1. Dispensable Drug Pref - Preferred
2. Dispensable Drug - All
3. Order Set
4. Comprehensive Drug Search

Prescription Action Panel

• Date: Displays the date on which the appointment was scheduled.
• 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 Attending Provider for the appointment.
• Encounter Type: Displays the encounter type selected for the appointment.
• Comments: Displays comments added for the appointment, if any.

• 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).

• 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.

ePA:

• Select: Users can check the checkbox associated with a drug to select it.
• 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. Users can also add drugs to the prescription directly by clicking the icon.
• Request Dt: Displays the date when the Electronic Prior Authorization request was submitted.
• ICD codes: Displays the ICD codes associated with the selected drug. ICD codes from the Assessment screen can be associated with drugs in this popup directly 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 the To Rx checkbox is selected for that drug, those ICD codes are associated with the drug and are reflected on the Prescription screen.
• Priority: Users can check this checkbox and then click the ePA REQUEST button to notify Surescripts that the ePA request is urgent.
• PBM: Displays the Pharmacy Benefit Manager name from the selected Eligibility.
• Plan:
Displays the Plan name from the selected Eligibility.
• Response: Displays the response to the 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 notes or comments received from Surescripts.
• PA No.: Displays the Prior Authorization Number received from Surescripts once the ePA is approved.
• ePA REQUEST button: Click the ePA REQUEST button to send an ePA request for a drug to Surescripts.

Properties:

Prescription Table

• 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.

• Patient Preferred Pharmacy: Displays a list of the patient’s preferred pharmacies. If a pharmacy is selected from this list, 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 the Preferred Pharmacy icon and select up to 10 pharmacies from the corresponding selection popup.
• Prescription Screen: Click 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.

• The related Valid Upto date is calculated for a refilled drug only when the No. of Days is present.
• When providers need to prescribe a prescription intended to start on a future date, the system sends this as additional information in the comments to Surescripts during ePrescribing. The user is first prompted with an alert indicating that the Prescription Start Date is a future date, and asked whether they would like to include this information in the comments during ePrescribing. If the user confirms, the Start Date will appear under the Comments column in the ‘Rx(s) for transmission’ popup. Clicking ‘Send’ ePrescribes the selected drug and sends it to the relevant pharmacy.

• If this option is selected for a drug, an Update adds the prefix ‘Denied’ to the Pharmacy Notes entered.
• A denied drug can be printed or faxed, but cannot be sent via eRx. Denied drug names are printed with the prefix ‘Denied’.
• Denied drugs are not displayed on the Current Medication list, but are part of the patient’s Past Rx.

• If a Cash Offer is applicable, a green $ indicator is shown.
• If a Copay Offer is applicable, a blue $ indicator is shown.
• If a Patient Enrollment Program is applicable, an orange $ indicator is shown.
• If Patient Support is applicable, a yellow $ indicator is shown.

Prescription Columns

1. The user adds a drug and clicks the update button.
2. The user adds a drug and presses the Enter key on the keyboard.
3. The user adds a drug and directly clicks 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.
4. The user adds a drug and clicks on another row in the Prescribed Drugs Table without clicking save or update. After the drug is saved, the user is automatically navigated to the row they clicked on. The save button remains enabled in this case and the user can add or modify another drug.
5. The user adds a drug and clicks the Past Rx button. The drug is saved, and the Medication List popup opens.

• Mark the drugs in the prescription that need to be sent to Printer, Fax, or eRx.
• By default, a newly added drug is selected. Note that if multiple selected drugs are sent, they will all be sent to the Pharmacy.

• This column displays the type of the drug – whether it is InHouse, eRx, Signed, or Not Signed. The following types apply to change requests, cancel Rx, and Rx Fill:
1. CHGREQ - Change request received for a drug from Pharmacy to Prescriber.
2. CHGRES_A - Approved change response for a drug sent by Prescriber to Pharmacy.
3. CHGRES_C - Approved change response for a drug with changes sent by Prescriber to Pharmacy.
4. CHGRES_D - Denied change request sent by Pharmacy to Prescriber.
5. CANREQ - Cancel request sent for a drug from Prescriber to Pharmacy.
6. CANRES_A - Approved cancel response for a drug from Pharmacy to Prescriber.
7. CANRES_D - Denied cancel response for a drug from Pharmacy to Prescriber.
8. RXFILL_F - Rx fully dispensed from Pharmacy to Prescriber.
9. RXFILL_PF - Rx partially dispensed from Pharmacy to Prescriber.
10. RXFILL_NF - Rx not dispensed from Pharmacy to Prescriber.

• Displays the Drug name and Strength.
• Drug names are displayed in Bold if they are InHouse. A check mark prefix is shown if the drug has already been sent.
• A red prefix is displayed if eRx is applicable.
• Formulary status of the drug is displayed with a Formulary Status: label in black and the status in blue. The formulary status is also displayed in the tooltip.
• Prescribing a Controlled Substance (CS) drug involves additional steps for ePrescribing. The Prescriber must sign the Prescription and the Prescribing provider has to keep the eToken connected to the USB drive of their 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 are considered. Drug-Drug interaction considers the prescribed drugs and Current Medication drugs for interaction. These checks are performed using the algorithms of FDB.
• Duplicate drugs are not allowed. For all other allergies, only a warning is displayed and the provider is not prevented from prescribing the drug.
• The system also checks for precautions and displays appropriate warnings.
• If there are any unapproved drugs in the list, the user (provider) with Approve rights can approve all of them by clicking ‘Save’. The ‘Save’ button is enabled only when the Prescription screen has any unapproved drugs in the list. The user (clinical staff) without Approve rights can only enter drugs on this screen; these entered drugs are approved by the provider.

Note:

Access Control

Users can reach this screen by several routes:

a) Encounter → Prescription

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

b) CPOE → Rx

If there is no current patient encounter, this option is disabled. If one is present, it is equivalent to taking the Encounter → Prescription route.

c) CPOE → Refill The Provider or Clinical Staff would receive a call from a patient requesting a Refill. The objective is to complete the process as quickly as possible. Clicking this option displays a Patient selection search popup. 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 drugs for deletion if they do not intend to order them. The provider can also add supporting drugs by clicking the button, adding new rows, or selecting any drug from the past Rx tab. Note the subtle difference: the Rx tab was populated with only the drugs from the previous encounter, while the past Rx tab displays all drugs prescribed to the patient across all encounters in the past six months. This six-month period is a default property and can be changed. Save the prescription, then click Send to send it to the Pharmacy. The system automatically closes the encounter. However, if the user navigates to another option in PrognoCIS without completing the Approve and Send steps, the encounter remains open (it appears on the Provider’s Home page) and must be handled like any other open encounter.

Note:

• A copy of the Refill Request is also sent to the Provider’s assistant along with the recipient Provider, if the property rx.refill.msg.send2assistant is set to ‘Y’. The property overrides the existing property mail.cc.A open encounter. The Denied Refill Request (from the Portal as well as the System) is tracked and displayed individually on the 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 must be ‘1’.

d) Message to Approve

If a clinical staff member has created a prescription, the provider receives an alert to approve it. Click the message to open this screen.

e) Message from Patient Portal Once the Patient Portal is operational, the provider will receive a Refill request message from the Patient. When the provider clicks the message, the system displays an error if there is any open encounter for that patient. If there is no open encounter, the provider will be taken to this prescription screen and a new encounter will be created. The Rx Tab will be displayed, populated with the drugs requested by the Patient. The provider can then add, remove, or edit drugs as needed, then save and send to the Pharmacy. The encounter is automatically closed, and a message is sent to the 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 their corresponding string or table tags (for example: [ENC_MED_BRF_STR_THIS] and [ENC_MED_BRF_TBL_THIS]) can be used to display the 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 the prescription was sent from the Prescription screen.
17	This displays the date on which the 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