Medical prescriptions

A prescription is a health-care programme implemented by a physician or other medical doctors 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. Commonly, the term prescription is used to mean an order to take certain medications. 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. As medications have increasingly become pre–packaged manufactured products and medical practice has become more complex, the scope of meaning of the term "prescription" has broadened to also include clinical assessments, laboratory tests, and imaging studies relevant to optimizing the safety or efficacy of medical treatment.

Format and definition
Prescriptions are handwritten on preprinted prescription forms that are assembled into pads, or alternatively printed onto similar forms using a computer printer or are in an electronic format. 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 (e.g. DEA Number in the United States). Unique for each prescription is the name of the patient. In the United Kingdom and Ireland, 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. There is the specific "recipe" of the medication and the directions for taking it.

 is a symbol meaning "prescription". It is sometimes transliterated as "Rx" or just "Rx". This symbol originated in medieval manuscripts as an abbreviation of the Late Latin verb recipe, the imperative form of recipere, "to take" or "take thus". Literally, the Latin word recipe means simply "Take...." and medieval prescriptions invariably began with the command to "take" certain materials and compound them in specified ways. Today, when a medical practitioner writes a prescription beginning with "", he or she is completing the command.

Folk theories about the origin of the symbol  note its similarity to the Eye of Horus, or to the ancient symbol for Zeus or Jupiter, (♃), gods whose protection may have been sought in medical contexts.

The word "prescription", from "pre-" ("before") and "script" ("writing, written"), refers to the fact that the prescription is an order that must be written down before a compound drug can be prepared. Those within the industry will often call prescriptions simply "scripts".

The fact that a prescription instructs someone to "take" rather than "give" is not a trivial distinction, but makes clear it is directed at the patient, and is not directly an instruction to anyone else. In certain states medical marijuana legislation has been drafted calling for a health care professional's written or oral "recommendation", in the belief that a written one would be legally distinguishable from a prescription, but since written advice to a patient is what a prescription is, that belief is mistaken. Jurisdictions may adopt a statutory definition of "prescription" which is applicable as a term of art only to the operation of that statute (see below about prescriptions that may legally be filled with prescription-only items), but the general legal definition of the word is this broad one.

Contents
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 cheaper generic drug substitutes that are therapeutically and biochemically 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". In other jurisdictions may they use completely different languages, never mind a different formula of words. In some jurisdictions, it may be a legal requirement to include the age of child on the prescription. For pediatric prescriptions some advise the inclusion of 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.) Adding the weight of the child is also helpful.

Prescriptions often have a "label" box. When checked, the 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; 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.

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 medical practitioner. 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
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 to 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 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.

As a legal document, some jurisdictions will mandate the archiving of the original paper prescription in the pharmacy. Often the patient cannot take the original prescription with them. Some jurisdictions may entitle patients to a copy. The retention period varies but can be as long as ten years (requirement of all prescriptions billed to a Medicare Part D plan.) 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 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.

It is estimated that three billion prescriptions were written in the United States in 2002. This number grew from 1.5 billion in 1989 and is expected to continue to grow.

Rx security – forgeries 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.

To make photocopying prescriptions more difficult, some medical practitioners use prescription pads that contain security measures similar to those used on bank checks. 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. New Jersey, for example, requires that only state approved printers may be used to print official "New Jersey Prescription Blanks." (See Exhibit E.) Prescribers can make it more difficult to forge dosages and quantities by writing out numbers in words. Again, this may be mandated by law.

Some jurisdictions help control stolen prescriptions by requiring special "triplicate prescriptions" for certain classes of drugs. Blank triplicates are only available from the regulating agency and are individually numbered. The medical practitioner 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 forged prescriptions that pharmacists can check. In this example, the prescription's validity is further limited to 72 hours from issuance. California has recently replaced triplicate 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).

When forgery is suspected, pharmacists will call the medical practitioner to verify the prescription. Forged prescriptions are no longer considered medical documents and doctor-patient confidentiality rules no longer apply.

Who can write prescriptions (that may legally be filled with prescription-only items)
Any jurisdiction that allows freedom of written communication generally must therefore allow anybody to write a prescription to anybody, inasmuch as the prescription itself is just written advice. Therefore "who can write prescriptions" will be explained below as shorthand for "whose prescriptions may legally be filled with items restricted to dispensing via the order of certain persons".

National or local (i.e. state or provincial) legislation governs who can write a prescription. In North America, physicians (either M.D. or D.O.) have the broadest prescriptive authority. All 50 States and the District of Columbia allow licensed certified Physician Assistants (PAs) prescription authority (with some limitations to controlled substances). All 50 States allow registered certified Nurse Practitioners and other advanced-practice nurses (such as certified nurse-midwives) prescription power (with some states including limitations to controlled substances). Many other healthcare professions also have prescriptive authority related to their area of practice. Veterinarians, dentists, and podiatrists have prescribing power in all 50 states and the District of Columbia. Clinical pharmacists are allowed to prescribe in some states through the use of a drug formulary or collaboration agreements. Florida Pharmacists can write prescriptions for a limited set of drugs. In all states, optometrists prescribe medications to treat certain eye diseases, and also issue spectacle and contact lens prescriptions for corrective eyewear. Several states have passed RxP legislation, allowing clinical psychologists (PhD's or PsyD's) who are registered as medical psychologists and have also undergone specialized training in script-writing to prescribe drugs to treat emotional and mental disorders. Rarely, people who practice the non-medical intervention of chiropractic may have the ability to write a prescription, but then only under certain conditions.

Legibility
Prescriptions, when handwritten, are notorious for being often illegible. In the US, medical practitioners' sloppy handwriting kills more than 7,000 people annually, according to a July 2006 report from the National Academies of Science's Institute of Medicine (IOM). Historically, physicians used Latin words and abbreviations to convey the entire prescription to the pharmacist. Today, many of the abbreviations are still widely used and must be understood to interpret prescriptions. At other times, even though some of the individual letters are illegible, the position of the legible letters and length of the word is sufficient to distinguish the medication based on the knowledge of the pharmacist. When in doubt, pharmacists call the medical practitioner. Some jurisdictions have legislated legible prescriptions (e.g. Florida). Some have advocated the elimination of handwritten prescriptions altogether and computer printed prescriptions are becoming increasingly common in some places.

Conventions for avoiding ambiguity
Over the years, prescribers have developed many conventions for prescription-writing, with the goal of avoiding ambiguities or misinterpretation. These include:
 * Careful use of decimal points to avoid ambiguity:
 * Avoiding unnecessary decimal points: a prescription will be written as 5 mL instead of 5.0 mL to avoid possible misinterpretation of 5.0 as 50.
 * Always using zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation of .5 as 5.
 * Avoiding trailing zeros on decimals: e.g. 0.5 instead of .50 to avoid misinterpretation of .50 as 50.
 * "mL" is used instead of "cc" or "cm³" even though they are technically equivalent to avoid misinterpretation of 'c' as '0' or the common medical abbreviation for "with" (the Latin "cum"), which is written as a 'c' with a bar above the letter. Further, cc could be misinterpreted as "c.c.", which is an uncommonly used abbreviation for "take with meals" (the Latin "cum cibo").
 * Directions written out in full in English (although some common Latin abbreviations are listed below).
 * Quantities given directly or implied by the frequency and duration of the directions.
 * Where the directions are "as needed", the quantity should always be specified.
 * Where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather than simply frequency (three times a day) and especially relationship to meals for orally consumed medication.
 * The use of permanent ink.
 * Avoiding unspecified prn or "as needed" instructions—instead, specific limits and indicators are provided e.g. "every 3 hours prn pain."
 * For refills, the minimum duration between repeats and number of repeats should be specified.
 * Providing the indication for all prescriptions even when obvious to the prescriber, so that the pharmacist may identify possible errors.
 * Avoiding units such as "teaspoons" or "tablespoons."
 * Writing out numbers as words and numerals ("dispense #30 (thirty)") as in a bank draft or cheque.
 * The use of apothecary/avoirdupois units and symbols of measure -- pints (O), ounces (℥), drams (ℨ), scruples (℈), grains (gr), and minims (♏) -- is discouraged given the potential for confusion. For example, the abbreviation for a grain ("gr") can be confused with the gram, abbreviated g, and the symbol for minims (♏), which looks almost identical to an 'm', can be confused with micrograms or metres.  Also, the symbols for ounce (℥) and dram (ℨ) can easily be confused with the numeral '3', and the symbol for pint (O) can be easily read as a '0'.  Given the potential for errors, metric equivalents should always be used.
 * The use of the degree symbol (°), which is commonly used as an abbreviation for hours (e.g., "q 2-4°" for every 2 – 4 hours), should not be used, since it can be confused with a '0'. Further, the use of the degree symbol for primary, secondary, and tertiary (1°, 2°, and 3°) is discouraged, since the former could be confused with quantities (i.e. 10, 20 and 30, respectively).

Abbreviations
See list of abbreviations used in medical prescriptions. Many abbreviations are derived from Latin phrases. Hospital pharmacies have more abbreviations, some specific to the hospital. Different jurisdictions follow different conventions on what is abbreviated or not. Prescriptions that don't follow area conventions may be flagged as possible forgeries.

Some abbreviations which are ambiguous, or which in their written form might be confused with something else, are not recommended and should be avoided. These are included in a separate list in Appendix 1. However, all abbreviations carry an increased risk for confusion and misinterpretation and should be used cautiously.

In Continental Europe
In continental Europe, prescriptions differ from their counterparts in the Anglosphere. With the exception of patient directions, they are written out entirely in abbreviations deriving from the Latin language. Furthermore, a larger proportion of prescriptions are compounded, and appropriate abbreviations and phrases exist for this.

Parts of a European prescription
A continental European prescription consists of three parts:


 * the inscritio, also known as the superscriptio, is the header of the prescription and consists of the patient's name, address, and identity document number, as well as the identifying number of the patient's private health insurance company, if applicable; and
 * the praescriptio is the prescription itself; that is, directions to the dispensing pharmacist to supply medication, made up of the following:
 * the invocatio, consisting of the abbreviation Rp; this is analogous to the Rx used in the Anglosphere, and stands for recipe, Latin for take [from the shelf]; and
 * the ordinatio, also known as the compositio, which consists either of the brand name, strength, and number and type of dosage units of a particular drug, or else of directions written entirely in the Latin accusative case, with the exception of ingredient names, written in the genitive case. Masses are written in grammes, without the unit name.  The compositio is followed by
 * the subscriptio, which consists of the directions according to which the medicament is to be prepared. An important part of this is the signatura, which is directed towards the patient and explains how to use the medication.  Unlike the rest of the prescription, the signatura is written in the national vernacular.

Other conventions
Should a patient require a dosage in excess of the maximum as established by the appropriate governmental body, this is marked by an exclamation mark and the highest recommended dosage in Latin. If this is not done, it is the responsibility of the pharmacist to contact the doctor as to dose requirements, or amend the dose to the highest recommended one.

In emergency situations, a prescription pad may not be available. In this situation, any piece of paper will do, provided it is marked Periculum in mora!; that is, danger in delay (other designations, such as Cito! or Statim!, are also used and understood). Such ad-hoc prescriptions have a limited period of validity; typically, this is the day after the prescription is written.

A doctor may self-prescribe, or prescribe for his family; this is done by replacing the signatura by the Latin phrase pro manus medici (for medical hands). This is to be done with caution; certain drugs self-prescribed will arouse suspicion, and may result in investigation by the medical board or another governmental body.

Brand-name drugs may be swapped for generics; if this is not wanted by the doctor, he may write dispense as written in the local language on the prescription.

Non-prescription drug prescriptions
Prescriptions are also used for things that are not strictly regulated as a prescription drug. Prescribers will often give non-prescription drugs out as prescriptions because drug benefit plans may reimburse the patient only if the over-the-counter medication is taken under the direction of a medical practitioner. Conversely, if a medication is available over-the-counter, prescribers may ask patients if they want it as a prescription or purchase it themselves. Pharmacists may or may not be able to price the medication competitively with over-the-counter equivalents. If the patient wants the medication not under prescription, the prescriber is usually careful to give the medication name to the patient on a blank piece of paper to avoid any confusion with a prescription. This is applied to non-medications as well. For example, crutches, and registered massage therapy may be reimbursed under some health plans, but only if given out by a prescriber as a prescription.

Prescribers will often use blank prescriptions as general letterhead. Legislation may define certain equipment as "prescription devices". Such prescription devices can only be used under the supervision of authorized personnel and such authorization is typically documented using a prescription. Examples of prescription devices include dental cement (for affixing braces to tooth surfaces), various prostheses, gut sutures, sickle cell tests, cervical cap and ultrasound monitor.

In some jurisdictions, hypodermic syringes are in a special class of their own, regulated as illicit drug use accessories separate from regular medical legislation. Such legislation will often specify a prescription as the means by which one may legally possess syringes.

Related usage of the term prescription
Prescription may also be used as a short form for prescription drugs to distinguish from over-the-counter drugs. In reference to the entire system of controlling drug distribution (as opposed to illicit drugs), "prescription" is often used as a metaphor for healthy directions from a prescribing medical practitioner. A green prescription is direction from a medical practitioner to a patient for exercise and healthy diet.

History
The concept of prescriptions dates back to the beginning of history. So long as there were medications and a writing system to capture directions for preparation and usage, there were prescriptions.

Modern prescriptions are actually "extemporaneous prescriptions" from the Latin (ex tempore) for "at/from time". "Extemporaneous" means the prescription is written on the spot for a specific patient with a specific ailment. This is distinguished from a non-extemporaneous prescription which is a generic recipe for a general ailment. Modern prescriptions evolved with the separation of the role of the pharmacists from that of the physician. Today the term "extemporaneous prescriptions" is reserved for "compound prescriptions" which requires the pharmacist to mix or "compound" the medication in the pharmacy for the specific needs of the patient.

Predating modern legal definitions of a prescription, a prescription traditionally is composed of four parts: a "superscription", "inscription", "subscription" and "signature".

The superscription section contains the date of the prescription and patient information (name, address, age, etc.). The symbol "" separates the superscription from the inscriptions sections. In this arrangement of the prescription, the "" is a symbol for recipe or literally the imperative "take." This is an exhortation to the pharmacist by the medical practitioner, "I want the patient to have the following medication" - in other words, "take the following components and compound this medication for the patient."

The inscription section defines what is the medication. The inscription section is further composed of one or more of:
 * a "basis" or chief ingredient indended to cure (curare)
 * an "adjuvant" to assist its action and make it cure quickly (cito)
 * a "corrective" to prevent or lessen any undesirable effect (tuto)
 * a "vehicle" or "excipient" to make it suitable for administration and pleasant to the patient (jucunde)

The "subscription" section contains dispensing directions to the pharmacist. This may be compounding instructions or quantities.

The "signature" section contains directions to the patient and is often abbreviated "Sig." or "Signa." It also obviously contains the signature of the prescribing medical practitioner though the word "signature" has two distinct meanings here and the abbreviations are sometimes used to avoid confusion.

Thus sample prescriptions in modern textbooks are often presented as: : medication Disp.: dispensing instructions Sig.: patient instructions

Use of technology
As a prescription is nothing more than information among a prescriber, pharmacist and patient, information technology can be applied to it. Existing information technology is adequate to print out prescriptions. Medical information systems in some hospitals do away with prescriptions within the hospital. There are proposals to securely transmit the prescription from the prescriber to the pharmacist using smartcard or the internet. In the United Kingdom a project called the Electronic Transfer of Prescriptions (ETP) within the National Programme for IT (NPfIT) is currently piloting such a scheme between prescribers and pharmacies.

Within computerized pharmacies, the information on paper prescriptions is recorded into a database. Afterwards, the paper prescription is archived for storage and legal reasons.

A pharmacy chain is often linked together through corporate headquarters with computer networking. Walgreens, for example, uses satellite technology to share patient information. A person who has a prescription filled at one Walgreen can get a refill of that prescription at any other store in the chain, as well as have their information available for new prescriptions at any Greensward.

Some online pharmacies also offer services to customers over the internet. Walgreen s' web site, for example, allows customers to order refills for medicine over the internet, and allows them to specify the store that they will pick up the medicine from. Their web site also allows consumers to look up their prescription history, and to print it out.

Many pharmacies now offer services to ship prescription refills right to the patient's home. CPS, for example, will ship refills free of charge. They also offer mail service where you can mail in a new, original prescription and a signed document, and they will ship the filled prescription back to you.

Pharmacy information systems are a potential source of valuable information for pharmaceutical companies as it contains information about the prescriber's prescribing habits. Prescription data mining of such data is a developing, specialized field.

Many prescribers lack the digitized information systems that reduce prescribing errors. To reduce these errors, some investigators have developed modified prescription forms that prompt the prescriber to provide all the desired elements of a good prescription. The modified forms also contain pre-defined choices such as common quantities, units and frequencies that the prescriber may circle rather than write out. Such forms are thought to reduce errors, especially omission and handwriting errors and are actively under evaluation. (See: Kennedy AG, Littenberg B. A Modified Outpatient Prescription Form to Reduce Prescription Errors. Joint Commission Journal of Quality and Safety 2004; 30:480-487.)

Exhibit A: sample legal definition of a prescription
Taken from California's Business and Professions Code Section 4040:
 * 4040. (a) "Prescription" means an oral, written, or electronic transmission order that is both of the following:
 * (1) Given individually for the person or persons for whom ordered that includes all of the following:
 * (A) The name or names and address of the patient or patients.
 * (B) The name and quantity of the drug or device prescribed and the directions for use.
 * (C) The date of issue.
 * (D) Either rubber stamped, typed, or printed by hand or typeset, the name, address, and telephone number of the prescriber, his or her license classification, and his or her federal registry number, if a controlled substance is prescribed.
 * (E) A legible, clear notice of the condition for which the drug is being prescribed, if requested by the patient or patients.
 * (F) If in writing, signed by the prescriber issuing the order, or the certified nurse-midwife, nurse practitioner, or physician assistant who issues a drug order pursuant to Section 2746.51,2836.1, or 3502.1.
 * (2) Issued by a precribing medical practitioner if a drug order is issued pursuant to Section 2746.51, 2836.1, or 3502.1.
 * (b) Notwithstanding subdivision (a), a written order of the prescriber for a dangerous drug, except for any Schedule II controlled substance, that contains at least the name and signature of the prescriber, the name and address of the patient in a manner consistent with paragraph (3) of subdivision (b) of Section 11164 of the Health and Safety Code, the name and quantity of the drug prescribed, directions for use, and the date of issue may be treated as a prescription by the dispensing pharmacist as long as any additional information required by subdivision (a) is readily retrievable in the pharmacy. In the event of a conflict between this subdivision and Section 11164 of the Health and Safety Code, Section 11164 of the Health and Safety Code shall prevail.
 * (c) "Electronic transmission prescription" includes both image and data prescriptions. "Electronic image transmission prescription" means any prescription order for which a facsimile of the order is received by a pharmacy from a licensed prescriber.  "Electronic data transmission prescription" means any prescription order, other than an electronic image transmission prescription, that is electronically transmitted from a licensed prescriber to a pharmacy.
 * (d) The use of commonly used abbreviations shall not invalidate an otherwise valid prescription.
 * (e) Nothing in the amendments made to this section (formerly Section 4036) at the 1969 Regular Session of the Legislature shall be construed as expanding or limiting the right that a chiropractor, while acting within the scope of his or her license, may have to prescribe a device.

Exhibit B: sample legal requirement for storage of prescriptions
From the Mississippi Board of Pharmacy:
 * ARTICLE XIII PRESCRIPTIONS TO BE FILED
 * 1. All prescriptions shall be filed in one of the following ways:
 * A. Three separate files may be maintained; a file for Schedule II prescriptions dispensed; a file for Schedule III, IV and V prescriptions dispensed; and a file for all other prescriptions dispensed.
 * B. Two files may be maintained; a file for all Schedule II prescriptions dispensed and another file for all other prescriptions dispensed, including those in Schedule III, IV and V. If this method is used, the prescriptions for Schedule III, IV and V substances must be stamped with the letter "C" in red ink, not less than one inch high, in the lower right-hand corner.  This distinctive marking makes the records readily retrievable for inspection.  Pharmacies with automatic data processing systems are exempted from marking Schedule III, IV and V controlled substance prescriptions with the red "C".
 * 2. A hard copy of original prescriptions, whether records are maintained manually or in a data processing system, shall be assigned a serial number and maintained by the pharmacy in numerical and chronological order. All prescriptions shall be maintained for at least five years from the date of original dispensing.
 * 3. If a pharmacy utilizes a data processing system for record keeping, all computer generated labels should be affixed to the prescription document in such a manner as not to obscure information on the face of the document.

Exhibit C: sample legal requirements for security and format
From Indiana Board of Pharmacy:
 * 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 contain the following security features:
 * (1) A latent, repetitive "void" pattern screened at five percent (5%) in reflex blue must appear across the entire face of the document when the prescription is photocopied.
 * (2) There shall be a custom artificial watermark printed on the back side of the base paper so that it may only be seen at a forty-five (45) degree angle. The watermark shall consist of the words "Indiana Security Prescription", appearing horizontally in a step-and-repeated format in five lines on the back of the document using 12-point Helvetica bold type style.
 * (3) An opaque RX symbol must appear in the upper right-hand corner, one-eighth (1/8) of an inch from the top of the pad and five-sixteenths (5/16) of an inch from the right side of the pad. The symbol must be three-fourths (3/4) inch in size and must disappear if the prescription copy is lightened.
 * (4) Six (6) quantity check-off boxes must be printed on the form and the following quantities must appear and the appropriate box be checked off for the prescription to be valid:
 * (A) 1-24
 * (B) 25-49
 * (C) 50-74
 * (D) 75-100
 * (E) 101-150
 * (F) 151 and over.
 * (5) No advertisements may appear on the front or back of the prescription blank.
 * (6) Logos, defined as a symbol utilized by an individual, professional practice, professional association, or hospital, may appear on the prescription blank. The upper left one (1) inch square of the prescription blank is reserved for the purpose of logos. Only logos, as defined by this subdivision, may appear on the prescription blank.
 * (7) Only one (1) prescription may be written per prescription blank. The following statement must be printed on the bottom of the pad: "Prescription is void if more than one (1) prescription is written per blank.".
 * (8) Refill options that can be circled by the prescriber must appear below any logos and above the signature lines on the left side of the prescription blank in the following order: Refill NR 1 2 3 4 5 Void after_____.
 * (9) Practitioner name and state issued professional license number must be preprinted, stamped, or manually printed on the prescription.
 * (10) All prescription blanks printed under this rule shall be four and one-fourth (4-1/4) inches high and five and one-half (5-1/2) inches wide.
 * (b) Nothing in this rule shall prevent licensed Indiana practitioners from utilizing security paper prescriptions for the prescribing of any legend drug. (Indiana Board of Pharmacy; 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 by the pharmacist
Taken from the Ontario's Drug and Pharmacies Regulation Act, paragraph 156.


 * (1) Every person who dispenses a drug pursuant to a prescription shall ensure that the following information is recorded on the prescription,
 * (a) the name and address of the person for whom the drug is prescribed;
 * (b) the name, strength (where applicable) and quantity of the prescribed drug;
 * (c) the directions for use, as prescribed;
 * (d) the name and address of the prescriber;
 * (e) the identity of the manufacturer of the drug dispensed;
 * (f) an identification number or other designation;
 * (g) the signature of the person dispensing the drug and, where different, also the signature of the person receiving a verbal prescription;
 * (h) the date on which the drug is dispensed;
 * (i) the price charged. R.S.O. 1990, c. H.4, s. 156 (1).

Exhibit E: New Jersey requirements for prescription blanks
From New Jersey official statutes:


 * 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 shall not 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.