Prescription Processing, Dispensing, and Recordkeeping
Items here test whether a prescription is legally valid, whether it may be filled or refilled, how it moves between pharmacies, and what must be recorded and printed.
Validity
A prescription must identify the patient, drug, strength, dosage form, quantity, directions, date, and prescriber, with the prescriber's address, DEA number if controlled, refills authorized, and signature (electronic counts). The prescriber must be licensed and acting within scope. Prescriptions lacking required elements should be verified with the prescriber and the contact documented.
Transmission
- Electronic: EPCS prescriptions must meet DEA two-factor authentication and audit requirements. Colorado mandates electronic prescribing of controlled substances subject to statutory exceptions; a pharmacist may still receive a compliant paper or oral order in those cases.
- Oral: permitted for most drugs. A CII may be taken orally only in a genuine emergency, must be reduced to writing immediately, and the prescriber must supply a written prescription within seven days.
- Fax: permitted; faxed CIIs are limited to federal exceptions such as long-term care, hospice, and compounding.
Refills and transfers
Non-controlled prescriptions may be refilled only as authorized. CIII-V: maximum five refills within six months of issue. CII: no refills-a new prescription is required. Transfers must be documented with both pharmacies, drug, quantity, refills remaining, dates, and pharmacist identities; CII transfers are restricted.
Records and labels
Prescription records must be retrievable, legible, and retained for the Board-required period, and produced on request for inspectors. CII hard copies are retained; CIII-V may be electronic with the required information. Labels must include pharmacy name, address, and phone; prescription number; fill date; patient name; prescriber; drug name, strength, and quantity; directions; beyond-use or expiration date; pharmacist initials; refills remaining; and required auxiliary warnings.
Worked example
A hospice nurse calls in morphine 20 mg/mL, 1 mL every 4 hours PRN, 100 mL. Analysis: an oral CII is permitted only in an emergency; hospice is a recognized fax exception, but the oral order still requires immediate reduction to writing and a follow-up written prescription within seven days. The pharmacist documents the emergency, the caller's identity, and the follow-up.
Traps
- Refilling a CII or exceeding authorized non-controlled refills.
- Accepting a routine oral CII.
- Missing the prescriber's DEA number or address.
- Omitting the beyond-use date on a label.
- Transferring without a written record.