Prescription Forms Clause Samples

The 'Prescription Forms' clause establishes the requirements and standards for the format and content of prescription documents used within a particular context, such as a healthcare setting or a pharmaceutical agreement. It typically specifies what information must be included on a prescription form, such as patient details, medication instructions, and prescriber identification, and may outline acceptable formats (e.g., electronic or paper forms). By setting these standards, the clause ensures consistency, legal compliance, and reduces the risk of errors or misuse in the prescription process.
Prescription Forms. APRN shall sign and shall issue prescriptions/orders on a form which contains the following: a. The name, address, and telephone number of the delegating physician b. The name of the APRN and the APRN’s DEA number (if applicable) c. The name and address of the patient d. The drug prescribed and the number of refills e. Directions to the patient with regard to taking and dosage of the drug
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Prescription Forms. APRN shall sign and shall issue prescriptions/orders on a form which contains the following: a. The name, address, and telephone number of the delegating physician b. The name of the APRN and the APRN’s DEA number (if applicable) c. The name and address of the patient d. The drug prescribed and the number of refills e. Directions to the patient with regard to taking and dosage of the drug 14 *Professional Drug Samples ((Please choose applicable statement): APRN is authorized by Physician to request, receive and sign for professional samples and may distribute professional samples to patients. APRN is not authorized by Physician to request, receive or sign for professional samples and may distribute professional samples to patients.
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Prescription Forms. The County will provide prescription forms suitable for presentation at commercial pharmacies, and will maintain up-to-date lists of medications covered by the Medicaid program readily available in clinical areas.
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Related to Prescription Forms

  • Prescription Plan The PPO plan will include a comprehensive prescription 37 program: 38

  • Prescription Drug Plan Retail and mail order prescription drug copays for bargaining unit employees shall be as follows:

  • Prescription Drugs This plan covers prescription drugs and diabetic equipment or supplies. When they are purchased from a pharmacy, prescription drugs and diabetic equipment or supplies are covered as a pharmacy benefit. In most cases, when the prescription drug requires administration by a provider other than a pharmacist (or the FDA approved recommendation is administration by a provider other than a pharmacist), the prescription drug is covered as a medical benefit referred to as “medical prescription drugs”. See subsection B: Medical Benefits - Prescription Drugs Administered by a Provider (other than a pharmacist) below for further information. Please see Pharmacy Benefits subsection A and Medical Benefits subsection B below for information about how these prescription drugs are covered. Prescription drugs and diabetic equipment or supplies are covered when dispensed using the following guidelines: • the prescription must be medically necessary, consistent with the physician’s diagnosis, ordered by a physician whose license allows him or her to order it, filled at a pharmacy whose license allows such a prescription to be filled, and filled according to state and federal laws; • the prescription must consist of legend drugs that require a physician’s prescription under law, or compound medications made up of at least one legend drug requiring a physician’s prescription under law; • the prescription must be dispensed at the proper place of service as determined by our Pharmacy and Therapeutics Committee. For example, certain prescription drugs may only be covered when obtained from a specialty pharmacy; and • the prescription is limited to the quantities authorized by your physician not to exceed the quantity listed in the Summary of Pharmacy Benefits.

  • Prescription Glasses This plan covers prescription glasses as follows: • Frames - one (1) collection frame per plan year; • Lenses - one (1) pair of glass or plastic collection lenses per plan year. This includes single vision, bifocal, trifocal, lenticular, and standard progressive lenses. This plan covers the following lens treatments: • UV treatment; • tint (fashion, gradient, and glass-grey); • standard plastic scratch coating; • standard polycarbonate; and • photocromatic/transitions plastic. This plan covers one (1) supply of contact lenses as follows: • conventional contact lenses - one (1) pair per plan year from a selection of • extended wear disposable lenses - up to a 6-month supply of monthly or two- week single vision spherical or toric disposable contact lenses per plan year; or • daily wear disposable lenses - up to a 3-month supply of daily single vision spherical disposable contact lenses per plan year. This plan also covers the evaluation, fitting, or follow-up care related to contact lenses. This plan covers additional contact lenses if your prescribing network provider submits a verification form, with the regular claim form, verifying that you have one of the following conditions: • anisometropia of 3D in meridian powers; • high ametropia exceeding -10D or +10D in meridian powers; • keratoconus when the member’s vision is not correctable to 20/25 in either or both eyes using standard spectacle lenses; and • vision improvement for members whose vision can be corrected two lines of improvement on the visual acuity chart when compared to the best corrected standard spectacle lenses.

  • label Prescription Drugs This plan covers off label prescription drugs for cancer or disabling or life-threatening chronic disease if the prescription drug is recognized as a treatment for cancer or disabling or life-threatening chronic disease in accepted medical literature, in accordance with R.I. General Law § 27-55-1.