REQUIRED ELEMENTS OF A WRITTEN PRESCRIPTION1
M.G.L. Chapter 94C § 22
M.G.L. Chapter 94C § 23
M.G.L. Chapter 112 § 12D
105 CMR 721.000
105 CMR 721.020
Effective July 1, 2013, a written prescription must be on a tamper-resistant form consistent with federal requirements for Medicaid.
The requirement above applies to all written prescriptions for drugs in federal Schedules II-V and Massachusetts Schedule VI. Massachusetts Schedule VI consists of all prescription drugs that are not in federal Schedules II-V.
|Category of Information||Specific Elements||Notes|
|Prescriber||Name – clearly indicated|
(Hospital and clinic forms must contain the name of the facility and a line directly below the signature line for the prescriber to print or type his/her name.)
|Address – clearly indicated|
(Hospital and clinic forms must contain the address of the facility)
|Registration Number (DEA number for Schedules II – V)||May use either DEA number or, for Schedule VI prescription, the MCSR2 number|
|Line for Signature on lower portion of form|
|Supervising Physician||For mid-level prescribers, the name of the supervising physician must be clearly indicated.|
|Prescription||Date of Issuance / Date Written|
|Date to be Dispensed (In accordance with DEA Rule)|
|Strength per Unit|
|Quantity of Dosage Units to be Dispensed|
|Directions for Use|
|Cautionary Statements if Required|
|Number of Times to be Refilled|
|Brand/Interchange||Below the signature line or the line provided for the prescriber to type his/her name there shall be a space in which the prescriber may indicate “no substitution.”|
|Below the space provided for the prescriber to indicate “no substitution,” there shall be printed the words “Interchange is mandated unless the practitioner indicates ‘no substitution’ in accordance with the law.”|
|Patient||Name (unless veterinary prescription or prescription for expedited partner therapy)||For expedited partner therapy, may enter “Expedited Partner Therapy”, “E.P.T.” or “EPT”.|
|Address (unless prescription for expedited partner therapy)||For expedited partner therapy, may leave blank|
1This document reflects Massachusetts requirements. The U.S. Drug Enforcement Administration may have additional requirements for prescriptions for controlled substances in Schedules II - V.
2Massachusetts Controlled Substances Registration.