Carol Holmes
 
 
 15/10/2015 FROM- CWFMD 
 Run Date/Time: 
 HCA Houston Conroe 
 Printed By: 
 14/03/2017 1118 
 Discharge - Patient Medication Report 
 3JFA6195 
 Acct# B89026517790 
 PRICE ERICA NICOLE 
 MR# BH0028805 
 ALLERGIES: [IV CONTRAST]. iodine. hydrocodone (From VICODIN). acetaminophen (From VICODIN). 
 ibuprofen (From VICOPROFEN). tramadol (From ULTRAM) 
 Adverse Drug Reactions: *** No ADR's Entered *** 
 PREFERRED PHARMACY: WALGREENS DRUG STORE #15012 9610 FM 1097 RD W. WILLIS TX. 773184998 
 ***FINALIZED** 
 Discharge Medications 
 ***FINALIZED*** 
 This med list indicates the medications you should be taking upon discharge 
 Do not take any medications not isted without consulting your doctors 
 Throw away an old drug lists, Give this new list to your doctors 
 Updated Home Medication List 
 GENERIC NAME (TRADE NAMES 
 LAST DOSE 
 DOSE 
 ROUTE 
 FREQUENCY 
 QTY/DAYS 
 DATE/TIME 
 ACETAMINOPHEN/CODEINE (TRADE NAME: TYLENOL WITH CODEINE #3 300/30 MG) 
 1 TAB 
 ORAL 
 EVERY 4 HOURS AS NEEDED. 
 INDICATION ACUTE PAIN 
 Age 49 
 Sex 
 MR# BH00288051 
 Adm/Syc 22/09/2017 
 Attend MD Punsalar Terria Leonor 
 Patient/Representative Initials 
 MEDR 
 Page: 1 (See Page 2) 
 Name: Carol Holmes 
 DOB: 09/08/1992 
 Date:
