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 screen, Assessment screen, CPOE → Rx, and Encounter TOC → Prescription.
- Prescription from a deleted encounter cannot be copied, and the Prescription from a reopened encounter cannot be considered.
- In case there is no prescription prescribed in the immediate previous encounter, then system automatically fetches the prescription from earlier encounter(s).
Analytics icon:
Click this icon to invoke the Rx Helper interface which is useful for analysing data with regard to diagnosis and prescription.
Here, Users have the provision to search, filter and view drug and prescription related information on the basis of age, gender and diagnosis.
The results are listed in form of bar chart, pie chart and listings.
This icon is displayed only if the property prognocis.analytics.show is set to ON.
Preview icon:
Click to preview the prescription details before it is faxed or printed and sent.
It is possible to preview prescriptions having only In House or Pharmacy drugs.
A list of all applicable Templates is available in the Template dropdown.
In case of In House drugs, all templates with name starting with In House are considered.
For other pharmacies, all templates (including those for In Housed drugs) are considered.
User can select a template and then print/fax the prescription.
Print icon: Click to print In House as well as other Pharmacy prescriptions.
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 icon: The prescription can be faxed to the Pharmacy by clicking this icon.
In House drugs cannot be faxed. It is required to select the drugs and save the information first.
eRx icon:
Drugs applicable for eRx can be sent electronically by clicking on this button.
In the ePrescription mode, the prescription is sent electronically directly to the selected Pharmacy.
On clicking the eRx button, the eRx Summary popup is displayed which contains Patient details, Prescriber details, Drug details and Pharmacy Details.
If Prior Authorisation is required for a drug in the prescription then on clicking eRx button, the Electronic Prior Authorisation warning message is displayed with the buttons ePA, eRx, and close.
The user can continue to send the eRx by clicking on the eRx button on this popup.Note:
- Drugs eligible for eRx cannot be printed or faxed until they have been sent electronically.
- Only ICD10 codes associated with the drugs are displayed on the eRx Summary popup as well as in the XML sent to the Pharmacy when drugs are sent via eRx. ICD9 codes are not displayed. The ICD10 codes are displayed without a decimal point in the ePrescription (For example, ICD10 code R50.83 is displayed in the ePrescription as ICD10:R5083).
If the Provider clicks on the send button without unselecting the consent checkbox, then the prescription is sent and an RxInform text message is sent to the patient’s cell phone number. If the Provider unselects the consent checkbox before clicking on the send button, then the prescription is sent but no text message is sent to the patient.
Note:
- The RxInform text messages are not sent to minor patients under the age of 18.
- Currently, if the patient’s cell phone number is not SMS-enabled and the provider selects the checkbox and sends the prescription, the patient does not receive any text message.
Cancel eRx icon: User can click on this icon to cancel the electronically sent prescription.
A click on Cancel eRx icon would display the Cancel/Discontinue eRx popup which consists of the Patient details, Prescriber details, Pharmacy details, and Drug details for cancellation.
Depending on the request type selected, the Provider may cancel the entire prescription or discontinue the refills from this popup.
If the Print Paramter 18 is used in the Prescription Parameter properties rx.rx.fields, rx.brf.fields and rx.det.fields. then canceled drug details suffixed with (Canceled eRx) in red and bold font are displayed in the Progress Notes for the encounter. The Print Paramter 18 cannot be used in the Prescription Parameter property rx.ccd.fields as CCD does not contain canceled drug information.
ePA: Click on the ePA button to invoke the Electronic Prior Authorization popup.
This popup has 2 sections—Drug List and Surescripts Accelerator.
The Drug List section displays those drugs in the prescription for which prior authorization is required. Following are the columns present in the Drug List section:
- Select: User can check the checkbox associated with the drug to select that drug.
- Drug Description: Displays the details of the drug in the Prescription for which Prior Authorization is required.
The details include the Drug Name, Strength and Frequency. User can also add drugs to the prescription directly by clicking on the
icon. - Request Dt: Populates the date as soon as the Electronic Prior Authorization is requested.
- ICD codes: Displays the ICD codes associated with the selected drug. ICD codes from the Assessment screen can directly be associated with drugs in this popup using the multi select button. Only ICD10 codes are displayed in this column. ICD9 codes are not displayed.
- To Rx: If ICD codes are assigned to a drug from this popup and To Rx checkbox is checked for that drug, then these selected ICD codes are associated with the drug and are reflected on the Prescription screen.
- Priority: User can check this checkbox and then click on the ePA REQUEST button to notify Surescripts that the ePA request is urgent.
- PBM: Displays the Pharmacy Benefit Manager Name as available from the selected Eligibility.
- Plan: Displays the Plan Name as available from the selected Eligibility.
- Response: Displays the Response to ePA request, as received from Surescripts. These responses may be: O:Open, A:Approved, D:Denied, P:Partially Denied, I:In Process and C:Close
- Reason: Displays the Reason for rejection as received from Surescripts.
- Note: Displays the Notes or Comments as received from Surescripts.
- PA No.: Displays the Prior Authorization Number as received from Surescripts once the ePA is approved.
- ePA REQUEST button: Click on the ePA REQUEST button to send ePA request for a drug to Surescripts.
Note: Prior Authorization Workflow for a drug is applicable only for the patients having valid Eligibility applied.
Patient Alert icon: On page load, the Patient Alert popup does not invoke automatically. Users need to click the icon to invoke the popup.
When clicked, the Patient Alert popup allows users to view existing alerts for the patient and create new alerts. The Patient Alerts option is utilized by front office staff
to manage alerts for patients who miss appointments or fail to make timely payments. Staff can input comments in the popup and define a valid date range for the alerts.
Additionally, Patient Alerts can be deleted directly from the Patient Alert popup. On saving alerts to this popup the icon turns to
.
Patient Appointment History icon:
This icon is present only on the Rx and Refill screens to allow users to access patient appointment history details.
If the patient has no previous appointments, then this icon is displayed as .
Once any appointments are scheduled for the patient, then this icon is displayed with a red indicator as 
.
On clicking this icon, the Appointment History popup is invoked which displays a list of all the scheduled appointments of the selected patient.
Appointment details are displayed in the following columns on this popup:
- Date: Displays the date on which the patient had taken the appointment.
- From: Displays the time at which the appointment was scheduled.
- Upto: Displays the time up to which the appointment was scheduled.
- Status: Displays the appointment’s status.
- Provider: Displays the name of the appointment’s Attending Provider.
- Encounter Type: Displays the encounter type selected for the appointment.
- Comments: Displays comments added for the appointment, if any.
Manage Columns icon is provided on the top right corner of the popup to change the display sequence of the columns in the popup.
Appointment history details can be printed by clicking on the 
Print icon.
The Appointment History popup can be closed by clicking on the OK button.
In House checkbox: Select the checkbox to select an InHouse drug. The drug list box will then display only the list of InHouse generic drugs.
Sample checkbox: If this checkbox is checked, then the drug is assumed to be dispensed InHouse, although it might not be part of the defined InHouse drug list.
Pharmacy: This is by default the pharmacy entered in the last prescription of the patient. This field is not mandatory and can be set to blank, because a patient may prefer to go to any pharmacy while on travel. On typing the pharmacy name, a list of matching names present in the master are displayed so that one of them can be selected. If the selected pharmacy supports electronic prescription receipt then a prefix: eRx is displayed; if it supports electronic prescription of Controlled Substances then a prefix: EPCS is displayed; and if it supports eRx cancellation service then a prefix of Cancel-eRx is displayed.
User can use the search button to select a pharmacy from the master list of pharmacies provided by Surescript. All the pharmacies listed here are not available under auto complete edit control described above. Search displays results on the basis of Geographic locations (City, State, and Zip), Mail Order pharmacies along with others. The Service column on Pharmacy Search displays New Rx as New and EPCS as Controlled Substance .
If pharmacy is changed for a drug row, then User must click on update button or on any other row in the Prescribed Drugs Table. On click, a Actions For Non Inhouse Drugs Only popup is invoked that helps user to apply the following options as per requirement:
- 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:
This button opens the Patient Pharmacy popup which displays a list of all Preferred Pharmacies selected for the patient, along with 2 icons:
Patient Preferred Pharmacy:
Displays a list of patient preferred pharmacies.
If a pharmacy is selected from this list then it is displayed in the Pharmacy field.
Clinic Preferred Pharmacy:
Displays a list of Clinic preferred pharmacies.
The list is added from menu: Settings → Configuration → Vendor column →Pharmacy.
- Patient Registration Screen:
Click on the Preferred Pharmacy icon and choose up to 10 pharmacies from the corresponding selection popup.
- Prescription Screen: Click on the add new button in the Patient Pharmacy popup to open the Pharmacy Vendors search popup. Select one or multiple pharmacies from the list, then click OK to add them to the top of the Patient Pharmacy popup list. These pharmacies are automatically added to the Patient Preferred Pharmacy list, accessible from the Patient Registration screen.
Note:
- The pharmacies added from the Prescription screen cannot be deleted directly from the Patient Pharmacy search popup. To remove any pharmacies, users must delete them from the patient's record on the Patient Registration screen.
- If a non-Patient Preferred Pharmacy is selected via the List of Pharmacies icon and associated to a Prescription, then on print or eRx of the Prescription, the associated Pharmacy Vendor is added to Clinic's preferred list.
Drug: Users can type the name for the drug to be added to the prescription in this field. As soon as some characters are entered, drug names are displayed in the dropdown listbox. The list of drugs displayed here depends on the whether the InHouse checkbox is checked and whether the property for inactive drug rx.show.inactive.drugs is turned On or Off. Compound drugs are also displayed here. On clicking on a drug name from the listbox, the default values for Strength, Dosage, Frequency, Days, Bulk Quantity, Refills is auto-populated.
Strength: This field displays the drug strength information of the selected drug. The strength listbox may display a suffix of * to an entry to indicate it is inactive.
Drug Info Button: Having entered both the drug and its strength, click on this button to see the detailed information available in FDB including: How to use, Side effects, Drug interactions, Min/Max Daily Adult Dose. A print button is also displayed at the bottom, which on click generates a preview of the Drug Information in PDF for a print.
Pediatric Dosage Button:
This button is displayed if the patient's age is less than 18.
It displays the computed pediatric dosage for a day.
The calculation is based on the patient's age and weight.
The system finds the weight entered on the Vitals screen in the current encounter.
If this is not entered, the system finds the Normal Average Weight for the specified patient age and sex.
The Min-Max dosage per day is computed and displayed.
Providers can use their discretion to decide the dosage and frequency accordingly.
Note that this is just a message displayed, which can be invoked by a user if and when required.
It in no way inhibits/warns a user from prescribing any drug.
Dosage: Specifies the dosage of the drug to be taken at a time. Any number, fraction or text like Half can be entered in this field. For example, 2 OR 0.5 OR Half.
Dosage Unit: Also known as Dispense Unit, it is a dropdown list of standard units supported by Surescripts. Only one dosage unit can be selected at a time, and users can define more units if required. However, note that only Surescripts units can be selected for Bulk Quantity. If a non-Surescripts dosage unit is selected, the same is not set to Bulk Unit and the Bulk Qty is not computed.
Note:
For any oral liquid drug, it is mandatory to select Milliliter as the Dosage Unit.
Frequency: It is displayed as a dropdown list of codes or names based on property rx.freq.byname. If the selected drug was never used, the default frequency selected will be the one which signifies daily. Selected frequency will be used to calculate the bulk quantity. It is also likely that in case of Ointments, there is no frequency specified. For such a case, user can select *NA* (for Not Applicable), and bulk will not be computed.
PRN checkbox: This checkbox indicates that the patient can take this drug on requirement basis. The label for this field can be changed in the property rx.prn.label. This checkbox is unchecked by default.
Days: It is the number of days for which the drug is prescribed. This needs to be specified as a whole number.
DEA Class: If the selected drug falls under DEA class, then its class is displayed here in red color.
Bulk: This is also referred to as Dispense Quantity, and is calculated for tablets, capsules and caplets ONLY. For calculating, the system first considers the integer part of dosage entered. If dosage entered was a valid number like 3 OR 0.5, then the calculation will be correct. In case of dosage values like ½ it will compute based on 1, and in case of "Half", it will be computed as Zero. The user can edit the bulk quantity if required. Quantity is always set to 1 for other types of Dispense Units (Liquids/Ointment).
Dispense Unit: By default, it is same as dosage unit. If this is selected to be different, then the quantity is not computed by the system. Note that unlike the dosage unit, the user defined units are not considered, only the Units defined by Surescripts are considered.
Note:
For any oral liquid drug, it is mandatory to select Milliliter as the Dispense unit.
Prohibit Refill Request checkbox: This checkbox is provided to determine whether to allow Refill Request to be sent for the selected drug. If this checkbox is checked for a prescribed drug, Refill Requests for it should not be expected from Pharmacy. This checkbox is independent of the Refills text field.
Refills: It is the number of allowed refills for the drug that the patient can take from the Pharmacy.
Direction: Direction is a combination of dosage, dosage unit, frequency code or name and number of days. This is a user-editable field with a character limit of 255 characters. Users can click on the
icon to invoke a bigger popup for easy editing.
The default format is Dosage+Dosage Unit+Frequency+Days.
Frequency can have a value of C (for Code) or N (for Name), accordingly it will be displayed as TID or Thrice a day.
Days can be:
- Blank to display Blank (i.e. for X Days not included in direction)
- FD for X Days
- DD dispense X Days
- Single characters are not allowed.
- The following sequences are not permitted: "-", "--", and "---".
- Numbers-only input is not allowed.
Reason: This field allows users to enter a justification reason of upto 50 characters.
Pharmacy Notes: Notes for the pharmacy upto 255 characters can be entered in this field. User can click on the
icon to see the Pharmacy Notes in a bigger popup and edit them as necessary.
Substitute checkbox: When checked, indicates the pharmacy to dispense a substitute drug if the prescribed drug is not available.
Long Term checkbox: Providers can check this checkbox to allow drugs to be seen as part of current medication even after the prescribed period is over.
Fill Date: This field allows users to specify a date on or after which the pharmacy is supposed to dispense the drug. If no date is specified here, then this date is set to the Encounter Date by default on clicking the save button on Prescription screen. If the drug's Valid Upto date is greater than or equal to Encounter Date then after refill, the RxDate will be the Valid Upto date for the refilled drug else the RxDate will be the Encounter Date.
Note:
- The related Valid Upto date is calculated for refilled drug only when the No. of Days is present.
- For times when Providers are required to prescribe a 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 they would like to send this information as part of comments while ePrescribing. If User confirms to send the 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.
If the eRx button is clicked for such drugs, then an error message is immediately displayed indicating which drugs have Fill Dates preceding the current date. This message is displayed in a popup with Ok and Cancel buttons. If the Ok button is clicked, the message popup closes, and the Fill Date is updated to the current date for each selected drug row and saved. The user must click on eRx button again to send the prescription via eRx. If the Cancel button is clicked, the message popup closes, and the user can change the Fill Date to be greater than or equal to the current date and click on eRx button again to send the prescription via eRx.
Diagnosis : Click on the Multi Select
icon in front of this field to invoke the
ICD Mapping (Assign ICDs) popup and associate primary and secondary ICD codes to the drug.
The first selected ICD code will be by default considered as Primary and the second selected ICD code as Secondary.
This can later facilitate analysis report on the drugs prescribed for various diagnosis.
The tooltip displays the Primary and Secondary ICD10 Codes, Description and SNOMED Codes.
An 
Add ICDs to Assessment button is made available on this popup,
clicking on which the Diagnosis Codes popup is invoked.
The user can select upto 10 codes and add those ICDs to the prescription.
The ICDs selected from this button are Assessment ICDs only and are shown on the Assessment screen.
A 
Add Past ICD Codes button is also available on this popup,
which on click invokes the Add Past Medical History ICD Codes popup.
Users can add ICD Codes from the Past Medical History screen to the prescription.
If the rx.assign.icd.popup property is set to On, and one or more prescribed drugs do not have an associated ICD code, clicking the save button opens the ICD Mapping (Assign ICDs) popup. This popup lists all prescribed drugs without an assigned ICD code. Users can add ICD codes by clicking the Add buttons, selecting the checkboxes for the appropriate ICD codes, and clicking OK to associate them with the corresponding drugs. The popup also includes an Assign top 2 ICDs to all drugs checkbox, which automatically assigns the top two ICD codes to all listed drugs.
No of Units: These are the Billable Units which are relevant for InHouse drugs, where the associated CPT/HCPC Codes are transferred to Assessment with these Units.
Note:
Upon exceeding the multiplication of No of Units field to 5 digits; the No of Units field value is reset to 1.
Also, if the multiplication of No of Units field exceeded to 5 digits for old data, then the CPT is not added on the Assessment screen of such old records.
Valid Upto Date: The pharmacy is supposed to dispense drug only upto this date. This is not the date up to which the medication is to be taken by the patient.
Eligibility Button: Users can select one of the possible multiple eligibilities returned by Surescript for the patient by clicking on this button.
Deny Checkbox: Users can select this option to inform the Pharmacy that the drug has been denied and need not be given to the patient.
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.
Formulary Status / Copay / Coverage Info: On start of the encounter the system gets the Eligibility Information from Surescript about the selected patient. (Note: It is not necessary to have entered any patient insurance). There can be multiple Pharmacy Benefit Eligibilities received from Surescript. Considering the first eligibility from the list, the program displays the Formulary Status / Copay / Coverage details for the selected drug. Alternately if the user has selected an alternate eligibility by clicking on the Eligibility button, that would be considered for working out the same for the selected drug.
Rx Coupon icon: This icon is displayed on Prescription screen only if the property rx.coupon.enable is set to On. If this property is set to Off, the Rx Coupon feature is disabled and this icon is not displayed on Prescription screen.
A click on this icon invokes the Rx Coupon/Enrollment Details popup to see applicable coupon details for the selected drug. If no drugs have been added, then on clicking this icon, a message: No information to show is displayed. If a drug has been added and save button is clicked, then a $ mark indicator is shown on the right of the drug name if any coupons/offers are applicable for it. If the prescribed drugs are from an encounter when its visit date is more than 3 days and/or above, the system does not check if the offer is available for the drug. The color of the $ icon next to the drug name determines the type of Rx Coupon that is applicable:
- If Cash Offer is applicable, then a green color $ mark indicator is shown.
- If Copay Offer is applicable, then a blue color $ mark indicator is shown.
- If Patient Enrollment Program is applicable, then orange color $ mark indicator is shown.
- If Patient Support is applicable, then a yellow color $ mark indicator is shown.
Note:
When the property rx.coupon.enable is set to ON, Rx Coupon details can be sent to the Patient via email or text based on the property rx.coupon.medium.
Based on the selection in the property rx.coupon.medium, the system shares either the cell phone number or email address or both
(cell phone number and email address) of the Patient with OPRX for sending the coupon details to the Patient.
Sending of Rx Coupon details to the Patient on the selected medium is dependent on the Text/Email feature available at OPRX.
Prescribed Drugs Table
The bottom half of the Prescription screen displays all the drugs prescribed to the patient in the encounter. The current row is displayed with a light blue background. On clicking on a row, all the drug details are transferred to the top part of the screen, so that they can be edited. The display of last prescribed drug details depends on the property, rx.default.dispensable.fields.blank. If this property is turned On then User is required to manually enter drug details each time.
Note: The property, rx.default.dispensable.fields.blank overrides the currently existing property rx.std.patient.chartno. in the system.
Drug details are saved and moved to the Prescribed Drugs Table when the following actions are taken:
- The user adds a drug and clicks on the update button.
- The user adds a drug and hits the Enter key on the keyboard.
- The user adds a drug and directly clicks on the save button without clicking the update button. After the drug is saved, the user is automatically navigated to the first row in the table and the save button is disabled until the user adds or modifies another drug.
- The user adds a drug and clicks on another row in the Prescribed Drugs Table without clicking on save or update. After the drug is saved, the user is automatically navigated to the row they have clicked on. The save button remains enabled in this case and the user can add or modify another drug.
- The user adds a drug and clicks on the Past Rx button. The drug is saved, and the Medication List popup is invoked.
Select Drug using the Add Drugs
icon:
- A click on this icon invokes the Drug Search popup which displays a list of dispensable drugs (drug names along with its strength).
- There are three tabs on the Drug Search popup as follows:
- Dispensable Drug Pref - Preferred
- All Drugs
- Order Set (This tab displays a 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 displayed in the Drug Search popup.
- This Drug Search popup does not display only InHouse Drugs.
Note:
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 selecting a drug from the Drug Search popup and clicking the ok button, the drug is populated in the Prescribed Drugs Table. If the selected drug is available as In House, then the In House checkbox is checked.
Select Drug using the Add Drugs with Therapeutic Class
icon:
- A click on this icon invokes the Drugs by Therapeutic Class which displays drugs along with their Therapeutic Drug Class information.
- 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
Delete Checkbox:
- A drug added in prescription can be deleted by checking this checkbox.
- For the Pharmacy having Cancel eRx service, the Del checkbox and update button will be disabled for drugs sent via eRx even if the property, rx.edit.sent.drugs is set to ON.
- 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
- This column displays the type of the drug i.e. whether the drug is Inhouse or eRx or signed or Not signed. Following are the types for change request, cancel Rx, and Rx Fill:
- CHGREQ - Change request came for drug from Pharmacy to Prescriber.
- CHGRES_A - Approved change response for drug sent by Prescriber to Pharmacy.
- CHGRES_C - Approved change response for drug with changes sent by Prescriber to Pharmacy.
- CHGRES_D - Denied the change request sent by Pharmacy to Prescriber.
- CANREQ - Cancel request sent for drug from Prescriber to Pharmacy.
- CANRES_A - Approved cancel response for drug from Pharmacy to Prescriber.
- CANRES_D - Denied cancel response for drug from Pharmacy to Prescriber.
- RXFILL_F - Rx fully dispensed from Pharmacy to Prescriber.
- RXFILL_PF - Rx partially dispensed from Pharmacy to Prescriber.
- RXFILL_NF - Rx not dispensed from Pharmacy to Prescriber.
- 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.
- Formulary status of the drug is displayed with a Formulary Status: label in black color and the status in blue color. The formulary status is also displayed in the tooltip.
- 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.
Pharmacy Notes: Drug Comments entered if any.
Disp: Dispensable Qty
Refills: Refill count
The bottom row of the screen displays:
Allergy: Allergies to Generic Drug, Allergens, Cross Sensitivity are the ones which are displayed in Red at the botton left of the screen.
Past Rx: A button to invoke Current Medication as seen on Facesheet with all its functionality, in a pop up, listing out the 'Old Med' drugs; 'Stopped' Drugs; and 'Over' drugs.
PMH: Display details based on a template defined.
Med Hist: The medical history details are displayed.
Action Buttons
save: Users can click on this button to save a drug added or modified in the patient's prescription. If some drug detail fields are blank i.e. if some drug details are missing for the drug being added to the patient’s prescription, then appropriate alert messages are displayed for the missing details on clicking this button. Similarly, if any validations are applicable for the drug, then appropriate validations messages are displayed on clicking the save button. The drug is moved to the Prescribed Drugs Table only after the missing drug details are entered or changes are made to satisfy the validation condition.
If a clinical staff saves the prescription, the status of the prescription changes to Entered. If a Provider or a person with Approve rights saves the prescription, then the status of the prescription is set to Approved.
- On save, the system checks for:
- Duplicate drug prescribed
- Patient Allergy to Generic Drug
- Patient Allergy to Dispensable Drug
- Allergens
- Cross Sensitivity
- 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.
- 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'.
When Prescriber saves a prescription that has controlled substances, a Summary screen popup is displayed that shows all the CS drugs that are not yet signed. Provider needs to review and mark the individual drugs are ready to sign, and then click on sign.
Note:
Following are the types that are displayed:
- Not Signed: A Controlled Substance prescription which is not digitally signed by provider.
- Signed: A Controlled substance Prescription which a digitally signed by Provider.
- eRx: A non-controlled substance prescription which can be send electronically.
- 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.
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:
a) Encounter → Prescription
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.
b) CPOE → Rx
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.
c) CPOE → Refill 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. 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 receives an alert to approve it. Click on the messages to come to this screen.
e) Message from Patient Portal Once Patient Portal is operational, the provider will receive a Refill request message from the Patient. When provider clicks on the message, the system displays 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.
Print Parameters
The following fields can be defined in Prescription Parameter properties (for example: rx.rx.fields, rx.brf.fields, rx.det.fields and rx.ccd.fields) and its corresponding string or table tags (for example: [ENC_MED_BRF_STR_THIS] and [ENC_MED_BRF_TBL_THIS]) can be used to display respective details in output templates.
| A | Srno (Not in Use) |
| B | Drug Name Generic |
| C | Drug Strength |
| D | Dosage |
| E | Freq Code |
| F | Freq Name |
| G | PRN |
| H | Duration in Days |
| I | Bulk Qty |
| J | Site specified for InHouse Drug under Dispense |
| K | Long Term |
| L | Substitute |
| M | Drug Expiry Date for InHouse under Dispense |
| N | Refills |
| O | Billing Unit |
| P | Sample |
| Q | DEA Class |
| R | Comments |
| S | Default Sig |
| T | Manufacturer for InHouse Drug under Dispense |
| U | Lot No for InHouse Drug under Dispense |
| V | In House or Sample |
| W | eRx eligible |
| X | Reason for prescribing Drug |
| Y | Bulk Dispense Unit |
| Z | Edited Sig |
| 0 | ICD Code |
| 1 | Remarks for Generic Drugs, Sig for Dispensable Drugs |
| 2 | Remarks for Generic Drugs, Sig for Dispensable Drugs |
| 3 | Drug Name Route and Strength |
| 4 | NDC Code for InHouse Drug |
| 5 | RX Norm Code |
| 6 | NDC Code for dispensable drug |
| 7 | Start Date |
| 8 | Status Stopped / Active |
| 9 | Pharmacy Name |
| 10 | Source |
| 11 | Justification |
| 12 | Upto Date |
| 13 | Pharmacy Address This displays Pharmacy Address Line 1, Address Line 2, City, State, and Zip. |
| 14 | Pharmacy Contact This displays the Pharmacy Work Tel1 and Fax. |
| 15 | This displays the timestamp when the drug was saved on the Prescription screen. |
| 16 | This displays the mode through which prescription was sent from the Prescription screen. |
| 17 | This displays the date on which prescription was sent via the above-mentioned mode from the Prescription screen. |
| 18 | This displays canceled drug details suffixed with (Canceled eRx) on the Progress Notes for the encounter. |
| See Also: | Past Medical History | Allergies | Current Medication | Drugs| Supervising Provider | Pharmacy Vendor Master | Preferred Pharmacy |
