How to write a prescription
In modern society, only qualified physicians and nurses are legally allowed to write a prescription. Very strict laws and safety guards are in place to prevent the forging of prescriptions. While forgeries still occur, they are becoming less prevalent with the government-regulated prescription pad changes made in 2007 by Medicaid. Companies that sell Rx pads and printer paper require proof that a medical practitioner is ordering the product by law.
Components of Tamper Resistant Prescription Pads
There are three levels of security features pre-printed on prescription pads used by almost all doctors. Because Medicaid has specific requirements for all prescriptions written for Medicaid patients, most doctors have adopted these high security pads for their entire practice rather than having two types of prescription pads.
Security measures to prevent copying of blank pads:
- Anti-copy Watermark. By tipping the paper towards the light, a picture appears to verify that the prescription is an original. Usually a Rx appears.
- Anti-Coy Coin Rub. By rubbing a penny across the back of the prescription the words “Secure Prescription Paper” appears.
- Hidden Message Technology. The word Void appears if a copy is made.
Security measures to prevent modification of a prescription:
- Toner Bond Security. The paper is treated with a compound that fuses with any ink used on it (including toner from printers).
- Blue Security Background. Prevents erasing of prescription.
Security measures to prevent counterfeiting of prescription forms:
- Unique Production Batch Numbers. Unique numbers are assigned to every printed batch by the manufacturer.
- Security Warning Band. Visible warning band provides warning of security measures on paper to prevent counterfeiting
- UV Fiber Secure. Invisible fluorescent fibers and threads that can only be seen under blacklight
While some physicians use printers and a specific program to write their prescriptions, the same strict guidelines are used in the design of the printer paper used for prescriptions as well.
Latin Terms on a Prescription
There are several components to writing prescriptions, one of which is the writing of specific keywords in Latin. However, in a modern world, many pharmacists are questioning the validity of writing prescriptions in both Latin and English terms and are taking steps to eradicate the use of Latin altogether.
Latin abbreviations used in prescription writing:
- bid – take twice a day
- IM – in the muscle
- IV – intravenous
- pc – take after meals
- po – orally
- pr – suppository
- prn – take as needed
- sl – under the tongue
- sq – under the skin
- tid – take three times a day
- qd – take every day
- qhs – take at bedtime
- qid – take four times a day
Drug Enforcement Administration Role in Prescription Writing
All medical prescribers are required to request and receive a DEA number, which contains two letters, six numbers, and one check digit (explained below) before a single narcotic prescription can be dispensed by the practitioner. This is a precaution taken by the Drug Enforcement Administration to ensure that controlled substances are being prescribed by only qualified professionals. Because most practitioners dispense narcotics at one time or another, it is very rare for a physician not to have this type of identifier. Most physicians include the number an all prescriptions as a tracking device for the prescriptions they write.
The first letter in the code is the type of practice:
- A – Deprecated
- B –Hospital/Clinic
- C – Practitioner
- D – Teaching Institution
- E – Manufacturer
- F – Distributor
- G – Researcher
- H – Analytical Lab
- J – Importer
- K – Exporter
- L – Reverse Distributor
- P- Narcotic Treatment Program
- R – Narcotic Treatment Program
- S – Narcotic Treatment Program
- T- Narcotic Treatment Program
- U – Narcotic Treatment Program
- X – Suboxone/Subutex Prescribing Program
The second letter is the initial of the practitioners last name. The third, fourth, fifth, and sixth numbers are randomly selected by a computer. The check digit is a calculation of the following:
- Addition of the first, third and fifth digits
- Addition of the second fourth and sixth digits times two
- Add the sums of the two numbers
- The sum is the last digit
What a Practitioner Writes on a Prescription
The body of a prescription is the same regardless of the field or specialty of medicine the prescription comes from. Pharmacists require certain information be included on a prescription, and a prescription is not legally allowed to be altered by any person, even a physician after it is written. If a doctor makes a mistake, he is required to re-write the prescription from a new page.
Some of the information contained on a prescription pad must be put in place by the pad manufacturer, such as:
- The name, address, and phone number of the practitioner
- Lines for the patient name, age, address, and the current date
- Line for refill amount
- Line for the physicians signature
- Line for the DEA number
- The letters Rx
All other information will be handwritten:
- The patients name, address, phone number and date of birth.
- The date the prescription is written.
- The name of the medication. This usually consists of the brand name of generic name of a medication, however occasional the antigen or compound is used when in doubt.
- Whether the brand name medication is medically required. If it is not required the doctor puts nothing and a generic is always used in place of a brand name.
- The dosage of a medication. For example a birth control pill might be 20 micrograms.
- How many doses can be taken at one time. I.e., Take two every two hours.
- How the medicine will be taken. Orally, rectally, injections, etc.
- How many times a day the medication should be taken.
- What time of day the medication should be taken. Morning, on an empty stomach, with food, etc.
- How much medication at once. I.e. one month worth, three months worth, etc.
- Number of refills. Narcotics, by law, cannot be refilled, a doctor must write a prescription ever time.
- DEA number.
- Doctor’s signature.
The Pharmacist's Role
Once a prescription is taken to the pharmacy, it is up to the pharmacist to check the security features on the prescription to ensure its validity. This check is supposed to occur with every narcotic prescription written to a pharmacy; however, some bigger pharmacies find they are filling too many prescriptions to be as detailed as necessary.
However, without the DEA number no pharmacist would fill a prescription for a controlled substance, as they can be held accountable for the illegal disbursement of a controlled substance. Furthermore, the DEA number on the prescription is entered into the computer and verified by the DEA before the prescription is filled to ensure that the prescription is from a legal source. Most pharmacy’s support the notion of calling the writing physician if there is even the smallest doubt about a prescription.
Penalties for Forging Prescriptions
The penalties for forging prescriptions vary from state to state. However, most states file the same charges against those forging prescriptions. Fraud, because they perpetuate fraud by presenting a fake prescription as a real one, and possession with intent to sell. Other charges can be brought against the offenders as well, but these are the two standard ones. The prosecutor can choose any class of felony or misdemeanor he or she chooses to bring against the forger. However, in most cases felony charges are filed and the class chosen (A, B, or C) is based on the criminal background of the defendant.
Sentences vary from state to state as well, however, in most state the jail time can range from five years to life, with states like Florida and Texas averaging 30-year sentences for these crimes. This conviction also comes with a hefty fine, with fines starting at $10,000 and going up, making forging prescriptions a very expensive proposition.