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J \n3 For Use \n. - - e 50 807000900 \nDOSE ROUTE |DATE O} DATE: \nT \ne - \no. \nO \nSIGNATURE OF PRESCRIBER INITIALS: \n) = \nADDITIONAL INSTRUCTIONS \/ COMMENTS \/ PHARMACY \n~\u00abtg\u2014\u2014\u2014\u2014\u2014\u2014 FOR PRESCRIBERS USE ONLY \u2014\u2014\u2014\u2014\u2014\u2014\u2014=\u00bb- . . . \nNote: To dis\u00e9ontinue_a prescription, initial and date appr'opriate boxes and draw a diagdna] line through 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