Example Syringe Prescription Example Pediatric Prescription Medical Abbreviations to Avoid

DEA# BH88888888-123
Unlicensed Residents use
Institutional DEA # with
your unique hospital issued
3 digit suffix attached
JOHN SMITH
Name: ________________________
2 Main Street, NY 10000
Address: _______________
License # 123456 NPI # 1234567891 DEA# BH88888888-123 License # 123456 NPI # 1234567891 DO NOT USE POTENTIAL PROBLEMS/ WRITE THIS
MISTAKEN FOR: INSTEAD:
or or
Attending physician’s Unlicensed Residents use Attending physician’s U (unit) Zero, “4,” or “cc” “unit”
Resident Physician M.D. Institutional DEA # with Resident Physician M.D.
Prime Example Hospital name, license, NPI your unique hospital issued Prime Example Hospital name, license, NPI IU (international unit) IV or “10” “international unit”
3 digit suffix attached
1 Main Street 1 Main Street
QD (daily) “daily” or
NY, NY 10000 NY, NY 10000 QOD (every other day)
Confused for one another
“every other day”
(888) 888-8888 (888) 888-8888
Never write a zero by
___ 9/12/1985
DOB: ___________________________ MIKE SMITH
Name: ________________________ ___ 9/15/2003
DOB: ___________________________ Trailing zero (X.0mg) itself after a decimal
__________ 24
Age: _____________________________ 2 Main Street, NY 10000
Address: _______________ __________ 6
Age: _____________________________ Lacking of leading zero Decimal point is missed point (4 mg) and always

Rx
use a zero before
Male
Sex: _________________________
4/15/10
Date: _______________
____
______________
NKDA
Allergies: _____________________
25kg
Weight: _______________
___
___________
Male
Sex: _________________________
4/15/10
Date: _______________
____
______________
(.Xmg)
decimal point (0.4 mg)
Preventing Prescribing Errors:
Rx
MS Confused for one another
Volume: 1ml syringes Drug: Amoxicillin “morphine sulfate” A Guide to Writing Safe and Complete Prescriptions
MSO4 and MgSO4 Morphine sulfate or
“magnesium sulfate”
Diameter: 31 Gauge Strength/Dosage form: 250mg/5ml Suspension magnesium sulfate
Length: 5/16” needle Sig: Take 1 tsp po bid x 5 days
Qty: 100 syringes Qty: 50ml HS (half strength
Confused for one another
“half strength” This pocket card includes examples of complete prescriptions for commonly
or bedtime) “bedtime” prescribed drugs and devices. To meet all regulatory requirements and
Sig: Use syringe to inject insulin subcutaneously TID Indication: acute otitis media
Indication: Insulin dosing Dosing calculation used: (10mg/kg)(25kg)=250mg avoid pharmacy call-backs, be sure that prescriptions include all items in red.
TIW (for three times Three times a day Handwritten prescriptions are prone to error and misinterpretation –
“3 times weekly”
weekly) or twice weekly
Resident Physician Resident Physician consider utilizing electronic prescribing systems when available.
_______________________ _______________________
(Signature) (Signature) SC or SQ (for “Sub-Q” or Note: Contents current through May 2010. For the most current information on prescribing
SL for sublingual or 5 every
subcutaneous) “subcutaneously”
regulations and processes visit:
THIS PRESCRIPTION WILL BE FILLED THIS PRESCRIPTION WILL BE FILLED n Drug Enforcement Agency
GENERICALLY UNLESS PRESCRIBER WRITES GENERICALLY UNLESS PRESCRIBER WRITES D/C (for discharge) Interpreted as discontinue “discharge” http://www.deadiversion.usdoj.gov; (800) 882-9539
“d a w” IN THE BOX BELOW “d a w” IN THE BOX BELOW n Expanded Syringe Access Program, NYSDOH
CC (for cubic centimeter) U (units) when poorly written “ml” or “milliliters”
Refills: __________
5 “Five” “DAW” in box if brand Refills: __________
0 “zero”
“DAW” in box if brand http://www.health.ny.gov/diseases/aids/harm_reduction/needles_syringes; (518) 402-0707
desired. Must also include desired. Must also include
AS/AD/AU (for left, “left,” “right,” n Medicaid, NY
statement “Brand Medically statement “Brand Medically OS, OD, OU, etc.
Necessary” if brand desired *0-write out “zero” Necessary” if brand desired right, both ears) or “both” ears http://www.health.ny.gov/health_care/medicaid/program/pharmacy.htm; (518) 486-3209
*0-write out “zero”
*1-11: write (“one”, for Medicaid. *1-11: write (“one”, for Medicaid. n Narcotic Enforcement, NYSDOH
“two”, etc.) “two”, etc.) http://www.health.ny.gov/professionals/narcotic; (518) 402-0708
*PRN=1 Refill Dispense as written *PRN=1 Refill Dispense as written > (Greater than)
“7” or “L”
“greater than”
n Office of Professions, NYSED
< (Less than) “less than”
http://www.op.nysed.gov/prof/pharm/; (518) 474-3817
n NYS Medicaid Manual for Pharmacy Providers
Abbreviations for http://www.emedny.org/ProviderManuals/Pharmacy/index.html
Similar drug entire drug name
NOTES: Expanded Syringe Access Program (ESAP) allows adults (18+) to purchase These illustrations are for educational purposes drug names
up to 10 syringes without prescription. See link on front panel. only. Official New York State prescription pads NOTES: This guide was created by IPRO for the New York State Department of Health as a result
@ (at) “2” “at”
Pre-Filled Syringes appear with slightly different formatting. 1 lb = 0.45 kg of a project funded by a grant from HRI. The grant was a part of a settlement by the
When prescribing pre-filled drug syringes (e.g. insulin pens, etc) refer to product http://www.jointcommission.org/PatientSafety/DoNotUseList – Updated 3/5/09 NYS Attorney General and Cardinal Health.
1 kg = 2.2 lbs
package insert to obtain information on available dosage forms, concentrations, Follow us on: health.ny.gov | facebook.com/NYSDOH | twitter.com/HealthNYGov | youtube.com/NYSDOH
package sizes, and administration instructions. 1418 New York State Department of Health 8/11
Example Non-Controlled Substances Prescription Example Controlled Substances (CII-CV) Prescription Medicaid Requirements/Restrictions Oral Order Instructions
DEA# BH88888888-123 License # 123456 NPI # 1234567891 DEA# BH88888888-123 License # 123456 NPI # 1234567891 n NPI – NPI is needed for prescription claims
n DMEPOS Claims – NY Medicaid requires diagnosis code to be ORAL QUANTITY
or or ORDERS ALLOWED COMMENTS
Unlicensed Residents use Attending physician’s Unlicensed
UnlicensedResidents
Residents use Attending physician’s present on all durable medical equipment, prosthetics, orthotics
Institutional DEA # with Resident Physician M.D. use Institutional
Institutional DEADEA #
# with Resident Physician M.D. and supplies (DMEPOS) claims
your unique hospital issued Prime Example Hospital name, license, NPI with your unique
your unique hospital issuedissued Prime Example Hospital name, license, NPI Pharmacist must notify NYSDOH within 7
3 digit suffix attached 3 3digit
digitsuffix
suffixattached
attached n Date written – Prescriptions expire 180 days from date written CII/Benzo 5 Days days of dispensing if no cover on oral order
1 Main Street 1 Main Street
NY, NY 10000 NY, NY 10000 (i.e. 6 mos)
(888) 888-8888 (888) 888-8888
30 Days or
n Quantity – 90 day quantity is allowed for many chronic medications Pharmacist must note lack of cover on
CIV 100 doses
JOHN SMITH
Name: ________________________ ___ 9/12/1985
DOB: ___________________________ JOHN SMITH
Name: ________________________ ___ 9/12/1985
DOB: ___________________________ (with 1 refill, total 6 months of therapy) (whichever oral order
2 Main Street, NY 10000
Address: _______________ __________ 24
Age: _____________________________ 2 Main Street, NY 10000
Address: _______________ __________ 24
Age: _____________________________ n Refills – 5 refill maximum for other prescriptions (total 6 months is less)
NKDA
Allergies: _____________________ ___ Male
Sex: _____________________________ NKDA
Allergies: _____________________ ___ Male
Sex: _____________________________
165 lbs
Weight: _______________ ___________ 4/15/10
Date: _______________
______________ 165 lbs
Weight: _______________ ___________ 4/15/10
Date: _______________
______________
of therapy)
Pharmacist must note lack of cover on

Rx Rx
CIII/CV 5 Days oral order
Drug: oxycodone/acetaminophen *No pre/post dating allowed-- Controlled Substance Instructions
Drug: Lisinopril Strength/Dosage form: 2.5mg/325mg tab date must reflect date signed
Strength/Dosage form: 10mg tablet Sig: Take 1 tab po q6hrs prn pain n Rx CANNOT be written if patient has >7 day supply of drug from Syringes and 100 Units Pharmacist must note lack of cover on
Sig: Take 1 tab po daily Qty: 360 “three hundred sixty” Needles oral order
MDD: 4 tabs
any previous fill of the same strength & dosage
Qty: 30 tabs
Indication: Hypertension Days Supply: 90 days n Rx is only valid for 30 days from the date written
Code: D Code required if >30 day
n MDD = Max Daily Dose For All the Above
supply. See next page
Resident Physician Indication: Pain n Without code/condition, limited to a 30 day supply
_______________________ n The pharmacy must receive a hard copy of the prescription
n With code/condition
(Signature) Resident Physician
_______________________ within 72 hours of oral order
n Can write for >30 day supply, but only 1 refill is allowed
THIS PRESCRIPTION WILL BE FILLED (Signature) n Refills are NOT allowed on oral orders for the items addressed
n Except CII/Benzo – no refills allowed
GENERICALLY UNLESS PRESCRIBER WRITES n Up to 3 month supply allowed (6 months for anabolic steroids) above
“d a w” IN THE BOX BELOW THIS PRESCRIPTION WILL BE FILLED
GENERICALLY UNLESS PRESCRIBER WRITES n Faxed orders for controlled substances follow the same rules
“DAW” in box if brand
Refills: __________
5 “Five” “d a w” IN THE BOX BELOW as oral orders and are allowed for emergency supply only,
desired. Must also include Codes Required for >30 Day Supply
statement “Brand Medically Refills: __________
0 “zero” “DAW” in box if brand unless recipient is in a qualified hospice program or residential
Necessary” if brand desired desired. Must also include
*0-write out “zero”
*1-11: write (“one”, for Medicaid. statement “Brand Medically
of Controlled Substances healthcare facility.
Dispense as written * PRN Refills= Not Allowed Necessary” if brand desired
“two”, etc.)
* CII, Benzo, Anabolic Steroids- for Medicaid.
*PRN=1 Refill
no refills allowed, write “zero” Dispense as written
Code A – Panic Disorders
* CIII, IV, V-max 5 refills, write Code B – Minimal brain dysfunction or ADHD
as “one”, “five”, etc.
Code C – Chronic, debilitating neurological condition
Code D – Pain from conditions or diseases chronic or incurable
This pocket card includes examples of complete prescriptions for commonly prescribed These illustrations are for educational purposes Code E – Narcolepsy
drugs and devices. To meet all regulatory requirements and avoid pharmacy call-backs, only. Official New York State prescription pads Code F – Hormone Deficiency
be sure that prescriptions include all items in red. appear with slightly different formatting.