Elements of a written prescription

Effective July 1, 2013, a written prescription must be on a tamper-resistant form consistent with federal requirements for Medicaid.

Required elements of a written prescription

• 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.

This document reflects Massachusetts requirements. The U.S. Drug Enforcement Administration may have additional requirements for prescriptions for controlled substances in Schedules II - V.

Table of required elements

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 Massachusetts Controlled Substances Registration (MCSR) 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)
Controlled Substance
	Name
	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/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