Medical prescription

A medical prescription (R_x) iswritten order bymedical doctor topharmacist fortreatmentbe provided todoctor's patient.

Tablecontents

1 FormatDefinition 1.1 Contents ofprescription 1.2 Handling ofprescription 1.3 Forgeries 2 Writing Prescriptions 2.4 Who can write prescriptions 2.5 Legibilityprescriptions 2.6 Writing good prescriptions 2.7 Abbreviations 3 Non prescription drug prescriptions 4 Related Usage ofTerm "Prescription" 5 History 6 Future directionsprescriptions 7 Appendix 1: Complete ListAbbreviations 8 Exhibit A: Sample Legal Definition ofPrescription 9 Exhibit B: Sample Legal RequirementFilingPrescriptions 10 Exhibit C: Sample Legal RequirementsSecurityFormat 11 Exhibit D: Sample Requirements on Information Added byPharmacist

FormatDefinition

Prescriptionstypically written on preprinted prescription forms thatassembled into pads. Preprinted onformtext that identifiesdocument asprescription,nameaddress ofprescribing doctorany other legal requirement such asregistration number (e.g. DEA Number inUnited States). Uniqueeach prescription isname ofpatient, date (some jurisdictions may placetime limit onprescription[1]),"recipe" ofmedication anddirectionstaking it. Finally there isdoctor's signature.

The symbol "R_x" means "prescription"is derived fromabbreviation "rx" [1] fromLatin word "to take", recipere[1]. Literally, "Rx"an instruction topatient, "to take" whatspecified inprescription. The word "prescription" can be decomposed into "pre""script"literally means, "to write before"drug can be prepared. Those withinindustry will often call prescriptions simply "scripts".

Contents ofprescription

Both pharmacistsphysiciansregulated professionsmost jurisdictions. A prescription ascommunications mechanism between themalso regulatedislegal document. Legislation may define what constitutesprescription,contentsformat ofprescription (includingsize ofpiecepaper - see Exhibit C paragraph 10)how prescriptionshandledstored bypharmacist. Many jurisdictions will now allow faxed or phone prescriptions containingsame information. Exhibit A below illustrateslegal definition ofprescription.

Many brand name drugs have less expense generic drug substitutes thatchemically equivalent. Prescriptions will also contain instructions on whetherdoctor will allowpharmacistsubstitutegeneric version ofdrug. This instructioncommunicated innumberways. In some jurisdictions,preprinted prescription contains two signature lines: one line has "dispense as written" printed underneath;other line has "subsitution permitted" underneath. Some havepreprinted box "dispense as written" fordoctorcheck off (but thiseasily checked off by anyoneaccess toprescription). Other jurisdictionsprotocolfordoctorhandwrite one offollowing phrases: "dispense as written", "DAW", "brand necessary", "do not substitute", "no substitution", "medically necessary", "do not interchange"[1].

Asguideline, pediatric prescriptions should includeage ofchild ifpatientless than twelve andagemonths if less than five. (In general, includingage onprescriptionhelpful.) In some jurisdictions,may belegal requirementincludeage child onprescription [1]. Addingweight ofchildalso helpful.

Prescriptions often have"label" box [1]. When checked, pharmacistinstructedlabelmedication. When not checked,patient only receives instructionstakingmedicationno information aboutprescription itself.

Some doctors further informpatientpharmacist by providingindicator formedication; i.e. whatbeing treated. This assistspharmacistcheckingerrors as many common medications can be usedmultiple medical conditions.

Some prescriptions will specify whetherhow many "repeats" or "refills"allowed; thatwhetherpatient may obtain more ofsame medication without gettingnew prescription fromdoctor. Legislation may restrict some categoriesdrugs from being refilled.

In group practices,preprinted portion ofprescription may contain multiple doctors' names. Doctors typically circle themselvesindicate whoprescribing or there may becheckbox nexttheir name.

Handling ofprescription

When filled bypharmacist, asmatterbusiness practice,pharmacist may write certain information right onprescription. This may also be mandated by legislation (see Exhibit D). Information such asactual manufacturer ofdrug anddatemedication was dispensed may be written right ontoprescription. Legislation may requirepharmacist signprescription. In computerized pharmacies, all such informationprintedstapled toprescription. Sometimes such informationprinted onto labels andlabels affixed right ontoprescription.

When filled bypharmacist, prescriptionstypically assigned"prescription number" (often abbreviated "Rx#") thatunique topharmacy that filledprescription. The prescription numberwritten right onprescription bypharmacist. The prescription number haspractical purposeuniquely identifyingprescription later on while filed (both manualelectronic). The prescription numberalso put onlabel ondispensed medication. The patient may be requiredreferenceprescription numberrefillsdrug insurance claims. There may also belegal requirementprescription numberssubsequent identification purposes.

Aslegal document, some jurisdictions will mandatearchiving oforiginal paper prescription inpharmacy. Very rarely canpatient takeoriginal prescriptionthem. The retention period varies but can be asas six years. See Exhibit Bsample legislation governingarchivingprescriptions. Onceretention period has passed, privacy legislation may dictate what can be done withoriginal paper prescription. Legislation may also dictate what happens toprescriptions ifpharmacy closes orsold.

Prescriptionsnon-narcotic drugs may also be "transferred" from one pharmacyanothersubsequent repeatsbe dispensed from another pharmacy. The physical piecepaper that isprescriptionnot transferred, but allinformation on ittransferred from one pharmacyanother. Legislation may dictateprotocol by whichtransfer occurswhethertransfer needsbe noted onoriginal paper prescription.

Itestimated that 3 billion (3 thousand million) prescriptions were written inUnited States2002class="external">[1. This number has grown from 1.5 billion1989is expectedcontinuegrow.

Forgeries

Prescriptionssometimes forged because many narcoticscheapersafer as prescription drugs than as street drugs. Forgery takes many forms: Doctor's prescription padssometimes stolen by drug addicts, amounts may be altered on legitimate prescriptions, call back numbers may be falsifiedphoned or faxed prescriptions faked[1].

Some doctors will use prescription pads that contain similar security measures as checksmake photocopying prescriptions harder. These security measures may be mandated by law - see Exhibit Csample legal specifications. Prescribers can makeharderamount forgeries by writing outamountswords. Again, this may be mandated by law[1].

Some jurisdictions help control stolen prescriptions by requiring special "triplicate prescriptions"certain classesdrugs[1]. Blank triplicatesonly available fromregulating agency andindividually numbered. The doctor retainscopy,secondthird copiesgiven topatientgive topharmacist. The pharmacist retainssecond copy andthird copysubmitted toregulating agency. The regulating agency can issue listsstolen prescriptions that pharmacists can check. In this example,prescription's validityfurther limited72 hours from issuance. This system also hasfurther benefitmanaging "double doctoring" where patients visit multiple doctorsget prescriptions.

When forgerysuspected, pharmacists will calldoctorverifyprescriptionwill attemptdetainsuspect pending arrivalauthorities. Forged prescriptionsno longer considered medical documentsdoctor-patient confidentiality rules no longer applies.

Writing Prescriptions

Who can write prescriptions

Who can issue prescriptionsgoverned by local legislation. Some examples are: veterinarians, dentists, some nurse practictioners. Ophthalmologists will also issue prescriptionscorrective eyeglasses, though technically thesenot medical prescriptions.

Legibilityprescriptions

Prescriptions, when handwritten,notoriousbeing often illegible (5% accordingan Irish study [1]). Contrarypopular belief, pharmacists do not have special deciphering skills. Whendoubt,calldoctor. At other times, even though some ofindividual lettersillegible,position oflegible letterslength ofwordsufficientdistinguishmedication based onknowledge ofpharmacist. For doctors thatpharmacist dealsregularly,learnreaddoctor's handwriting. Patientsadvisedensure thatprescriptionlegible before leavingdoctor's office. Some jurisdictions have made legible prescriptionslaw (e.g. Florida[1]). Some have advocatedeliminationhandwritten prescriptions altogether[1].

Writing good prescriptions

Independent ofactual prescribing decision, elements ofgood prescription writing include: [1] [1] [1]

• careful usedecimal pointsavoid ambiguity:
  • avoid unneccessary decimal points: 5 mL instead5.0 mLavoid possible misinterpretation5.0=50
  • alway zero prefix decimals: e.g. 0.5 instead.5avoid misinterpretation.5=5
  • never have trailing zeros on decimals: e.g. use 0.5 instead.50avoid misinterpretation.50=50
  • avoid decimals altogether by changingunits: 0.5 g =500 mg
• "mL"used instead"cc" or "cm³" even though theytechnical equivalent
• directions should be written outfullEnglish although some common Latin abbreviationslisted below
• quantities can be given directly or implied byfrequency & duration ofdirections
• wheredirections"as needed"quantity should always be specified
• where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather than simply frequency (3 timesday)especially relationshipmealsorally consumed medication
• use permanent ink
• avoid prn "as needed" - limits & indicators should be specified e.g. "q 3h prn pain"
• for refills - minimum duration between repeats & numberrepeats should be specified

Abbreviations

See Appendix 1 forcomplete listcommon abbreviations found on prescriptions. Many abbreviationsderived from Latin phrases. Hospital pharmacies have more abbreviations, some specific tohospital. Different jurisdictions follow different conventions on whatabbreviated or not. Prescriptions that don't follow area conventions may be flagged as possible forgeries.

To avoid ambiguity,following abbreviationsnot recommended [1]:

• a.u., a.d., a.s. - latinboth, leftright ears;"a" can be misreadbe an "o"interpretedmean both, right or left eyes
• d/c - can mean "discontinue" or "discharge"
• h.s. - can mean half strength or "hoursleep"
• q.d. - meant "every day" but"." after"q"interpretedbe an "i" thus "q.i.d." or quadruplingdose4 timesday
• q.o.d. - meant "every other day" but"o" can be interpreted as "." or "i" resultingdouble or eight timesfrequency
• SC/SQ - meant "subcutaneaous" but mistaken"SL""sublingual"
• T.I.W - meant 3 timesweek but mistakentwiceweek
• U - meant "units" but mistaken"0", "4" or "cc" when poorly written; conversely cc can be mistaken"U"
• μg - meant "microgram" but mistaken"mg"

Non prescription drug prescriptions

Prescriptionsalso usedthings thatnot strictly regulated asprescription drug. Doctors will often give non-prescription drugs out as prescriptions because drug benefit plans may reimbursepatient only ifover-the-counter medicationtaken underdirection ofdoctor. Conversely, ifmedicationavailable over-the-counter, doctors may ask patients ifwantasprescriptionpossibly incurpharmacist's dispensing fee or whetherwantgetthemselves atlower price. Ifpatient wantsmedication not under prescription,doctorusually carefulgivemediation name topatient onblank piecepaperavoid any confusion withprescription. Thisappliednon-medications as well. For example, crutches,registered massage therapy may be reimbursed under some health plans, but only if given out bydoctor asprescription.

Doctors will often use blank prescriptions as general letterhead. A "doctor's note"absent days from school or workminor illnesses will often be written onblank prescription.

Legislation may define certain equipment as "prescription devices"[1]. Such prescription devices can only be used undersupervisionauthorized personnelsuch authorizationtypically documented usingprescription. Examplesprescription devices include dental cement (for affixing bracestooth surfaces), various prothesis, gut sutures, sickle cell tests, cervical capultrasound monitor.

In some jurisdictions, hypodermic syringesinspecial classits own, regulated as illicit drug use accessories[1] separate from regular medical legislation. Such legislation will often specify prescription asmean by which one may legally possess syringes.

Related Usage ofTerm "Prescription"

Prescription may also be used asshort formprescription drugsdistinguish from over-the-counter drugs. It may also be usedreference toentire systemcontrolling drug distribution (as opposedillicit drugs).

History

The conceptprescriptions date back tobeginninghistory. Soas there were medications andwriting systemcapture directionspreparation usage, there were prescriptions class="external">[1.

Modern prescriptionsactually "extemporaneous prescriptions" fromLatin (ex tempore)"instant"[1]. "Extemporaneous" meansprescriptionwritten onspot forspecific patient withspecific ailment. Thisdistinguished froma non-extemporaneous prescription which isgeneric recipe forgeneral ailment. Modern prescriptions evolved withseparation ofrole ofpharmacists from that ofphysician[1]. Todayterm "extemporaneous prescriptions"reserved"compound prescriptions" which requirespharmacistmix or "compound"medication inpharmacy forspecific needs ofpatient.

Predating modern legal definitions ofprescription,prescription traditionallycomposedfour parts: "superscription", "inscription", "subscription""signature"[1].

The superscription section containsdate ofprescriptionpatient information (name, address, age, etc). The symbol "Rx" separatessuperscription frominscriptions sections. In this arrangement ofprescription,"Rx"literally an abberviationan exhortation topatient"take thou" whatdescribed ininscription section.

The inscription section defines what ismedication. The inscription sectionfurther composedone or more of[1]:

• "basis" or chief ingredient indendedcure (curare)
• an "adjuvant"assist its actionmakecure quickly (cito)
• "corrective"prevent or lessen any undesirable effect (tuto)
• "vehicle" or "excipient"makesuitableadministrationpleasant topatient (jucunde)

The "subscription" section contains dispensing directions topharmacist. This may be compounding instructions or quantities.

The "signature" section contains directions topatient[1] is often abbreviated "Sig."[1]. It also obviously containssignature ofprescribing doctor thoughword "signature" has two distinct meanings here.

Thus sample prescriptionsmodern textbooksoften presented as:

Rx:  medication
Disp.:  dispensing instructions
Sig.: patient instructions

Future directionsprescriptions

Asprescriptionnothing more than information amongdoctor, pharmacistpatient, information technology can be appliedit. Existing information technologyadequateprint out prescriptions. Medical information systemssome hospitals do awayprescriptions withinhospital. Thereproposalssecurely transmitprescription fromdoctor topharmacist using smart cards andinternet[1].

Within computerized pharmacies,information onpiecepaper that isprescriptioncaptured immediately. Thereafter,prescriptionsimply an entry withinpharmacy's information system andpaper prescriptionstoredlegal reasons only.

Pharmacy information systems arepotential sourcevaluable informationpharmaceutical companies ascontains information about doctor's prescribing habits. Prescription data miningsuch data isdeveloping, specialized field[1].

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Appendix 1: Complete ListAbbreviations

This appendixmeantbecomplete listall abbreviations usedprescriptions. Its listing here does not mean such abbreviations should be used. See main articlediscussion onuseabbreviations. This listing does not include abbreviationsactual pharmaceuticals (which isseparate articleitself.) Capitalization anduse ofperiod ismatterstyle. Inattached list, Latinnot capitalized whereas English acronyms are. The periodused wherever thereletters omitted inabbreviation.

• aa (ana) -each
• ad - to, up to
• a.c. (ante cibium) - before meals
• a.d. (aurio dextra) - right ear
• ad lib. (ad libitum) - use as much as one desires; freely
• admov. (admove) - apply
• agit (agita) - stir/shake
• alt. h. (alternis horis) - every other hour
• a.m. (ante meridian) - morning, before noon
• amp - ampule
• amt - amount
• aq (aqua) - water
• a.l., a.s. (aurio laeva, aurio sinister) - left ear
• A.T.C. - aroundclock
• a.u. (auris utrae) - both ears
• bis (bis) - twice
• b.i.d. (bisdie) - twice daily
• B.M. - bowel movement
• bol. (bolus) -large pill
• B.S. - blood sugar
• B.S.A - body surface areas
• cap., caps. (capsula) - capsule
• c (cum) -(usually written withbar on top of"c")
• c (cibos) - food
• cc - cubic centimetre; also means "with food" (cum cibos)
• cf -food
• C.H.F. - congestive heart failure
• comp. - compound
• cr., crm - cream
• D5W - dextrose 5% solution (sometimes written as D₅W)
• D5NS - dextrose 5%normal saline (0.9%)
• D.A.W. - dispense as written
• dc, D/C, disc - discontinue
• dieb. alt. (diebus alternis) - every other day
• dil. - dilute
• disp. - dispense
• div. - divide
• d.t.d. (dentur tales doses) - givesuch doses
• D.W. - distilled water
• elix. - elixir
• e.m.p. (ex modo prescripto) - as directed
• emuls. (emulsum) - emulsion
• et - and
• ex aq -water
• fl., fld. - fluid
• ft. (fiat) - make; letbe made
• g - gram
• G.I. - gastrointestinal
• gr - grain
• gtt(s) (gutta(e)) - drop(s)
• G.U. - gentiourinary
• H - hypodermic
• h, hr - hour
• H.A. - headache
• H.B.P. - high blood pressure
• h.s. (hora somni) - at bedtime
• HTN - hypertension
• ID - intradermal
• IM - intramuscular (with respectinjections)
• inj. (injectio) - injection
• IP - intraperitoneal
• IV - intravenous
  • IVP - intravenous push
  • IVPB - intravenous piggyback
• '''L.A.S."' - label as such
• LCD - coal tar solution
• lin (linimentum) - liniment
• liq (liquor) - solution
• lot. - lotion
• M. (misce) - mix
• m, min (mininum) -minimum
• mcg - microgram
• mEq - milliequivalent
• mg - milligram
• mist. (mistura) - mix
• mitte (mitte) - send
• mL - millilitre
• N&V, N/V - nauseavomitting
• nebul (nebula) -spray
• N.K.A. - no known allergies
• N.K.D.A. - no known drug allergies
• N.M.T. - not more than
• noct. (nocte) - at night
• non rep. (non repetatur) - no repeats
• NPO, n.p.o. (non per os) - nothing by mouth
• NS - normal saline (0.9%)
• 1/2NS - half normal saline (0.45%)
• N.T.E. - notexceed
• o_2 - both eyes, sometimes written as o₂
• o.d. (oculus dexter) - right eye
• o.s. (oculus sinister) - left eye
• o.u. (oculo utro) - both eyes
• oz - ounce
• per - by or through
• p.c. (post cibium) - after meals
• p.m. (post meridian) - evening or afternoon
• prn (pro re nata) - as needed
• p.o. (per os) - by mouth or orally
• p.r. - by rectum
• pulv. (pulvis) - powder
• q (quaque) - every
• q.a.d. ("quoque alternis die'') - every other day
• q.h. (quaque hora) - every hour
• q.1h (quaque 1 hora) - every 1 hour; (can replace "1"other numbers)
• q.d. (quaque die) - every day
• q.i.d. (quaterdie) - four timesday
• q.o.d. - every other day
• q.s. (quantum sufficiat) -sufficient quantity
• R- rectal
• rep., rept. (repetatur) - repeats
• RL, R/L - Ringer's lactate
• s (sine) - without (usually written withbar on top of"s")
• s.a. (secundum artum) - use your judgement
• SC, subc, subq, subcut - subcutaneous
• sig - write on label
• SL - sublingually, undertongue
• S.O.B. - shortnessbreath
• sol (solutio) - solution
• s.o.s., si op. sit (si opus sit) - if there isneed
• ss (semis) - one half
• stat (statum) - immediately
• supp (suppositorium) - suppository
• susp - supsension
• syr (syrupus) - syrup
• tab (tabella) - tablet
• tal., t (talus) - such
• tbsp - tablespoon
• troche (trochiscus) - lozenge
• tsp - teaspoon
• t.i.d. (terdie) - three timesday
• t.i.w. - three timesweek
• top. - topical
• T.P.N. - total parenteral nutrition
• tr, tinc., tinct. - tincture
• u.d., ut. dict. (ut dictum) - as directed
• ung. (unguentum) - ointment
• U.R.I. - upper respitory infection
• U.S.P. - United States Pharmacopeia
• U.T.I. - urinary tract infection
• vag - vaginally
• V.S. - vital signs
• w - with
• W.B.C. - white blood count
• w/o - without
• X - times
• Y.O. - years old

Exhibit A: Sample Legal Definition ofPrescription

Taken from California's BusinessProfessions Code Section 4040 [1]:

4040. (a) "Prescription" means an oral, written, or electronic transmission order thatboth offollowing:

(1) Given individually forperson or personswhom ordered that includes all offollowing:

(A) The name or namesaddress ofpatient or patients.

(B) The namequantity ofdrug or device prescribed anddirectionsuse.

(C) The dateissue.

(D) Either rubber stamped, typed, or printed by hand or typeset,name, address,telephone number ofprescriber, his or her license classification,his or her federal registry number, ifcontrolled substanceprescribed.

(E) A legible, clear notice ofconditionwhichdrugbeing prescribed, if requested bypatient or patients.

(F) Ifwriting, signed byprescriber issuingorder, orcertified nurse-midwife, nurse practitioner, or physician assistant who issuesdrug order pursuantSection 2746.51,2836.1, or 3502.1.

(2) Issued byphysician, dentist, optometrist, podiatrist, or veterinarian or, ifdrug orderissued pursuantSection 2746.51, 2836.1, or 3502.1, bycertified nurse-midwife, nurse practitioner, or physician assistant licensedthis state.

(b) Notwithstanding subdivision (a),written order ofprescriber fordangerous drug, exceptany Schedule II controlled substance, that contains at leastnamesignature ofprescriber,nameaddress ofpatient inmanner consistentparagraph (3)subdivision (b)Section 11164 ofHealthSafety Code,namequantity ofdrug prescribed, directionsuse, anddateissue may be treated asprescription bydispensing pharmacist asas any additional information required by subdivision (a)readily retrievable inpharmacy. Inevent ofconflict between this subdivisionSection 11164 ofHealthSafety Code, Section 11164 ofHealthSafety Code shall prevail.

(c) "Electronic transmission prescription" includes both imagedata prescriptions. "Electronic image transmission prescription" means any prescription orderwhichfacsimile oforderreceived bypharmacy fromlicensed prescriber. "Electronic data transmission prescription" means any prescription order, other than an electronic image transmission prescription, thatelectronically transmitted fromlicensed prescriber topharmacy.

(d) The usecommonly used abbreviations shall not invalidate an otherwise valid prescription.

(e) Nothing inamendments madethis section (formerly Section 4036) at1969 Regular Session ofLegislature shall be construed as expanding or limitingright thatchiropractor, while acting withinscopehis or her license, may haveprescribedevice.

Exhibit B: Sample Legal RequirementFilingPrescriptions

FromMississippi BoardPharmacy [1]:

ARTICLE XIII PRESCRIPTIONS TO BE FILED

1. All prescriptions shall be filedone offollowing ways:

A. Three separate files may be maintained;fileSchedule II prescriptions dispensed;fileSchedule III, IVV prescriptions dispensed; andfileall other prescriptions dispensed.

B. Two files may be maintained;fileall Schedule II prescriptions dispensedanother fileall other prescriptions dispensed, including thoseSchedule III, IVV. If this methodused,prescriptionsSchedule III, IVV substances must be stamped withletter "C"red ink, not less than one inch high, inlower right-hand corner. This distinctive marking makesrecords readily retrievableinspection. Pharmaciesautomatic data processing systemsexempted from marking Schedule III, IVV controlled substance prescriptions withred "C".

2. A hard copyoriginal prescriptions, whether recordsmaintained manually or indata processing system, shall be assignedserial numbermaintained bypharmacynumericalchronological order. All prescriptions shall be maintainedat least five years fromdateoriginal dispensing.

3. Ifpharmacy utilizesdata processing systemrecord keeping, all computer generated labels should be affixed toprescription documentsuchmanner as notobscure information onface ofdocument.

Exhibit C: Sample Legal RequirementsSecurityFormat

From Indiana BoardPharmacy [1]:

856 IAC 1-34-2 Security feature requirements

Authority: IC 35-48-7-8

Affected: IC 16-42-19-5

Sec. 2. (a) All controlled substance prescriptions written by licensed Indiana practitioners, as defined by IC 16-42-19-5, must containfollowing security features:

(1) A latent, repetitive "void" pattern screened at five percent (5%)reflex blue must appear acrossentire face ofdocument whenprescriptionphotocopied.

(2) There shall becustom artificial watermark printed onback side ofbase paper so thatmay only be seen atforty-five (45) degree angle. The watermark shall consist ofwords "Indiana Security Prescription", appearing horizontally instep-and-repeated formatfive (5) lines onback ofdocument using 12-point Helvetica bold type style.

(3) An opaque RX symbol must appear inupper right-hand corner, one-eighth (c)an inch fromtop ofpadfive-sixteenths ( 5 /16)an inch fromright side ofpad. The symbol must be three-fourths (3/4) inchsizemust disappear ifprescription copylightened.

(4) Six (6) quantity check-off boxes must be printed onform andfollowing quantities must appear andappropriate box be checked off forprescriptionbe valid:

(A) 1-24

(B) 25-49

(C) 50-74

(D) 75-100

(E) 101-150

(F) 151over.

(5) No advertisements may appear onfront or back ofprescription blank.

(6) Logos, defined assymbol utilized by an individual, professional practice, professional association, or hospital, may appear onprescription blank. The upper left one (1) inch square ofprescription blankreserved forpurposelogos. Only logos, as defined by this subdivision, may appear onprescription blank.

(7) Only one (1) prescription may be written per prescription blank. The following statement must be printed onbottom ofpad: "Prescriptionvoid if more than one (1) prescriptionwritten per blank.".

(8) Refill options that can be circled byprescriber must appear below any logosabovesignature lines onleft side ofprescription blank infollowing order: Refill NR 1 2 3 4 5 Void after_____.

(9) Practitioner namestate issued professional license number must be preprinted, stamped, or manually printed onprescription.

(10) All prescription blanks printed under this rule shall be fourone-fourth (4-1/4) inches highfiveone-half (5-1/2) inches wide.

(b) Nothingthis rule shall prevent licensed Indiana practitioners from utilizing security paper prescriptions forprescribingany legend drug. (Indiana BoardPharmacy; 856 IAC 1-34-2; filed Jul 5, 1995, 9:45 a.m.: 18 IR 2782, eff Jan 1, 1996)

Exhibit D: Sample Requirements on Information Added byPharmacist

Taken fromOntario's DrugPharmacies Regulation Act [1], paragraph 156.

(1) Every person who dispensesdrug pursuant toprescription shall ensure thatfollowing informationrecorded onprescription,

(a)nameaddress ofpersonwhomdrugprescribed;

(b)name, strength (where applicable)quantity ofprescribed drug;

(c)directionsuse, as prescribed;

(d)nameaddress ofprescriber;

(e)identity ofmanufacturer ofdrug dispensed;

(f) an identification number or other designation;

(g)signature ofperson dispensingdrug and, where different, alsosignature ofperson receivingverbal prescription;

(h)date on whichdrugdispensed;

(i)price charged. R.S.O. 1990, c. H.4, s. 156 (1).