Listed below are the requirements for controlled substance
prescription:
- Must be dated and signed on the date of issue
- Patient's full name and address
- Preprinted prescriber's full name, address, and DEA number
- If the prescription form lists multiple prescribers, the form must include a checkbox next to each prescriber's name. The prescriber must check the box next to his or her name when prescribing.
- Drug name and strength
- Dosage form
- Quantity prescribed
- Prescriber must check off the corresponding quantity check-off box
- Directions for use
- Number of refills (if any)
- Number of drugs prescribed
The prescription must be written in ink or typed and must be
manually signed by the prescriber of the date when issued.
How Do I Know I Am
Looking at a Tamper-Resistant Prescription Form?
The following are security features located on the security form that will help you ensure that you have a valid tamper-resistant prescription
form:
- “Prescription is void if the number of drugs prescribed is not noted” must be printed on the bottom of all controlled substance prescription forms.
- "Void" must appear across the prescriptions if it is scanned, photocopied, or faxed.
- Pharmacist must always use their best judgement when receiving a prescription with the "void" pattern
- Printed watermark: "California Security Prescription" on the backside of the prescription blank.
- Protection against chemical alterations. "Void" will appear on any area that is altercated.
- Thermochromic ink that will change color or disappear when exposed to heat
- Opaque writing that disappears when lightened.
- Quantity Check-off Boxes with unit designation
- "Do Not Substitute" Check Box
- Form Batch Numbers: Unique lot number on the forms- each form within a specific batch is number sequentially
Eligible prescribers must order controlled substance prescription forms from companies that have been pre-approved by the Board of Pharmacy and the Department of Justice. These companies are located at http://oag.ca.gov/security-printers/approved-list
http://www.pharmacy.ca.gov/publications/multi_rxform.pdf
http://www.pharmacy.ca.gov/publications/rxform_look.pdf
