Note:

• If the previous encounter is a zero duration encounter (including RR – Refill Request and SR- Surescript Refill) then the prescription of such an encounter is ignored and the prescription from the encounter prior to the zero duration encounter is copied over to the prescription of the current encounter.
• The prescription from the previous non-zero encounter is NOT copied on start of a consecutive new encounter, rather only if the Prescription screen is accessed for prescription in the current encounter. It includes prescription screen being accessed from Doctor Forms, Assessment screen, CPOE > Rx, and Encounter TOC > Prescription.
• Prescription from a deleted encounter is not copied and the Prescription from a reopened encounter is not considered.
• In case there is no prescription prescribed in the immediate previous encounter then system automatically fetches the prescription from encounter(s) previous to it.

Analytics :

Preview:

Print :

Fax :

eRx :

Help :

• Apply to drugs with NO pharmacy mentioned
• Apply to ALL drugs
• Apply to this row only

Note: The label of the prescription screen changes from 'Prescription' to 'Multi-Pharmacy' in case the prescription has been saved with multiple pharmacies.

Pref Pharm button : The user can select Patient Preferred Pharmacy from the Patient Registration screen. On the Patient Registration screen, there is a icon‘ Pharmacy' on the top right and side of the screen. When the user clicks on this icon, a popup to select ‘ Patient Pharmacy' invokes; wherein the user can select a maximum of 10 pharmacies. The popup displays the Name, Address, and telephone number of the Pharmacy. The selected pharmacy list is available on the Prescription screen too. On the Prescription screen the ‘ Pref Pharm' button is displayed near the Pharmacy field.

 Patient Preferred Pharmacy icon : Click to view Patient preferred pharmacy search list. The list is added from menu: Patient → Register → click pharmacy icon to add Pharmacy vendor(s) to the new or existing list of Patient Preferred Pharmacies

 Clinic Preferred Pharmacy icon : Click to view the Clinic preferred pharmacy search list. The list is added from menu: Settings → Configuration → Pharmacy under the Vendor column

Note:

• From the Pharmacy search, if a non-preferred Pharmacy is selected and associated to a Prescription then on print or eRx of the Prescription the associated Pharmacy vendor is added to Clinic's preferred list.
• The Pharmacy name selected on Prescription > Pref Pharm popup is displayed in the Pharmacy field.

Note:

• The related Upto date is calculated for refilled drug only when the No. of Days is present.
• For times when Providers require to prescribe prescription that is meant to be started on a future date, the system explicitly sends this as additional information under comments to Surescript while ePrescribing..User is first alerted with a prompt that the Prescription Start Date is currently a future date and if he/she would like to send this information as part of comments while ePrescribing.If User confirms to send information then on 'Rx(s) for transmission' pop-up the Start date is visible under the Comments column. And on 'Send' the selected drug is ePrescribed and sent across to the relevant pharmacy.

• Blank to display Blank (i.e. for X Days not included in direction)
• FD for X Days
• DD dispense X Days

Note:

• If option is selected for a particular drug then on Update, a prefix, ‘Denied' appears in Pharmacy Notes entered.
• A denied drug can be printed, faxed, but not sent via eRx. And print denied drug(s) names with a prefix, ‘Denied'.
• Denied drugs are not displayed on Current Medication list, but are part of patient's Past Rx.

Note: The property, rx.default.dispensable.fields.blank overrides the currently existing property in the System, rx.std.patient.chartno.

Drug Selection

Select Drug using the Button :

• This button displays list of dispensable drugs (drug names along with its strength).
• There are three tabs on the search to give list of
  1. Doc Pref Drugs
  2. All Drug
  3. Order Set (This tab displays the list of all existing Order Sets. User may decide to overwrite an existing Order Set or create a new one. User may select any one of the Order Set. The provider can make Order Sets of often prescribed drugs for various common ailments.)
• Custom Drugs are also included
• This search does not display Only InHouse Drugs

Important: This will need to be used conditionally using a property. Further Note that the applicability of InHouse support read from property is based on Logged in Location for MultiLocation version.

On Selection, the search returns the Generic Drug Ids. If selected Drug is available as In House, it sets the In House check Box.

Select Drug using the Button :

• Invokes Drug Search also displaying the Therapeutic Drug Class
• The Dispensable Drug is found considering selected Drug as Doc Pref
• If it is not found as Doc Pref, it will consider All Drugs option listed above

• Dispensable Drug details as saved in the Order Set.

• The search displays the list of Drugs as on Current Medication screen
• User is free to mark any Drug under Current List Box option as Refill
• User can also select the Old Med List Box option and mark any drug as Add to Rx. In either case a Drug entry is added to prescription

• A drug added in prescription can be deleted by checking this check Box

• Mark the drugs in the prescription which need to be sent to Printer / fax / eRx
• By default a newly added drug will be selected. Note that, it multiple selected drugs are sent out, they will be sent to the Pharmacy

• Displays the Drug name and Strength
• The Drug names in this table are displayed in Bold, it they are for InHouse. A prefix of a Check Mark is displayed if it is already Sent
• A prefix of Red is displayed if eRx is applicable
• Prescribing a CS drug has specific differences in the way it is ePrescribed - there is a step involved where the Prescriber needs to sign the Prescription and the Prescribing provider has to keep his eToken connected to the USB drive of the his/her PC (Personal Computer).
• DEA Class II drugs can be dispensed only once from the Prescription screen.

• On save the system checks for
  1. Duplicate drug prescribed
  2. Patient Allergy to Generic Drug
  3. Patient Allergy to Dispensable Drug
  4. Allergens
  5. Cross Sensitivity
  6. Drug-Drug Interaction
• Allergens and Cross Sensitivity defined in the Face Sheet allergy is considered. Drug-Drug interaction considers the prescribed drugs and Current Medication drugs for interaction. These checks are done using the algorithms of FDB.
• Duplicate drugs are not allowed. In case of all other allergies only a warning is displayed and does not stop the provider from prescribing the drug.
• The system also checks for precautions and gives appropriate warning.
• Added a new feature on the Prescription screen; wherein if there are any unapproved drugs in the list, then the user (provider) with approve rights can approve all of them by clicking on ‘Save'. The ‘Save' button is enabled only when the Prescription screen has any non- approved drugs in the list. The user (clinical staff) without approve rights can only enter drugs on this screen. But these entered drugs are approved by the provider.

Note: For approved drugs , their status is displayed as ‘ Approved' ; whereas for unapproved drugs the status is ‘ Entered'.

Note: Following are the types that are displayed:

1. Not Signed : A Controlled Substance prescription which is not digitally signed by provider.
2. Signed : A Controlled substance Prescription which a digitally signed by Provider.
3. eRx : A non-controlled substance prescription which can be send electronically.
4. Blank : The drug is not allowed to send electronically. It could be because the Provider is not registered for ERX, Pharmacy does not support ERX, or the drug is controlled substance and provider is not ready for EPCS.

Note: For CS drugs: A prescription once signed refreshes to display the Send button. The eRx Summary screen now displays the Signed CS drugs alongside the Non-CS eRx drugs. On click of send button, all signed Controlled substances plus any non-controlled substance prescriptions are sent to Surescripts.

Preview : It is possible for In House or Pharmacy Dugs. A List Box of all applicable Templates is available. In case of In House, all Templates with name starting from In House are considered. For Other Pharmacy all templates (including In House) are considered. User can select a template and then Print/Fax the prescription.

Print Button : Prints both the In House Prescription As well as Other Pharmacy prescription. Both appear in different formats/templates. (For In House dispensing, Pharmacy Name and Address must not be printed). In House Prescription uses alphabetically the first prescription template with the name starting with In House Non In House prescription uses alphabetically the first prescription template without any constraints on its name.

Depending on the property, allow.directprint.druginfo being turned ON or OFF, a click on print button directly sends the PDF of the respective Drug Info to the default printer for a print or the popup for a printer selection is displayed

Fax Button : The prescription can be faxed to the Pharmacy by clicking button. In House drugs are not considered.

eRx Button : Drug applicable for eRx are sent electronically using this button. Note that drugs eligible for eRx cannot be printed / faxed (until they have been sent electronically)

Dispense Button : This button is enabled only if in-house drug is prescribed to patient. Popup is displayed on click of Dispense button. Basic drug dispensing information like the date of manufacture (Mfg), Site, Lot No, date of expiry (Expires On) can be recorded before any in-house drugs are dispensed. This information come handy whenever there is a requirement to trace back any drug that was dispensed.

Access Control

User can come to this option by many routes:

This is the most common and natural route. If the encounter is closed, Prescription cannot be edited, it can only be viewed. If the encounter is live Prescription can be edited.

If there is no Current Patient Encounter, this option is disabled. If it is present, it is as good as taking the Encounter > Prescription route.

• The Provider/Clinical Staff would get a call from a patient requesting for a Refill. The objective is to be able to complete the process at the earliest. A click on this option displays a Patient selection search pop up. Only patients who do not have an open encounter and who have at least one closed encounter are displayed. Select a patient. The system creates a new encounter for the patient, with the encounter type as RR (Refill request), and the prescription screen is displayed. By default the Rx tab will display all the drugs prescribed in the previous encounter. The provider may flag as delete drugs which he doesn't intend to order. He also retains the flexibility to add supporting drugs by clicking on the button or adding new rows or selecting any drug from the past Rx tab. Please note the subtle difference, the Rx tab was populated with only the drugs in the previous encounter while the past Rx tab displays the list of all drugs prescribed to the patient in all encounters in the past six months. This period of six months is also set as a default property, which can be changed. Finally Save the prescription. Then click on Send, to send the prescription to the Pharmacy. The system automatically closes the encounter also. However if the user goes to some other option in Prognocis without Approve and Send, then the encounter remains open (it appears on the Provider’s Home page), and user will have to deal with it like any other open encounter.

Note: A copy of Refill Request is also sent to Provider's assistant along with the recipient Provider, if the property, rx.refill.msg.send2assistant is set as ‘Y'. The property overrides the existing property, mail.cc.A open encounter. The Denied Refill Request (from Portal as well as System) is tracked and displayed individually on Patient's Document List (Encounter → TOC → Document List ) where each denied Refill Request can be previewed individually but cannot be edited.

• For CS drugs - For DEA Class II drugs the User is allowed to dispense only once. The value of Total No. of dispensing approved field on Refill Request has to be ‘1'.

In case a clinical staff has created a prescription, the provider gets an Alert to Approve it. Click on the messages to come to this screen.

• Once Patient Portal is operational, the provider will receive a Refill request message from the Patient. When provider clicks on the message, the system prompts an error if there is any open encounter for a patient. If there is no open encounter, he will come to this prescription screen, a new encounter will be created, Rx Tab will be shown populated with Drugs requested by the Patient. Doctor can now Add / Remove / edit if required, He then Saves and Sends to Pharmacy. The encounter is automatically closed, and a message is sent to patient.

• In the property tag: rx.drugs.all.fields Use one or more of the following characters for printing Drug details in Prescription: