Medical prescription

A medical prescription (℞) is a written order by a medical doctor to a pharmacist for a treatment to be provided to the doctor's patient.

Format and definition

Prescriptions are typically 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 doctor and any other legal requirement such as a registration number (e.g. DEA Number in the United States). Unique for each prescription is the name of the patient, date (some jurisdictions may place a time limit on the prescriptionhttp://www.med.rug.nl/pharma/who-cc/ggp/chapter9/page01.htm), the "recipe" of the medication and the directions for taking it. Finally there is the doctor's signature.

Related Topics:
Computer printer - DEA Number

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The symbol "Rx" meaning "prescription" is a transliteration of a symbol resembling a capital R with a cross on the diagonal ({{IPA|℞}}).

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There are various theories as to 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 recipere, "to take" http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=recipe, and it is quite possible that more than one of these factors influenced its form. Literally, "Rx" indicates an instruction "to take" what is specified in the prescription, although this was probably originally directed at the pharmacist who needed to take a certain amount of each drug and prepare them, rather than at the patient who must take the medicine, in the sense of consuming it.

Related Topics:
Horus - Jupiter - Latin

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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".

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Contents of the prescription

Both pharmacists and physicians are regulated professions in most jurisdictions. A prescription as a communications mechanism between them is also regulated and is a legal document. Legislation 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.

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Many brand name drugs have less expensive generic drug substitutes that are chemically equivalent. Prescriptions will also contain instructions on whether the doctor 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 doctor to check off (but this is easily checked off by anyone with access to the prescription). Other jurisdictions the protocol is for the doctor to handwrite one of the following phrases: "dispense as written", "DAW", "brand necessary", "do not substitute", "no substitution", "medically necessary", "do not interchange"http://www.alesse.com/pdf/prescribe.pdf.

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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 http://bnf.org/bnf/bnf/current/doc/29440.htm. Adding the weight of the child is also helpful.

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Prescriptions often have a "label" box http://www.sh.lsuhsc.edu/fammed/OutpatientManual/PrescripWriting-PDR.htm. 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.

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Some doctors further inform the patient and pharmacist by providing the indicator for the medication; i.e. what is being treated. This assists the pharmacist in checking for errors as many common medications can be used for multiple medical conditions.

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Some prescriptions will specify whether and how many "repeats" or "refills" are allowed; that is whether the patient may obtain more of the same medication without getting a new prescription from the doctor. Legislation may restrict some categories of drugs from being refilled.

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In group practices, the preprinted portion of the prescription may contain multiple doctors' names. Doctors typically circle themselves to indicate who is prescribing or there may be a checkbox next to their name.

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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.

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When filled by the pharmacist, prescriptions are typically assigned a "prescription number" (often abbreviated "Rx#") that is 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.

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As a legal document, some jurisdictions will mandate the archiving of the original paper prescription in the pharmacy. Very rarely can the patient 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.

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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 is the prescription is not transferred, but all the information on it is 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.

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It is estimated that 3 billion (3 thousand million) prescriptions were written in the United States in 2002http://www.usaweekend.com/02_issues/021201/021201healthsmart.htmlhttp://www.psychiatrictimes.com/massmedia.html. This number has grown from 1.5 billion in 1989 and is expected to continue to grow.

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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: Doctor's prescription pads are sometimes stolen by drug addicts, amounts may be altered on legitimate prescriptions, call back numbers may be falsified and phoned or faxed prescriptions fakedhttp://www.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm.

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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 prescriptionshttp://www.in.gov/hpb/boards/isbp/pad.html. New Jersey, for example, requires that only state approved printers may be used to print official "New Jersey Prescription Blanks."http://www.state.nj.us/lps/ca/njpb.htm (See Exhibit E.) Prescribers can make it harder for amount forgeries by writing out the amounts in words. Again, this may be mandated by lawhttp://www.cpsa.ab.ca/collegeprograms/attachments_tpp/tpp%20information%20for%20prescriber.doc.

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Some jurisdictions help control stolen prescriptions by requiring special "triplicate prescriptions" for certain classes of drugs http://www.cpsa.ab.ca/collegeprograms/attachments_tpp/tpp%20information%20for%20prescriber.doc. 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.

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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).http://lis.njleg.state.nj.us/cgi-bin/om_isapi.dll?clientID=35399066&Depth=2&TD=WRAP&advquery=prescription%20blank&depth=4&expandheadings=on&headingswithhits=on&hitsperheading=on&infobase=statutes.nfo&rank=&record={151F}&softpage=Document42&wordsaroundhits=2&zz=

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When forgery is suspected, pharmacists will call the doctor to verify the prescription and will attempt to detain the suspect pending arrival of authorities. Forged prescriptions are no longer considered medical documents and doctor-patient confidentiality rules no longer apply.

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