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.

Table of Contents

Required 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.

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

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