Amendment 0001_Attachment 3_Prescription Pad.pdf

This is an image of a prescription form (Rx) from the Department of Health & Human Services, USPHS Indian Health Center located in Lame Deer, Montana. The form is a standard medical prescription pad used for documenting patient medications and treatment instructions. It contains fields for patient information including name, address, date of birth, age, and weight, along with spaces for the prescriber's signature and printed name. The form includes checkboxes for generic substitution options and a DEA number field for controlled substances. A notation at the bottom indicates that security features are listed on the back of the form. This is a medical administrative document unrelated to federal contract opportunities.