In-Practice Physician Dispensing Program

Sample Proposal

PracticeMD, Inc.

PO Box 6657 ● 242 Lynbrook Boulevard Shreveport ● Louisiana ● 71136

318.841.4320 direct ● 318.841.4319 fax info@PracticeMDRx.com

Chicago ● Dallas ● Miami ● Oklahoma City ● Orlando ● Sacramento ● Tampa Bay

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Orthopedic Surgeon Clinic Pro formaAugust 24, 2009

Code Brand Name Generic Name Price Size3328 Mobic 15mg Tablet Meloxicam 15mg Tablet $6.35 30

1339 Flexeril 10mg Tablet Cyclobenzaprine 10mg Tablet $7.99 30

3178 Lortab 7.5/ 500mg Tablet (CIII) Hydrocodone/ Apap 7.5/500mg (CIII) $8.39 60

2868 Ultram 50mg Tablet Tramadol 50mg Tablet $8.99 90

1623 Robaxin 750mg Tablet Methocarbamol 750mg Tablet $9.99 90

1477 Naprosyn 500mg Tablet Naproxen 500mg Tablet $6.99 60

1729 Medrol Dosepak 4mg Methylprednisolone 4mg $6.99

1621 Restoril 30mg (CIV) Capsule Temazepam 30mg (CIV) Capsule $7.59 30

1308 Soma 350mg Tablet Carisoprodol 350mg Tablet $9.99 90

3115 Lorcet 10/650 mg (CIII)Tablet Hydrocodone/ APAP 10/650mg (CIII) $9.99 60

1319 Keflex 500mg Capsule Cephalexin 500mg Capsule $8.99 28

3056 Neurontin 300mg Capsule Gabapentin 300mg Capsule $8.99 90

3548 Ambien 10mg Tablet (ClV) Zolpidem Tartrate 10mg Tablet(CIV) $6.29 30

Average Price $8.27Workers Comp Patients

Generic Price Size AWP (1) Price ProfitMeloxicam 15mg Tablet $6.35 30 209.70$ $6.35 98.50$

Naproxen 500mg Tablet $6.99 60 152.00$ $6.99 76.61$ Cyclobenzaprine 10mg Tablet $7.99 90 138.77$ $7.99 61.40$ Tramadol 50mg Tablet $8.99 90 129.59$ $8.99 62.28$ Hydrocodone/ Apap 7.5/500mg (CIII $8.39 60 53.85$ $8.39 18.54$

Average WC reimbursement 63.46$

2400 WC Scripts Per Month 152,315.76$ Cash & Carry

Generic Price Size Cash Price ProfitMethylprednisolone 4mg $6.90 20.00$ $6.90 13.10$ Cephalexin 500mg Capsule $8.99 28 20.00$ $8.99 11.01$ Carisoprodol 350mg Tablet $9.99 90 20.00$ $9.99 10.01$ Cyclobenzaprine 10mg Tablet $7.99 90 20.00$ $7.99 12.01$ Zolpidem Tartrate 10mg Tablet(CIV $6.29 30 20.00$ $6.29 13.71$ Temazepam 30mg (CIV) Capsule $7.59 30 20.00$ $7.59 12.41$ Meloxicam 15mg Tablet $6.35 30 20.00$ $6.35 13.65$

Orthopedic Doctors (2) 10 Total Per Patient 12.27$ number of days open per week 5

400 scripts per day Total. (3) 3920 Scripts per Month 48,104.00$ 400 X 20 working days a month = 8000

30% workers' compensation = 2400 Total Profit Per Month 200,419.76$ 70% C&C scripts captured = 3920

Grand Total Per Year 2,405,037.12$

(1) Reimbursements are subject to modification on a state-by-state basis(2) Orthopedic Clinic 20 practicing physicians(3) Scripts illustrated reduced by 40% from original total

PCP - Pro formaOctober 23, 2009

Code Brand Name Generic Name Price Size3548 Ambien 10mg Tablet (ClV) Zolpidem Tartra Cte 10mg Tablet( IV) $6.29 301236 Amoxil 500mg Tablet Amoxicillin 500mg Tablet $8.99 303317 Celexa 40mg Tablet Citalopram 40mg Tablet $7.99 303668 Coreg 6.25mg Tablet Carvedilol 6.25mg Tablet $7.29 302548 Coumadin 5mg Tablet Warfarin Sodium 5mg Tablet $8.25 301395 Glucophage 500mg Tablet Metformin 500mg Tablet $7.50 301341 Klonopin 0.5mg (CIV) Tab Clonazepam 0.5mg (CIV) Tablet $6.09 303178 Lortab 7.5/500mg Tab (CIII) Hydr Cocodone / Apap 7.5/500mg ( III) $7.99 301728 Lotensin 20mg Tablet Benazepril Hcl 20mg Tablet $8.99 301565 Norvasc 10mg Tablet Amiodipine Besylate 10mg Tablet $8.99 301840 Paxil 20mg Tablet Paroxetine 20mg Tabltet $8.99 301621 Restoril 30mg (CIV) Capsule Temazepam 30mg (C eIV) Capsul $7.59 302712 Synthroid 50mg Tablet Levothyroxine 50mg Tablet $8.99 301497 Tagamet 400mg Tablet Cimetidine 400mg Tablet $7.89 302626 Tenormin 100mg Tablet Atenolol 100mg Tablet $6.99 302868 Ultram 50mg Tablet Tramadol 50mg Tablet $6.99 301523 Valium 5mg (CIV) Tablet Diazepam 5mg (CIV) Tablet $6.99 301526 Vasotec 10mg Tablet Enalaoril Maleate 10mg Tablet $8.95 302736 Ventolin 4mg Tablet Albuterol 4mg Tablet $7.99 301541 Xanax 0.50mg (CIV) Tablet Alprazolam 0.50mg (CIV) Tablet $6.99 301671 Zantac 15mg/Ml Syrup Ranitidine 15mg/MI rup Sy $8.99 302908 Zestril 20mg Tabletg Lisinopril 20mg Tablet $6.99p g 303385 Zocor 40mg Tablet Simvastatin 40mg Tablet $10.99 303309 Zoloft 100mg Tablet Sertraline 100mg Tablet $9.99 301677 Zovirax 400mg Tablet Acyclovir 400mg Tablet $9.99 301675 Zyloprim 100mg Tablet Allopurinol 100mg Tablet $8.99 30

Average Price $8.18

Code Generic Name Size Cash Price Profit2736 Albuterol 4mg Tablet 30 $20.00 $7.99 $12.011541 Alprazolam 0.50mg (CIV) Tablet 30 $20.00 $6.99 $13.011497 Cimetidine 400mg Tablet 30 $20.00 $7.89 $12.111840 Paroxetine 20mg Tabltet 30 $20.00 $8.99 $11.012548 Warfarin Sodium 5mg Tablet 30 $20.00 $8.25 $11.753548 Zolpidem Tartrate 10mg Tablet(CIV) 30 $20.00 $6.29 $13.71

Average Net Profit per Prescription $12.27

Physicians (1) 1 Total Scripts / Month 360 Number of days per week 5

30 scripts per day Total. (2) Total Profit / Month 4,416$ 30 @ 20 working days a month = 600

60% Private Pay Rx Captured 360Total Profit / Year 52,992$

(1) Estimated Participating Physicians(2) Scripts illustrated reduced by 40% from original total.Representative Sample of Prescriptions Dispensed

PROGRAM OVERVIEW

PracticeMD is a program that allows physicians to dispense pre-packaged medication at the point of care. Through Cash Pay Deductibles and Workers’ Compensation, PracticeMD allows practices to easily increase profitability within the practice. It allows doctors to enjoy a new source of income while offsetting cutbacks in managed care.

PracticeMD also provides a “One Stop Shop” model for patients by implementing its program directly into their doctor’s practice. This means that patients are able to get a diagnosis from a physician and have their prescriptions filled on-site in one trip, preventing multiple stops at retail pharmacies.

Improved Treatment Compliance

In a recent national study, three out of four Americans said they would have their prescription filled in their doctor's office instead of a pharmacy if given the choice. This enhances patient compliance by ensuring prescriptions are filled and the prescribed course of treatment is followed. Studies suggest as many as 20% of all prescriptions go unfilled each year. PracticeMD in-office medication dispensing ensures your patients have their medications in hand before they leave your office.

How it works

Practices typically will need to carry a selection of their most commonly prescribed medications. At the time of patient checkout, they provide these medications to them for a small fee, usually equivalent to co-pays.

PracticeMD sets up a Formulary for your practice that will enhance profitability through low cost pricing. This program also eliminates insurance filings for medications.

Declining reimbursement rates, combined with the emergence of consumer driven healthcare, is leading doctors to explore new and innovative ways to heighten the patient experience and find new sources of income. Improve patient satisfaction and enhance revenue with the PracticeMD in-office medication dispensing program. In-practice medication dispensing is the process of distributing safety sealed pre-packaged medications to patients at the point of care. Most medication dispensing programs utilize a cash and carry model, eliminating the hassle of filing insurance claims. PracticeMD also offers Workers’ Compensation, Personal Injury and PIP (auto Personal Injury Protection) programs where available.

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PROGRAM BENEFITS

SAVE YOUR PATIENTS TIME AND MONEY

Patients who are ill, in pain or very busy will appreciate the convenience that comes from receiving their medications from their physician or dentist, sparing them a separate trip and long wait at the pharmacy.

INCREASE INCOME

Medication dispensing is a great way to generate additional income for your practice. With typical net revenue ranging from $5 to $15 per prescription dispensed for our “cash & carry” model and potentially much higher revenue using our Workers’ Compensation, Personal Injury and PIP (auto Personal Injury Protection) program, an active in-office dispensing program can significantly strengthen your practice’s bottom line.

FIRST-DOLLAR PROFITABILITY There is no upfront cost to the practice for installation of equipment (DEA-approved prescription storage cabinets, hand held scanners, labels & software), and there is a 30-day contract with “no cause” opt out. Prescriptions are delivered with a 30-day net due invoice. The traditional prescription order equates to a two week prescription trend. Prescriptions are delivered via express courier with signed delivery receipt. The PracticeMD system of delivering prescriptions with a 30-day net due invoice allows each Practice to cover all cost on a cash & carry basis from day one. Most practices receive their 2nd or 3rd two-week resupply order prior to payment of the original invoice.

PRACTICE ACTIVATION PracticeMD provides training for physicians and staff, and establishes a work-flow for dispensing operations. Traditional implementation of services requires a two (2) week activation protocol. Staff training requires approximately one hour. Upon receipt of the first prescription order, custom software is installed (web based), training is implemented, and the dispensing path confirmed for delivery of prescriptions to patient through patient check out. Key Practice support and training advantages:

Workers’ Compensation EDI Support Formulary Development & Support 24 Hour Technical Support On-Call Pharmacists Online and Continuing Education / Training Available Dedicated Client Service Personnel

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Web Based Software

Point-of-care dispensing solution for unit-of-use medications

Delivers maximum flexibility to meet your practice’s dispensing needs

Bar-code technology verifies the prescribed medication for each bottle dispensed. Once verified, the following steps are automated with the average dispense completed in less than 30 seconds

Patient Specific Label (peel & stick)

DUR Compliance

Drug/Drug Interaction

Drug/Allergy Contraindications

Drug Over-Utilization

Physician Override Required

Education & instruction sheet provided

Inventory tracking

Refill Monitoring and Automated Patient Sequencing

Detailed Management, Utilization & Financial Reporting

Multi-Re packager Ordering Capability & Automated Inventory Reorder

Product Expiration Alerts

DEA Compliance & Reporting

STARK Regulation Compliant

Workflow – Dispensing Path (Physician approved)

Compliance Reporting

DEA “Controlled Substance” Compliant

Pharmacy Board Compliance & Reporting

HL-7 Data Interface and Data Exchange Capability

Electronic NCPDP 5.1 Claims Submission Capability

Electronic State Scheduled Drug Reporting (PDMP)

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PracticeMD – A Common Sense Solution

“The average physician spends up to 60 minutes a day dealing with pharmaceutical issues for no revenue. For every three physicians, there is usually one employee dealing exclusively with pharmaceutical issues. This employee is often a registered nurse whose salary and benefits may reach up to $100,000 annually.”

- Noffsinger R. Chin S. Improving the delivery of care and reduction healthcare cost with digitization of information. Healthcare Information Mgmt, 2000

“American Medical Association (AMA) guidelines do not preclude office dispensing as long as state and federal regulatory requirements are fulfilled, the doctor prescribes only to his/her patients and allows them to fill prescriptions where they want.”

- American Medical Association Counsel on Ethical & Judicial Affairs 8.06

PracticeMD Dispensing FAQ The # 1 question asked by physicians: Is it legal? Yes, every physician is allowed by law to dispense medications to his/her own patients within the practice environment. Under Stark regulations, physician dispensing is considered acceptable when the dispensing is limited to the physician’s own patients; and the medications and products dispensed meet FDA guidelines for repackaging and labeling. There are only four states (Montana, New York, Utah, and Texas) that have more restrictive laws concerning point of care dispensing; it is allowed, but limited. Is dispensing right for my office? Dispensing is traditionally provided in offices which prescribe heavily for acute conditions requiring a single course of therapy. Typical medications include antibiotics, anti-inflammatory, pain management, etc. All medications are delivered to your office as safety sealed pre-packaged medications. Will I be a full-service pharmacy? No. The key to a successful dispensing program is to identify and support existing physician prescribed courses of medication. Physicians typically prescribe like medications repeatedly, and the ideal in-practice formulary consists of the most frequently prescribed medications in their most commonly ordered strengths and package size (“unit-of-use”). In-practice dispensing is not intended to replace a full-service pharmacy, but rather to provide a subset of medications that make up 60% to 80% of prescriptions prescribed, depending on one’s specialty. May I provide mail order service to my patients? Yes. However, in compliance with Stark Regulations, mail order prescriptions are recognized as an out-of-practice delivery and therefore not eligible for compensation. Physicians that offer mail order services usually provide this option as a courtesy to one’s patients. How much will point of care medication dispensing cost my practice? There are no upfront cost for workers’ compensation, 3rd party insurance (i.e. State Farm Auto) and/or cash & carry generic program. PracticeMD Dispensing will provide the use of the dispensing software, medications, medication cabinet, bar code scanner, pharmacy labels, pharmacy bags, training and support. The insurance adjudication program requires a reasonable enrollment fee which credentials the entire practice to electronically process their pharmacy claims through the respective payer. This means that regardless of the number of physicians within the practice, all prescriptions written at that location will be eligible for electronic claims submission. We have found that this small investment is quickly recouped within the first few weeks of dispensing. However, each practice is required to pay for the actual cost of medications dispensed. PracticeMD delivers medications with a 30-day net due invoice. Additionally, medications are delivered using a two (2) week trend; this allows most practices to dispense 2 to 3 deliveries prior to payment of the first invoice. Several states may require an inventory or sales tax, and/or a dispensing license per physician. PracticeMD will provide support for these requirements, if applicable. PracticeMD provides a “no cause” ninety (90) day initial contract for services provided.

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Does point of care medication dispensing comply with state and federal drug dispensing regulations? The PracticeMD Dispensing system complies with all DEA and FDA requirements. Repackaging companies are held to more stringent guidelines than pharmacies and all medications are repackaged in sterile environments to assure compliance. What is Stark Regulations? How does this affect me if I become a dispensing practitioner? Stark law pertains to physician self-referral for Medicare and Medicaid patients. There are exemptions to this status for in-office ancillary services including physician dispensing. The in-office ancillary services exception of Stark law permits physician owners of a medical group, and other members of the group, to refer patients to their group for certain Designated Health Services (DHS). An outpatient prescription drug given to a patient in the physician’s office, but taken by the patient at home, is now covered by the in-office ancillary services exception. To qualify for protection under the in-office ancillary services exception, the DHS must be furnished personally by the referring physician or another physician member in the same group practice or by individuals who are "directly supervised" by the referring physician or group practice member. The in-office ancillary services must be furnished in the same building in which the referring physician or a group practice member furnishes substantial physician services unrelated to the furnishing of DHS. What is the profit potential to my practice? If your practice is using the PracticeMD Dispensing system by promoting it to all patients and encouraging use of the program, the profit potential can be significant. As with any program, utilization is the key. For a single physician practice seeing 30 patients per day, the average annual income range is between $50,000 - $125,000. Workers’ compensation costs and profit margins vary by state and will generally produce much higher margins. Why have I not heard of this before? Is point of care medication dispensing a new concept? The practice of point of care medication dispensing has been around since physicians began practicing medicine; but a re-emergence as an industry began in the early 1980s with repackaged drugs being introduced into the market. In 1983, a nationwide campaign lead by the retail pharmacy industry was begun with the intent to eliminate the physician’s rights to dispense. In 1985, legislation in Congress was passed in 46 states to secure the physician’s rights to dispense FDA approved medications to their own patients. The 1990s dispensing systems were developing to make the process fast, easy and cost effective for the physician and now in the 2000s with reimbursement cut backs to physicians and only a limited amount of time to see patients which decreases the chance of a physician increasing his patient load, physicians are turning to ancillary services such as dispensing to help increase their profit margins. Does the physician need a special license to dispense medications in the office? Most states do not require anything beyond your existing DEA and State license in order to dispense medications. There are a few states that have a designated dispensing license per physician. In most cases it is offered at a minimal cost. PracticeMD Dispensing can help you in assuring you have all proper licensure to participate in your states. How will point of care medication dispensing benefit my patients? First and foremost is the convenience factor for your patients, no longer will they have to wait in long lines at a pharmacy to fill prescriptions. Filling prescriptions from your practice is an added service to

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your patients that saves them time and adds no additional cost. In many cases this can also mean a cost savings to the patient because no extra commute is required. What if patients ask about our pricing versus their regular pharmacy? PracticeMD Dispensing system communicates using the same technology that any major retail pharmacy uses in order to process a pharmaceutical insurance claim through the insurance payer. This allows for instant electronic confirmation of eligibility, patient co-pay and reimbursement to the practice. Therefore, a patient’s co-pay for brand or generic product is exactly the same as if they had gone to the pharmacy. Note that this program does not offer a $4 generic program as most of these subsidized drug programs are limited to a select group of generic medications and days’ supply. Who can dispense the medications in our office? Will I need additional staff to dispense? In most states, a directive from the physician allows other staff members to dispense medications within the office. A few states do require that the physician actually do the dispensing. What liability does the physician practice assume with point of care medication dispensing? The liability is the same as it would be when a physician writes a prescription which is filled by a pharmacy. In point of care dispensing, there are stringent guidelines concerning packaging and labeling of the re-packaged medications. The PracticeMD Dispensing system meets all DEA and FDA requirements. What if we have multiple physicians in our practice? Having multiple physicians in a practice is not a problem, as each physician is assigned a specific password and can track their dispensing history separately for bookkeeping, documentation or patient information purposes. You can also have security access assigned at different levels to approved staff members who will be assisting in the dispensing process. What if we have multiple office locations in our practice? Physicians may dispense from multiple office locations, however if a physician dispenses controlled substances, then in accordance DEA Regulations, all locations must be listed on the physician’s DEA license. PracticeMD will assist physicians in amending their DEA license to list all locations. Please note that a physician can immediately dispense from their recognized location and expand to additional locations upon amendment. Will dispensing cause my malpractice premiums to increase? No, whether a physician prescribes medications that are filled at a pharmacy or at their practice, the physician responsibility is the same. Malpractice carriers do not charge higher rates for dispensing physicians. Do we have to file insurance for drugs dispensed in the practice? How do we handle Medicare and Medicaid patients? Drug cards? While PracticeMD Dispensing offers the use of the insurance adjudication program, it is not necessary to file insurance claims for medications dispensed in your office for a either cash & carry and/or workers’ compensation patient. The patient can always “opt out” of using their insurance ID card and simply pay out of pocket cost “co-pay deductible” -- otherwise termed as a “cash dispense.”

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Is the PracticeMD Dispensing software program easy to use? Will PracticeMD Dispensing train my staff? How long will the training take? PracticeMD Dispensing software is a web based application which means that any computer within the office that has an internet connection can be used as a dispensing terminal. The application requires minimal time, is easy to navigate and insures an accurate dispense. It features a drug utilization review for possible contraindications, allergies, conditions, etc., as well as generates bottle labeling and pharmacy education printouts. State mandated reporting is also compiled and submitted by the intuitive software application. PracticeMD Dispensing will provide complete training on the software and technical support when you have questions or concerns. Is point of care dispensing efficient? How much time will it take my staff to dispense a medication? The PracticeMD Dispensing program is easily integrated into your office procedures and is a streamlined process that can be completed between 30 seconds to 2 minutes depending on the level of information the physician requires on each patient. Trained staff can handle dispensing with minimal interruption to other office responsibilities. Does the PracticeMD Dispensing program have a patient database with dispensing history? Yes, patients are loaded in the database automatically when you dispense a medication and you can pull reports on dispensing history by patient, medication, date, etc. How much time will it take to enter a new patient into the database? A new patient can be added in under 2 minutes while dispensing, depending on the amount of information that the physician requests on each patient. Other demographic information is built into the system and can be added at time of dispense or at a later date if desired. This will vary with each individual office and the specific software programs in which the office participates. You do not have to add this additional information for a dispensing order to be completed. Does the PracticeMD Dispensing program have an inventory tracking process? The PracticeMD Dispensing program will automatically tell you when a particular medication is below the pre-set levels that will be determined by each individual office at the time of installation and training. You can re-order medications at the inventory site with the click of a button. How secure is the PracticeMD Dispensing program? A sophisticated password protection system is built into the PracticeMD Dispensing software. Each function performed by the software can be password protected to accommodate the needs and parameters of the individual physician practice. A double check system will not allow you to dispense a medication through the system that does not have a code match to the scanned bottle. In addition, the DUR (Drug Utilization Review) feature confirms with your EMR or dispense history stored in our software. Will point of care dispensing upset local pharmacies? If the local pharmacists are genuinely interested in good quality care, increased compliance on prescriptions actually filled and low costs to patients, they should have no problems with point of care dispensing. The pharmacy industry statistics report that only 70% - 80% of prescriptions are ever actually filled, and with point of care dispensing, the physician knows that the patient filled the prescription -- therefore increasing the chances that the patient will use the medication in compliance with his physician’s orders. Most physicians who are using point of care dispensing will dispense only

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about 30%-40% of the total prescriptions written in the office, the rest will be filled at a pharmacy; so the market share is equitable. How much space is required for the PracticeMD dispensing cabinet and computer hardware? Is the cabinet a locked system? The PracticeMD Dispensing cabinet is a white metal cabinet measuring approximately 19½” wide x 25” high and 7 ½ ” deep and weighs 24 lbs. The cabinet will hold up to 300 medications. It is a locking, wall mounted cabinet and conforms to DEA regulations concerning the storage of controlled substances. Depending on practice size we offer other cabinet/storage solutions. Are the pre-packaged medications supplied as starter doses or full course doses? Most dispensing physicians prefer to prescribe a full course dose of medication therapy to their patients, but starter doses can be dispensed in some situations. How do we determine which medications and how many to order? Can PracticeMD Dispensing provide any medications I choose, including controlled substances? PracticeMD Dispensing can supply any Schedule II - V controlled substance, as well as over the counter medications, injectables, and compounded medications. We suggest that initially you stock one week's supply of the 15-20 meds you prescribe daily. This offering can always be expanded, but it is best to start with a conservative inventory. The system will track all dispenses which will accurately determine which medications you are using most frequently and an accurate level of inventory control keeps your practice from running low on a particular medication. Your practice’s drug offering may develop over time and can change with seasonal practice activity. How do we re-order medications? The PracticeMD Dispensing program will automatically alert you of low inventory on specific drugs; these inventory levels are determined at the time of installation and training by the physician. When you receive a low inventory notice, you simply click a button to reorder that specific medication. You can expect delivery, under normal circumstances, within 3-5 business days from order submission. How do I set pricing for the medications? PracticeMD Dispensing designed the program around the national average co-pay of $20.00 per medication. PracticeMD Dispensing prescriptions are all approximately $20.00 for generics; a few may be slightly higher depending on the average wholesale price of the medication, but usually never over $20.00 for a generic. The patient simply pays the physician’s office a fee similar to the co-pay amount. Which medications generate the most income for the practice? Generally, generic medications and drug products offer the most profit potential for a physician’s practice and the greatest savings to the patients. What about theft? The PracticeMD Dispensing process is managed in such a way that theft is rarely a problem. Password protection, an automatic inventory system and dispensing records of who dispensed make it difficult to hide theft of medications. Every container is accounted for in the inventory system and the reports allow the staff to easily and quickly determine if there is a problem; unlike the basic supply closet concept.

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Why purchase re-packaged medications? State and Federal regulations state that dispensing is allowed through the physician’s practice only if the medications are properly packaged and labeled. Products must comply to federally-mandated current Good Manufacturing Practices (cGMPs) as noted in Title 21 of Code of Federal Regulations. Noncompliance with these laws could render the medication as adulterated and or misbranded. It is a federal crime to dispense an adulterated or misbranded medication to a patient. Why repackaged medications are repackaged in negative airflow sterile rooms? The FDA reports that 50% of all drug reactions in the United States are caused by penicillin and cephalosporin contamination. It is almost impossible to get medications from a pharmacy that do not have some contamination of dust spores from penicillin/cephalosporin-based medications, as all medications are sorted using the same trays as the penicillin/cephalosporin-based medications and cross contamination is a constant problem. One unit of penicillin is invisible to the naked eye, and many patients are highly allergic to penicillin/cephalosporin, which can lead to anaphylactic shock. Repackaging medications in sterile negative airflow environments greatly decreases the chance of cross contamination. What happens if there is a product recall from a drug manufacturer? The PracticeMD Dispensing software program can help you quickly identify any patients who are currently using a medication that has been recalled. Will the software system track additional products in addition to prescriptions? Yes, the software program is designed to track medication dispensed in-practice, prescriptions written for a pharmacy, drug samples given to patients and virtually any other commodity the physician or office manager wishes to track, such as Durable Medical Equipment and supplies. Please note that additional items may not be recognized or readable via hand held bar code scanners. Who do I call if I have problems with software, medication delivery, regulatory questions, etc? We at PracticeMD Dispensing are service oriented and have technical support available at any time to help with questions and concerns, software problems and problems with medication orders. You will have contact information for a technical support staff member upon installation and training.

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medication. Antibiotics wrk best when the amount ot medicin€ in your body is kept at a constant level. lt is important not to miss

a dose. To help you remomb€r and to keep the drug at a constant level, take it at the sam€ times every day. Continue to tak€ thismedication until the full prescrib€d amount is finished, even il symptoms disappear aftera fewdays. Stopping the medication too

early may allow bacteria to cohtinue to grow, which may result in a return of the infection. lell your doctor if your condition

persists or rcrsens.

Sl D E EF F EC TS: See also \Ahrn ing sectaon. N au sea, diarrhea, dizines s, lightheadedn es s, headac he or trouble sleepi ng m ay

occur. lf any of these effects persist or wrsen, toll y our doctor or pharmacist promptly. Remember that y our doctor has

proscribed this medication because he or she has judged that the benefit to you is greater than the risk of side 6ffects. Many

people using this medication do not have serious side efl€cts. lell your doctor immodiately if any of these unlik€ly but serious

side effects occur: mental/mood changes (e.g., anxiety, confusion, hallucinations, depression, rare thoughts of suicide), shaking

(tremors), skin that sunburhs more €asily (sun sensitivity). Ciprofloxacin may .arcly cause serious nerve problems that may be

reversible if identified and treated earjy. Seek immediate medical attention if you develop any of the following symptoms:pain/numbness/burning/tingling/reakness in any part of the body, changes jn how you sense touch/paih/temperature/body

position/vibration. Tell your doctor immediately if any of these rare but very s€rious side effecls occur: unusual bruising/bleedlng,

severe/p€rsistent headache, signs of a newinfsction (e.g., nevpersistent fever, persistent sore throat), unusual change in the

amount of urine, change in color of urine (redlpink urine), signs of liver problems (e.g., unusual tiredness, stomach/abdominal pain,

persistent nausea/vomiting. yellowing eyes/skin, dark urine), vision changes. Seek immediate medical attention if any of these

rare but very serious side effects o6cur severe diziness, fainting, fast/irregular heartbeat, seizures. This medication may Erely

cause a sev ere intestinal condition (pseudomem branous colitis) due to a ty pe of resistaht bacteria. This condition may occur during

treatment or reeks to months after treatment has stopped. Do not use anti{iarrhea products or narcotic Pain m6dications it you

have any of the following symptoms because th€se products may make them rcrse. Tell yourdoctor immediately if you develop:

p6rsistent diarrhea, abdominal or stomach pain/cramping, blood/mucus in your stool. Use of this medication for prolonged or

repeat6d periods may result in oral thrush or a new vaglnal yeast infection. Contact your doctor it you notice white patches in your

mouth. a change in vaginal discharge, or other n€w symptoms. A very serious allergic reaction to this drug is rare. However, seek

immediate medical attention if you notice any of the following symptoms of a sorious allergic reaction: rash, itching/swlling

(especially ol the face/tongue/throat), severe diziness, trouble breathing. This is not a comPlete list of possibl€ side elfects. Itw^',^^ri-a^tha'effsi.h^tlierFdah^vp.^ni..tv^".d^.t^r^r^h2rm.^i<t lnihpllS-Crllv^'rrdMt^rf^rmcdi.aladvi.Frh^r't

Rx100016 9/16/09 7:45 AMMEDeRx Demo SiteANelby, Marcus MD SAMPLE,JOHN't11 Main Street 123 MAIN ST,2ABoise lD 83333 BOISE lD 83605Medication lnfo: DOB:1/1/1 965CIPROFLO)({CIN HCL 30 x500MG TAB Payment:$0.00TAKE ONE OR TWO TABLETS EVERY 8 HOURS

needed. Discuss the risks and benefits with your doctor. This medication pass€s into breast milk. Breastfeeding js not recommendodvvhile taking thas drug. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: See also the How to Use section. Your doctor or pharmacist may already be aMre of any possible druginteractions and may be monitoring you for them. Do not start, stop, or chang€ th€ dosage ol any medicine before checking withthem lirst. This drug should not be usod with the following medications because v€ry serious interactions may occur: strontium,tianidine. lf you are currently using any of these medications listed above, tell your doctor or pharmacist before startingciprofloxacin. l\4any drugs b€sides ciprofloxacin may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide,quinidine, procainamid€, sotalol, c€rtain macrolide antibiotics (e.9., orythromycin, clarithromycin), and certain antapsychoticmedicatiohs (e.9., pimozide, thioridazine, ziprasidone), among others. Therefore, bofore using ciprofloxacih, report all medications youare currently using to your doctor or pharmacist. Before using this medication, tell your doctor or pharmacist of all prescription andnonprescription/h€rbal products you may use, especially of: live bacterial vaccines (e.9., typhoid, BCG), "blood thinhers" (e.9.,Mrfarin), corticosteroids (e.9., prednisone, hydrocortisone), cyclosporine, drugs removed trom your body by certain livor enzymes(such as clozapine, duloxetine, phenytoin, ropinirole, tacrine), drugs for diab€tes (e.9., glyburide, insulin), methotrexate, nonsteroidalanti-inflammatory drugs (NSAlDs such as ibuprofen, naproxen), probenecid, sevelamer, theophylline, urinary alkaliniars (e.9.,potassium/sodium citrate). Also report the us6 of drugs that might increase seizure risk when combined wth this modication such asisoniazid (lNH), phenothiazines (e.9., chlorpromazine), or tricyclic antidepressants (s.9., amitriptyline), among others. Consult yourdoctor or pharmacist for details. Avoid drinking large amounts of toverages containing caflejne (coffee, tea, colas), eating large

amounts of chocolate, or taking over-the{ounter products that contain caffein€ to keep you aMke and alert. This drug mayincrease and/or prolong the eflects of caff€ine. This document does hot contain all possible interactions. Therefore, b€fore using thisproduct, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the llstwith y our doctor and pharmacist.

OVERDOSE: lf overdose is suspected, contact yourlocal poison control center oremergency room immediately- US residents cancall the US National Poison Hotline at 1-80G222-1222. Canada residents can call a provincial poison control center.

NOTES: Do not share this msdicatioh with others. This medication has been prescnb€d tor your current condition only. Do not use itlater for another infection unless told to do so by your doctor. A different medication may be necessary in those cases. Laboratoryahd/or medical t6sts (e.9., kidn€y function, blood counts, cultures) should b€ p€rformed p€riodically to monitor your progress orcheck for side effects. Consult your doctor for more details.

MISSED DOSE: lf you miss a dose, take it as soon as you rem6mbsr. lf it is near the time of the hext dose, skip the missed dose

and resume your usual dosing schedule. Do not double the dose to catch up.

Call tlour doctor tor medicaladvlce about slde eF6cts. You nray report side effect3 to FDA at l-800-FD41088.Pationt lnformation for: CIPROFLOXACIN HCL30 x 500ltlc T a

yorirk d 4a66 G q., hhftd ni c) ciFdd*ih.y q6.rc6db6rd

heart problems (heart failure, slow heartbeat, QT prolongataon in the EKG), family history of cortain heart problems (QT prolongationin the EKG, sudden cardiac death). Low levels of potassium or magnesium in the blood may also increase your risk of QTprolongation. This risk may increase if you use csrtain drugs (such as diuretics/"Mter pills") or it you hav6 conditions such assevere sreating, diarrhea, or vomiting. Talk to your doctor about using ciprofloxacin safely. This medication may mrely causeseriols changes in blood sugar levels, especially if you have diab€tes. VVatch for symptoms of high blood sugar including increased

Econc6rdd(38 ..pndcm.),dtryd hmF.chekyourd n yd dFi{ca trn*mr d @

/tendon pain or srelling honey, or candy, or drink fruit juice or hon-diet soda. Tell your doctor immediately about the reaction and the use of this product. To

help prev ent low blood sugar, eat meals on a regular schedule, and do not skip meals. This drug may make y ou dizy. Oo not driv e,

beverages. This medicatioh may make you mor6 sensitiv6 to the sun. Avoid prolonged sun exposure, tanning booths, and sunlampsUse a sunscre6n and war prot€ctive clothing when outdoors. Caution is adv ised v"hen using this drug in children because they maybe more sensitive to its possible side sff€cts (e.9., joint/tendon problems). Discuss the risks and benefits with tho doctor. Kjdney

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57064 SPECIAL DUO.WEB STVLE F

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convenience. If you would like to participate in this program, please ask yourdoctor or our staff for more information.

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RIGHT HERE.In many cases you may purchase your prescription medications here at ouroffice rather than making an extra

trip to the pharmacy. The medication youpurchase here is in full compliance with

FDA regulations for your safety andconvenience. If you would like to participate

in this program, please ask yourdoctor or our staff for more information.

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right here, right now. Ask how.Get your prescribed medication

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In many cases you may purchase your prescription medication here at ouroffice rather than making an extra trip to the pharmacy. The medication youpurchase here is in full compliance with FDA regulations for your safety and

convienience. If you would like to participate in this program, please ask yourdoctor or our staff for more information.

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