Medical prescription Totally Explained

Everything about Medical Prescription totally explained

A prescription (℞) is a health-care program implemented by a physician or other qualified healthcare practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist. Prescriptions are often written, though they may be typed into a computerized physician order entry system or issued verbally to the patient, a nurse, a pharmacist or other therapist. Prescriptions have legal implications, as they may indicate that the prescriber takes responsibility for the clinical care of the patient and in particular for monitoring efficacy and safety.

Format and definition

Prescriptions are either entered into a Computerized Physician Order Entry system, handwritten on preprinted prescription forms that are assembled into pads, or alternatively printed onto similar forms using a computer printer. Preprinted on the form is text that identifies the document as a prescription, the name and address of the prescribing provider and any other legal requirement such as a registration number (for example DEA Number in the United States). Unique for each prescription is the name of the patient. In the United Kingdom the patient's name and address must also be recorded. Each prescription is dated and some jurisdictions may place a time limit on the prescription(External Link

). There is the specific "recipe" of the medication and the directions for taking it. Finally there's the doctor's signature.
The symbol "R_x" meaning "prescription" is a transliteration of a symbol resembling a capital R with a cross on the diagonal (℞).
There are various theories about the origin of this symbol - some note its similarity to the Eye of Horus, others to the ancient symbol for Jupiter, both gods whose protection may have been sought in medical contexts. Alternatively, it may be intended as an abbreviation of the Latin "recipe", the imperative form of "recipere", "to take"(External Link

), and it's quite possible that more than one of these factors influenced its form. Literally, "Recipe" means simply "Take...." and when a doctor writes a prescription beginning with "Rx", he or she's completing the command. This was probably originally directed at the pharmacist who needed to take a certain amount of each ingredient to compound the medicine, rather than at the patient who must "take" the medicine, in the sense of consuming it.
The word "prescription" can be decomposed into "pre" and "script" and literally means, "to write before" a drug can be prepared. Those within the industry will often call prescriptions simply "scripts".

Contents of the prescription

Both pharmacists and prescribers are regulated professions in most jurisdictions. A prescription as a communications mechanism between them is also regulated and is a legal document. Regulations may define what constitutes a prescription, the contents and format of the prescription (including the size of the piece of paper - see Exhibit C paragraph 10) and how prescriptions are handled and stored by the pharmacist. Many jurisdictions will now allow faxed or phone prescriptions containing the same information. Exhibit A below illustrates the legal definition of a prescription. Many brand name drugs have less expensive generic drug substitutes that are therapeutically equivalent. Prescriptions will also contain instructions on whether the prescriber will allow the pharmacist to substitute a generic version of the drug. This instruction is communicated in a number of ways. In some jurisdictions, the preprinted prescription contains two signature lines: one line has "dispense as written" printed underneath; the other line has "substitution permitted" underneath. Some have a preprinted box "dispense as written" for the prescriber to check off (but this is easily checked off by anyone with access to the prescription). Other jurisdictions the protocol is for the prescriber to handwrite one of the following phrases: "dispense as written", "DAW", "brand necessary", "do not substitute", "no substitution", "medically necessary", "do not interchange"(External Link

).
As a guideline, pediatric prescriptions should include the age of the child if the patient is less than twelve and the age and months if less than five. (In general, including the age on the prescription is helpful.) In some jurisdictions, it may be a legal requirement to include the age of child on the prescription (External Link

). Adding the weight of the child is also helpful.
Prescriptions often have a "label" box (External Link

). When checked, pharmacist is instructed to label the medication. When not checked, the patient only receives instructions for taking the medication and no information about the prescription itself.
   Some prescribers further inform the patient and pharmacist by providing the indicator for the medication; for example what is being treated. This assists the pharmacist in checking for errors as many common medications can be used for multiple medical conditions.
   Some prescriptions will specify whether and how many "repeats" or "refills" are allowed; that's whether the patient may obtain more of the same medication without getting a new prescription from the doctor. Regulations may restrict some types of drugs from being refilled.
   In group practices, the preprinted portion of the prescription may contain multiple prescribers' names. Prescribers typically circle themselves to indicate who is prescribing or there may be a checkbox next to their name.

Handling of the prescription

When filled by a pharmacist, as a matter of business practice, the pharmacist may write certain information right on the prescription. This may also be mandated by legislation (see Exhibit D). Information such as the actual manufacturer of the drug and the date the medication was dispensed may be written right onto the prescription. Legislation may require the pharmacist sign the prescription. In computerized pharmacies, all such information is printed and stapled to the prescription. Sometimes such information is printed onto labels and the labels affixed right onto the prescription.
   When filled by the pharmacist, prescriptions are typically assigned a "prescription number" (often abbreviated "Rx#" in the US) that's unique to the pharmacy that filled the prescription. The prescription number is written right on the prescription by the pharmacist. The prescription number has the practical purpose of uniquely identifying the prescription later on while filed (both manual and electronic). The prescription number is also put on the label on the dispensed medication. The patient may be required to reference the prescription number for refills and drug insurance claims. There may also be a legal requirement for prescription numbers for subsequent identification purposes.
   As a legal document, some jurisdictions will mandate the archiving of the original paper prescription in the pharmacy. Often the patient can't take the original prescription with them. Some jurisdictions may entitle patients to a copy. The retention period varies but can be as long as six years. See Exhibit B for sample legislation governing the archiving of prescriptions. Once the retention period has passed, privacy legislation may dictate what can be done with the original paper prescription. Legislation may also dictate what happens to the prescriptions if the pharmacy closes or is sold. For example, if the pharmacy goes out of business, the pharmacist may be required to return the prescription to the patient, to the next closest pharmacy or to the governing body for pharmacists.
   Prescriptions for non-narcotic drugs may also be "transferred" from one pharmacy to another for subsequent repeats to be dispensed from another pharmacy. The physical piece of paper that's the prescription isn't transferred, but all the information on it's transferred from one pharmacy to another. Legislation may dictate the protocol by which the transfer occurs and whether the transfer needs to be noted on the original paper prescription.
   It is estimated that 3 billion (3 thousand million) prescriptions were written in the United States in 2002(External Link

)(External Link

). This number has grown from 1.5 billion in 1989 and is expected to continue to grow.

Forgeries, thefts and prevention

Prescriptions are sometimes forged because many narcotics are cheaper and safer as prescription drugs than as street drugs. Forgery takes many forms: Prescription pads are sometimes stolen, amounts may be altered on legitimate prescriptions, call back numbers may be falsified and phoned or faxed prescriptions faked(External Link

).
Some doctors will use prescription pads that contain similar security measures as checks to make photocopying prescriptions harder. These security measures may be mandated by law—see Exhibit C for sample legal specifications. Legislation may mandate that only certain printers may print prescriptions(External Link

). New Jersey, for example, requires that only state approved printers may be used to print official "New Jersey Prescription Blanks."(External Link

) (See Exhibit E.) Prescribers can make it harder for amount forgeries by writing out the amounts in words. Again, this may be mandated by law(External Link

). Some jurisdictions help control stolen prescriptions by requiring special "triplicate prescriptions" for certain classes of drugs (External Link

). Blank triplicates are only available from the regulating agency and are individually numbered. The doctor retains a copy, the second and third copies are given to the patient to give to the pharmacist. The pharmacist retains the second copy and the third copy is submitted to the regulating agency. The regulating agency can issue lists of stolen prescriptions that pharmacists can check. In this example, the prescription's validity is further limited to 72 hours from issuance. This system also has the further benefit of managing "double doctoring" where patients visit multiple doctors to get prescriptions. California has recently replaced tripicate forms with new forms that are impossible to photocopy or fax: the background is printed with repetitions of the word void in a color that shows up as black on a photocopy.
States have various laws making theft of prescription blanks or forgery of prescriptions criminal offenses and/or providing special treatment for these offenses (for Example N.J. Stat. 2C:21-1. making forgery of a prescription blank a third degree rather than fourth degree offense).(External Link

) � 45:14-55 Use of New Jersey Prescription Blanks.

� 16. a. A practitioner practicing in this State shall use non-reproducible, non-erasable safety paper New Jersey Prescription Blanks bearing that practitioner's license number whenever the practitioner issues prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety.

� b. A licensed practitioner practicing in this State shall maintain a record of the receipt of New Jersey Prescription Blanks. The practitioner shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey Prescription Blank in the practitioner's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action, including notification to the Department of Human Services and the Attorney General.

� 45:14-56 Health care facility prescriptions.

� 17. a. Prescriptions issued by a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) shall be written on non-reproducible, non-erasable safety paper New Jersey Prescription Blanks. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety. The New Jersey Prescription Blanks shall bear the unique provider number assigned to that health care facility for the issuing of prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items.

� b. A health care facility shall maintain a record of the receipt of New Jersey Prescription Blanks. The health care facility shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey Prescription Blank in the facility's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action including notification to the Department of Human Services and the Attorney General.

� 45:14-57 Requirements for prescription to be filled.

� 18.A prescription issued by a practitioner or health care facility licensed in New Jersey shan't be filled by a pharmacist unless the prescription is issued on a New Jersey Prescription Blank bearing the practitioner's license number or the unique provider number assigned to a health care facility.

� 45:14-59 Format for New Jersey Prescription Blanks.

� 20.The Division of Consumer Affairs in the Department of Law and Public Safety shall establish the format for uniform, non-reproducible, non-erasable safety paper prescription blanks, to be known as New Jersey Prescription Blanks, which format shall include an identifiable logo or symbol that will appear on all prescription blanks. The division shall approve a sufficient number of vendors to ensure production of an adequate supply of New Jersey Prescription Blanks for practitioners and health care facilities statewide.

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