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 InformationSpecific ElementsNotes
PrescriberName – 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 PhysicianFor mid-level prescribers, the name of the supervising physician must be clearly indicated. 
PrescriptionDate of Issuance / Date Written 
Date to be Dispensed (In accordance with DEA Rule) 
Controlled SubstanceName 
Dosage Unit 
Strength per Unit 
Quantity of Dosage Units to be Dispensed 
Directions for Use 
Cautionary Statements if Required 
Number of Times to be Refilled 
Brand/InterchangeBelow 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.” 
PatientName (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.

5/4/2012
 


This information is provided by the Drug Control Program within the Department of Public Health.