Prescriptions

Front 1

Patient Information

Back 1

~Name
~Address
~ Age (required on triplicate or "official"
~Weight
~ Time

Front 2

Superscription

Back 2

~Symbol for prescription~ lines up other parts of the script

Front 3

Inscription

Back 3

~Drug name
~Dose
~Dose form

Front 4

Subscription

Back 4

~Quantity to be dispensed
(for controlled substances write in numbers and letters ex. #24(twenty four)
~Special Compounding instructions

Front 5

Signa

Back 5

~Route of administration
~Number of dosage units per dose
~Frequency of dosing
~Duration of dosing
~Purpose of medication
ex: Sig: take two tablets by mouth every 6 hrs as needed for pain
~Special Instructions
~Warnings

Front 6

Refills and Date Prescribed

Back 6

~ Indicate either no refills or the number you want
~ Date the prescription
~All prescript. expire after one year
~Schedule II drugs/within 7 days

Front 7

Expirations/Refills

Back 7

~ CV-CIII can be refilled for 5 time in 6 mo. maximum
~Automatic stop orders (inpatient)
antibiotics-7days controlled subst 3 days

Front 8

DEA/ Signature

Back 8

~needed on any controlled subst.
~ Makes script legal, include your degree
~must write "brand necessary" to get non-generic agent

Front 9

Stamp

Back 9

~ your name
~ address
~ phone/beeper
~ For controlled subst: DEA printed/stamped on Rx