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Electronic Prescription Reference

*_ This document can’t be used for dispensing inside the emirate of Dubai.
*_ This document can be used for dispensing outside the emirate of Dubai with the proper stamps and signatures.

Details

Reference Prescription
ID: Plan: Member ID: Clinician ID:
Number Date:

DHA-F-0000583-INS013- Metlife 4718260000- DHA-P-


107758861 11/02/2024
20240211114410 Alico 000320994-1 0244978

Denial: Comments:

Diagnoses:
Type Diagnosis
Principal E55.9 - Vitamin D deficiency, unspecified
Showing 1 to 1 of 1 entries

Drugs:
Patient
ID Drug Status Denial Duration Qty Net Instructions ROA Refills
Share
0444-640412-
0971 - EURO- Take 1
D 50000 IU, BOTTLE(s), 1
15407945 15'S, 50000 IU, Approved - 60 1.00 5.10 0.00 Time(s) per ORAL 0
SOFT Week For 60
GELATIN Day(s).
CAPSULES
Total: 5.10 0.00
Showing 1 to 1 of 1 entries

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