011).is('')"]
[textarea default="--Pyridium (200 mg), 1 tab PO TID for 2 days, Disp: 6, RF: 0, take with or after meals" size="80"][/conditional][checkbox memo="Prozac (Fluoxetine) (20 mg)" name="Proz_5952" value=""][conditional field="Proz_5952" condition="(Proz_5952).is('')"]
[text default="--Prozac (Fluoxetine) (20 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Relafen (Nabumetone) (500 mg)" name="Rela_1255" value=""][conditional field="Rela_1255" condition="(Rela_1255).is('')"]
[text default="--Relafen (Nabumetone) (500 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Risperdal (Risperidone) (1 mg)" name="Risp_3866" value=""][conditional field="Risp_3866" condition="(Risp_3866).is('')"]
[text default="--Risperdal (Risperidone) (1 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Seroquel (Quetiapine) (100 mg)" name="Sero_183" value=""][conditional field="Sero_183" condition="(Sero_183).is('')"]
[text default="--Seroquel (Quetiapine) (100 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Singulair (Montelukast SOD) (10 mg)" name="Sing_6939" value=""][conditional field="Sing_6939" condition="(Sing_6939).is('')"]
[text default="--Singulair (Montelukast SOD) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Spiriva (18 mcg)" name="Spir_130" value=""][conditional field="Spir_130" condition="(Spir_130).is('')"]
[text default="--Spiriva (18 mcg), 1 puff INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Strattera (18 mg)" name="Stra_6584" value=""][conditional field="Stra_6584" condition="(Stra_6584).is('')"]
[text default="--Strattera (18 mg), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Synthroid (Levothyroxine) (50 mcg)" name="Synt_5136" value=""][conditional field="Synt_5136" condition="(Synt_5136).is('')"]
[text default="--Synthroid (Levothyroxine) (50 mcg), 1 tab PO daily, Disp: 30, RF: 3, take before morning meal" size="80"][/conditional][checkbox memo="Synthroid (Levothyroxine) (100 mcg)" name="Synt_67" value=""][conditional field="Synt_67" condition="(Synt_67).is('')"]
[text default="--Synthroid (Levothyroxine) (100 mcg), 1 tab PO daily, Disp: 30, RF: 3, take before morning meal" size="80"][/conditional][checkbox memo="Tenormin (Atenolol) (25 mg)" name="Teno_7198" value=""][conditional field="Teno_7198" condition="(Teno_7198).is('')"]
[text default="--Tenormin (Atenolol) (25 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Tenormin (Atenolol) (50 mg)" name="Teno_5605" value=""][conditional field="Teno_5605" condition="(Teno_5605).is('')"]
[text default="--Tenormin (Atenolol) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Terazol (Terconazole 0.80%) ( )" name="Tera_9368" value=""][conditional field="Tera_9368" condition="(Tera_9368).is('')"]
[text default="--Terazol (Terconazole 0.80%) ( ), 1 supp PV BID for 10 days, Disp: 20, RF: 3" size="80"][/conditional][checkbox memo="Topamax (Topiramate) (50 mg)" name="Topa_4605" value=""][conditional field="Topa_4605" condition="(Topa_4605).is('')"]
[text default="--Topamax (Topiramate) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Toprol XL (Metoprolol XL) (50 mg)" name="Topr_9959" value=""][conditional field="Topr_9959" condition="(Topr_9959).is('')"]
[text default="--Toprol XL (Metoprolol XL) (50 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="tri-cyclen (Tri-Sprintec) ( )" name="tri-_7180" value=""][conditional field="tri-_7180" condition="(tri-_7180).is('')"]
[text default="--tri-cyclen (Tri-Sprintec) ( ), 1 tab PO daily, Disp: 28, RF: 3" size="80"][/conditional][checkbox memo="Tricor (145 mg)" name="Tric_934" value=""][conditional field="Tric_934" condition="(Tric_934).is('')"]
[text default="--Tricor (145 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Truvada" name="Truv_772" value=""][conditional field="Truv_772" condition="(Truv_772).is('')"]
[text default="--Truvada, 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Tylenol/Codeine (Acetaminophen/Codeine) (30 mg)" name="Tyle_7510" value=""][conditional field="Tyle_7510" condition="(Tyle_7510).is('')"]
[text default="--Tylenol/Codeine (Acetaminophen/Codeine) (30 mg), 1 tab PO every 6 hours as needed, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Ultram (Tramadol) (50 mg)" name="Ultr_4740" value=""][conditional field="Ultr_4740" condition="(Ultr_4740).is('')"]
[text default="--Ultram (Tramadol) (50 mg), 1 tab PO every 4-6 hours as needed for pain, Disp: 18, RF: 0" size="80"][/conditional][checkbox memo="Valtrex (Valacyclovir) (500 mg)" name="Valt_5002" value=""][conditional field="Valt_5002" condition="(Valt_5002).is('')"]
[text default="--Valtrex (Valacyclovir) (500 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Vasotec (Enalapril) (10 mg)" name="Vaso_104" value=""][conditional field="Vaso_104" condition="(Vaso_104).is('')"]
[text default="--Vasotec (Enalapril) (10 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Ventolin HFA" name="Vent_7291" value=""][conditional field="Vent_7291" condition="(Vent_7291).is('')"]
[text default="--Ventolin HFA, 4 puffs INH daily, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Ventolin HFA (Rescue)" name="Vent_72" value=""][conditional field="Vent_72" condition="(Vent_72).is('')"]
[text default="--Ventolin HFA (Rescue), 2 puffs INH Q3-4 Hrs PRN Wheezing, Disp: 1 MDI, RF: 3" size="80"][/conditional][checkbox memo="Viagra (100 mg)" name="Viag_4754" value=""][conditional field="Viag_4754" condition="(Viag_4754).is('')"]
[text default="--Viagra (100 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Vibramycin (Doxycycline) (100 mg)" name="Vibr_5517" value=""][conditional field="Vibr_5517" condition="(Vibr_5517).is('')"]
[text default="--Vibramycin (Doxycycline) (100 mg), 1 cap PO daily, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Vicodin (Hydrocodone/Acetominophen) (5 mg/500 mg)" name="Vico_3544" value=""][conditional field="Vico_3544" condition="(Vico_3544).is('')"]
[text default="--Vicodin (Hydrocodone/Acetominophen) (5 mg/500 mg), 1 tab PO daily, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Vicodin (Hydrocodone/Acetominophen) (7.5 mg/750 mg)" name="Vico_7273" value=""][conditional field="Vico_7273" condition="(Vico_7273).is('')"]
[text default="--Vicodin (Hydrocodone/Acetominophen) (7.5 mg/750 mg), 1 tab PO daily, Disp: 30, RF: 0" size="80"][/conditional][checkbox memo="Vitamin D (50000 units)" name="Vita_3857" value=""][conditional field="Vita_3857" condition="(Vita_3857).is('')"]
[text default="--Vitamin D (50000 units), 1 cap PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Vytorin (10 mg/20 mg)" name="Vyto_3536" value=""][conditional field="Vyto_3536" condition="(Vyto_3536).is('')"]
[text default="--Vytorin (10 mg/20 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Wellbutrin SR (Bupropion SR) (150 mg)" name="Well_1069" value=""][conditional field="Well_1069" condition="(Well_1069).is('')"]
[text default="--Wellbutrin SR (Bupropion SR) (150 mg), 1 tab PO daily, Disp: 60, RF: 3" size="80"][/conditional][checkbox memo="Xalatan (Latanoprost) (0.01 %)" name="Xala_6101" value=""][conditional field="Xala_6101" condition="(Xala_6101).is('')"]
[text default="--Xalatan (Latanoprost) (0.01 %), 1 gtts daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Xanax (Alprazolam) (0.5 mg)" name="Xana_8276" value=""][conditional field="Xana_8276" condition="(Xana_8276).is('')"]
[text default="--Xanax (Alprazolam) (0.5 mg), 1 tab PO TID, Disp: 90, RF: 0" size="80"][/conditional][checkbox memo="Yaz (3 mg/ .02 mg)" name="Yaz_2628" value=""][conditional field="Yaz_2628" condition="(Yaz_2628).is('')"]
[text default="--Yaz (3 mg/ .02 mg), 1 tab PO daily, Disp: 28, RF: 0" size="80"][/conditional][checkbox memo="Zantac (Ranitidine) (150 mg)" name="Zant_7387" value=""][conditional field="Zant_7387" condition="(Zant_7387).is('')"]
[text default="--Zantac (Ranitidine) (150 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Zestoretic (Lisinopril/Hctz) (20 mg/12.5 mg)" name="Zest_8507" value=""][conditional field="Zest_8507" condition="(Zest_8507).is('')"]
[text default="--Zestoretic (Lisinopril/Hctz) (20 mg/12.5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Zofran (Ondansetron) (4 mg)" name="Zof" value=""][conditional field="Zof" condition="(Zof).is('')"]
--Zofran ([text name="Zof_dose" default="8" memo="4-8" size="2"] mg), SL, PRN TID N/V, disp: 15, refill(s) 1[/conditional][conditional field="Zest_8507" condition="(Zest_8507).is('')"]
[text default="--Zestoretic (Lisinopril/Hctz) (20 mg/12.5 mg), 1 tab PO daily, Disp: 30, RF: 3" size="80"][/conditional][checkbox memo="Zyrtec (Cetirizine) (5 mg)" name="Zyrtec" value=""][conditional field="Zyrtec" condition="(Zyrtec).is('')"]
--Zyrtec ([text name="Zyrtec_dose" default="5" memo="5-10" size="2"] mg), PO Daily, disp: 30, RF: 3[/conditional]
Weight Blank Drug Blank Drug Blank Drug Blank Drug Blank Drug Blank PRN Drug Blank PRN Drug Acetaminophen (160mg/5mL) (Ped) Abilify (10 mg) Accupril (Quinapril) (10 mg) Actonel (35 mg) Actos (Pioglitazone) (15 mg) Actos (Pioglitazone) (30 mg) Adderall XR (Amphetamine Salt XR) (10 mg) Advair Diskus (250 mcg/50 mcg) Allegra (Fexofenadine) (180 mg) Altace (Ramipril) (5 mg) Amaryl (Glimepiride) (2 mg) Ambien (Zolpidem) (10 mg) Ambien CR (Zolpidem CR) (12.5 mg) Amoxycillin (Q8H) (Ped) Amoxil (Amoxicillin) (500 mg) Aricept (Donepezil) (5 mg) Augmentin (Q12H) (Ped 3+ months) Augmentin (Amox Tr-K Clv) (875 mg) Avapro (150 mg) Avelox (400 mg) Azithromycin (Ped) Azithromycin (Adult) Bactrim (Sulfameth/Trimeth) Bactroban (Mupirocin) Benicar (20 mg) Boric Acid (Vaginal) Boniva (150 mg) Catapres (Clonidine) (0.1 mg) Celebrex (200 mg) Celexa (Citalopram) (20 mg) Chantix (1 mg) Cialis (5 mg) Cipro (Ciprofloxacin) (500 mg) Combivent (ipratropium bromide/albuterol) (20 mcg-100 mcg) Coreg (Carvedilol) (6.25 mg) Coumadin (Warfarin) (5 mg) Cozaar (Losartan) (50 mg) Crestor (10 mg) Cymbalta (30 mg) Depakote (Divalproex) (500 mg) Desyrel (Trazodone) (50 mg) Diflucan (Fluconazole) (400 mg) Dilantin (Phenytoin) (100 mg) Diovan (80 mg) Effexor XR (Venlafaxine XR) (75 mg) Evista (60 mg) Flagyl (Metronidazole) (500 mg) Flexeril (Cyclobenzaprine) (10 mg) Flexpen (Novolog 70-30) Flomax (Tamsulosin) (0.4 mg) Flonase (Fluticasone) (50 mcg) Flovent HFA (110 mcg) Fluticasone Folic Acid (1 mg) Fosamax (Alendronate) (70 mg) Glucophage (Metformin HCL) (500 mg) Glucophage (Metformin HCL) (1000 mg) Glucophage XR (Metformin ER) (500 mg) Glucotrol XL (Glipizide ER) (5 mg) Glucotrol XL (Glipizide ER) (10 mg) Hydrodiuril (Hydrochlorothiazide) (12.5 mg) Hydrodiuril (Hydrochlorothiazide) (25 mg) Hytone (Hydrocortisone) (2.5 %) Ibuprofen (Ped) Imitrex (Sumatriptan) (100 mg) Januvia (100 mg) K-dur (Potassium) (20 mEq) Keflex (Cephalexin) (500 mg) Ketoconazole Klonopin (Clonazepam) (1 mg) KWIKPEN (Humalog) (75 -25) Lamictal (Lamotrigine) (25 mg) Lamisil (Terbinafine) (250 mg) Lanoxin (Digoxin) (0.125 mg) Lantus Lasix (Furosemide) (20 mg) Lasix (Furosemide) (40 mg) Lexapro (Escitalopram) (10 mg) Lipitor (Atorvastatin) (10 mg) Lipitor (Atorvastatin) (20 mg) Loestrin FE ( ) Lopressor (Metoprolol) (50 mg) Lotrisone (Clotrimazole/Betam) (1 %-0.05 %) Lyrica (50 mg) Macrobid (Nitrofurantoin) (100 mg) Maxzide (Triamterene/HCTZ) (37.5 mg) Mobic (Meloxicam) (7.5 mg) Motrin (Ibuprofen) (600 mg) Motrin (Ibuprofen) (800 mg) Namenda (10 mg) Naprosyn (Naproxen) (500 mg) Nasonex (25 mcg) Neurotin (Gabapentin) (300 mg) Nexium (40 mg) Norvasc (Amlodipine) (10 mg) Paxil (Paroxetine) (20 mg) Penicillin-VK (500 mg) Percocet (Oxycodone/Acetaminophen) (5 /325 mg) Plavix (Clopidogrel) (75 mg) Pravachol (Pravastatin) (20 mg) Prednisone (5 mg) - 5 Days Prednisone (20 mg) Premarin (0.625 mg) Prevacid (Lansoprazole) (30 mg) Prilosec (Omeprazole) (20 mg) Procardia XL (Nifedipine ER) (30 mg) Proscar (Finasteride) (5 mg) Protonix (Pantoprazole) (40 mg) Proventil (90 mcg) Proventil (Albuterol) (0.08 %) Pyridium Pyridium (200 mg) Prozac (Fluoxetine) (20 mg) Relafen (Nabumetone) (500 mg) Risperdal (Risperidone) (1 mg) Seroquel (Quetiapine) (100 mg) Singulair (Montelukast SOD) (10 mg) Spiriva (18 mcg) Strattera (18 mg) Synthroid (Levothyroxine) (50 mcg) Synthroid (Levothyroxine) (100 mcg) Tenormin (Atenolol) (25 mg) Tenormin (Atenolol) (50 mg) Terazol (Terconazole 0.80%) ( ) Topamax (Topiramate) (50 mg) Toprol XL (Metoprolol XL) (50 mg) tri-cyclen (Tri-Sprintec) ( ) Tricor (145 mg) Truvada Tylenol/Codeine (Acetaminophen/Codeine) (30 mg) Ultram (Tramadol) (50 mg) Valtrex (Valacyclovir) (500 mg) Vasotec (Enalapril) (10 mg) Ventolin HFA Ventolin HFA (Rescue) Viagra (100 mg) Vibramycin (Doxycycline) (100 mg) Vicodin (Hydrocodone/Acetominophen) (5 mg/500 mg) Vicodin (Hydrocodone/Acetominophen) (7.5 mg/750 mg) Vitamin D (50000 units) Vytorin (10 mg/20 mg) Wellbutrin SR (Bupropion SR) (150 mg) Xalatan (Latanoprost) (0.01 %) Xanax (Alprazolam) (0.5 mg) Yaz (3 mg/ .02 mg) Zantac (Ranitidine) (150 mg) Zestoretic (Lisinopril/Hctz) (20 mg/12.5 mg) Zofran (Ondansetron) (4 mg) Zyrtec (Cetirizine) (5 mg)

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