If a paper CII script is missing date of birth AND patient address, can we just add them on there?

[swatchgirl]

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Is that equivalent to changing the identity of the patient? It's not, right? As long as the full name is written on there, adding the birthday and the address (as given to us by the customer/patient), is fine, right? Do we need to card them to make sure the birthday matches the person, the name and the address on their driver's license? What if the address has been changed, but photo and name matches? Can we just add in the birthday and the new address provided on the license?

The law says we can't touch the first and last name of the patient as written on a CII script, but it doesn't say we can't alter or add on a birthday or address. Right?

 

[BenJammin]

You need to talk to your state board because the DEA contradicted themselves in rules nearly 10 years ago regarding what we can change. Texas says the 4 things you cannot change are the patients name, doctor's signature, the drug, and the written date.

 

[doublehh03]

Is that equivalent to changing the identity of the patient? It's not, right? As long as the full name is written on there, adding the birthday and the address (as given to us by the customer/patient), is fine, right? Do we need to card them to make sure the birthday matches the person, the name and the address on their driver's license? What if the address has been changed, but photo and name matches? Can we just add in the birthday and the new address provided on the license?

The law says we can't touch the first and last name of the patient as written on a CII script, but it doesn't say we can't alter or add on a birthday or address. Right?

Yes you can after validating patient's current valid form of ID. If you have further questions, you can call the prescriber and verify additional information about the identity of the patient.

 

[catalyzt]

this.^^^^^^^^

 

[Sine Cura]

Birth date is not a DEA requirement.

 

[cj98]

I'd say just use your best judgment? Look over the rx to see if everything else looks legit, check ID if it's a new patient, check PMDP system and then write it in. Call dr to verify if something seems off.

 

[ldiot]

It 100% depends on your state. Your state may have more strict requirements than the DEA.

 

[NateRobinson]

There is no field on a prescription for date of birth. There is one for age, but it is not required.

PLEASE don't tell me you turn away patients who probably just got out of the hospital for kidney stones or whatever and prescribed Percocet because their ADDRESS IS MISSING. 95% of doctors are in a rush and don't write in the patients address. They simply don't have the time, nor do they care.

 

[ldiot]

There is no field on a prescription for date of birth. There is one for age, but it is not required.

PLEASE don't tell me you turn away patients who probably just got out of the hospital for kidney stones or whatever and prescribed Percocet because their ADDRESS IS MISSING. 95% of doctors are in a rush and don't write in the patients address. They simply don't have the time, nor do they care.

What if the doctor writes hydrocodone/acetaminophen 5mg. Do you just dispense whatever you feel like, call the MD, or make the MD write the strength? I've seen the same pharmacist in the same situation do all 3 of these things. I'm sure if they were a highly valued emerging leader they would be more consistent.

 

[Niosh]

PLEASE don't tell me you turn away patients who probably just got out of the hospital for kidney stones or whatever and prescribed Percocet because their ADDRESS IS MISSING. 95% of doctors are in a rush and don't write in the patients address. They simply don't have the time, nor do they care.

My wife had a patient turned away from a pharmacy because she didn't write capsules on the script. The same pharmacy has turned patients away for no address too. Since then she's written the patient's phone number in the address spot and wrote capsules as large as she could and then squeezed the rest in around it. Some pharmacists are dicks.

 

[zelman]

My wife had a patient turned away from a pharmacy because she didn't write capsules on the script. The same pharmacy has turned patients away for no address too. Since then she's written the patient's phone number in the address spot and wrote capsules as large as she could and then squeezed the rest in around it. Some pharmacists are dicks.

Yeah. Following the law. What dicks.

 

[Lnsean]

Is that equivalent to changing the identity of the patient? It's not, right? As long as the full name is written on there, adding the birthday and the address (as given to us by the customer/patient), is fine, right? Do we need to card them to make sure the birthday matches the person, the name and the address on their driver's license? What if the address has been changed, but photo and name matches? Can we just add in the birthday and the new address provided on the license?

The law says we can't touch the first and last name of the patient as written on a CII script, but it doesn't say we can't alter or add on a birthday or address. Right?

You can add them.

 

[Niosh]

Yeah. Following the law. What dicks.

What law says they can't write that **** in themselves? What law says you have to send the patient back to the provider to get a new hard copy? Confirm the address with the patient and write it on the script. Problem solved. No need to refuse service and force the provider to print new scripts at a site that she won't be back at for 3 more weeks. Same thing for the capsules, it was even a drug that is only available in capsules. You are wasting your own time, the patients time, and the providers time.

Just in case:

10.21(5) Schedule II prescriptions. With appropriate verification, a pharmacist may add information provided by the patient or patient’s agent, such as the patient’s address, to a Schedule II controlled substance prescription. A pharmacist shall never change the patient’s name, the controlled substance prescribed except for generic substitution, or the name or signature of the prescriber. After consultation with the prescriber or the prescriber’s agent and documentation of such consultation, a pharmacist may change or add the following information on a Schedule II controlled substance prescription:
a. The drug strength;
b. The dosage form;
c. The drug quantity;
d. The directions for use;
e. The date the prescription was issued; and
f. The prescriber’s address or DEA registration number.

 

[croquemonsieur]

So many threads. So little capacity for personal judgement.

 

[sosoo]

if u can come up with a reason to deny service, do it. tell them your reason for denial. that way next time, n each n every time they come back, its all filled in. train them the same way u train your techs.

 

[Niosh]

if u can come up with a reason to deny service, do it. tell them your reason for denial. that way next time, n each n every time they come back, its all filled in. train them the same way u train your techs.

I wouldn't return to you if you refused me service because the address wasn't on my script.

 

[owlegrad]

I wouldn't return to you if you refused me service because the address wasn't on my script.

Then he won. Obviously the point is he doesn't want to fill the script in the first place.

Sent from my SAMSUNG-SM-G920A using SDN mobile

 

[Sine Cura]

These days, the vast majority of those who intentionally generate invalid hard copy controlled scripts tend to practice at community clinics, or are dentists or pill mill prescribers. "Forcing the provider to print new scripts," wut. Sounds like someone who just uses the same pad regardless of the actual address of the practice site

 

[hye345]

I almost never see a C2 script with the patient's address on it... I always confirm with the patient and fill it in myself. As far as the birthday, I have seen a couple of scripts that had the patient's age ,but not month and day; I fill these in as well. Can't recall if I have ever seen a script that was missing any age info though...

 

[Niosh]

These days, the vast majority of those who intentionally generate invalid hard copy controlled scripts tend to practice at community clinics, or are dentists or pill mill prescribers. "Forcing the provider to print new scripts," wut. Sounds like someone who just uses the same pad regardless of the actual address of the practice site

The pharmacist would not allow the address to be written on a script that was otherwise printed. She uses whatever computer system that prints a hard copy on special paper that she then signs with ink. This pharmacist would allow no modifications to the hard copy.

 

[Sine Cura]

If you have a printer, why can't it print the patient's address? Why even bother to print the DEA number? We can modify that (except in CA among other states). These aren't blanks where you have to write in everything

 

[Niosh]

It probably can print the address, but just because it didn't doesn't mean you can't fill it. Same for DEA #, call the office and confirm, write it on the script and fill it.

 

[Deja]

My wife had a patient turned away from a pharmacy because she didn't write capsules on the script. The same pharmacy has turned patients away for no address too. Since then she's written the patient's phone number in the address spot and wrote capsules as large as she could and then squeezed the rest in around it. Some pharmacists are dicks.

was it one of those C2s that have different forms but not interchangeable?

 

[radio frequency]

It probably can print the address, but just because it didn't doesn't mean you can't fill it. Same for DEA #, call the office and confirm, write it on the script and fill it.

Yes, this is all doable -- but really, prescribers should get this right. We don't have time to fix this all day log; there are enough actual errors and scripts to fill that fixing the prescriber's annoying DEA and address omission is just a big inconvenience when multiplied by a large script volume. I've had offices where I call multiple times requesting that they get this stuff correctly written on their prescriptions...no dice; they continue to screw it up over and over. I don't have time to deal with wilfully defiant prescribers. Some computer systems don't make it super easy to rescan the prescription and frankly we just don't have the time.

I haven't denied people based on this in the past, but I've often felt it would work well if done once or twice to ensure the prescriber stops missing key info on their prescriptions.

 

[Sine Cura]

If it's a blank, fine. If there's a PO box or it says "homeless," fine, we'll get a physical address. If you can print everything and don't even bother, **** that ****.

 

[swatchgirl]

What if the doctor writes hydrocodone/acetaminophen 5mg. Do you just dispense whatever you feel like, call the MD, or make the MD write the strength? I've seen the same pharmacist in the same situation do all 3 of these things. I'm sure if they were a highly valued emerging leader they would be more consistent.

In that case, I would consistently dispense the 5/325 strength without calling the prescriber. I've concluded that stressing over minor stuff like this is not worth my time or my health. Doctors need to take some of that "corresponding responsibilities" too by writing complete medication names and strengths. If they go with the short-handed way (writing hydrocodone/apap 5 instead of hydrocodone/apap 5/325), then I'll interpret it as the first thing that comes to mind. As long as the Sig checks out, the dosing is below or equal to the maximum dosages allowed, I'll fill it.

 

[sunakuma]

In that case, I would consistently dispense the 5/325 strength without calling the prescriber. I've concluded that stressing over minor stuff like this is not worth my time or my health. Doctors need to take some of that "corresponding responsibilities" too by writing complete medication names and strengths. If they go with the short-handed way (writing hydrocodone/apap 5 instead of hydrocodone/apap 5/325), then I'll interpret it as the first thing that comes to mind. As long as the Sig checks out, the dosing is below or equal to the maximum dosages allowed, I'll fill it.

So if this Rx is being audit, will you get in trouble? Is this legal? (I know lots of time things done in pharmacy does not all follow the laws all the time). But what kind of trouble would you get in if this is found?

I also experience C2 script missing either dob or address a lot, and we just ask patient and write down ourselves, never call doctor.

Another question---if the C2 is missing the Date written, we hand it back to patient. But we won't know for sure, if pt bring this back to doctor, or they just write a date on it by themselves. If patient bring it back, we just fill it or call MD office to confirm?

 

[doublehh03]

So if this Rx is being audit, will you get in trouble? Is this legal? (I know lots of time things done in pharmacy does not all follow the laws all the time). But what kind of trouble would you get in if this is found?

I also experience C2 script missing either dob or address a lot, and we just ask patient and write down ourselves, never call doctor.

Another question---if the C2 is missing the Date written, we hand it back to patient. But we won't know for sure, if pt bring this back to doctor, or they just write a date on it by themselves. If patient bring it back, we just fill it or call MD office to confirm?

Well, if it's a new patient, then I will call. Most of the time I've it's not so if they have had 5/325 before, I'll just dispense that. I don't think you can get in trouble unless the patient specifically requests 5/300 and you dispense 5/325 (say their history has had one strength, and you dispense the other without verifying with prescriber)

Well look at the handwriting and the ink. Usually doctors will initial it since they know we sent it back to be filled out. If a customer brings it back 5-10 mins later, then you knw they did it themselves and that makes the script invalid. I've caught a few customers do that and I told them this is now an invalid prescription and they have to get a brand new one.

 

[ldiot]

In that case, I would consistently dispense the 5/325 strength without calling the prescriber. I've concluded that stressing over minor stuff like this is not worth my time or my health. Doctors need to take some of that "corresponding responsibilities" too by writing complete medication names and strengths. If they go with the short-handed way (writing hydrocodone/apap 5 instead of hydrocodone/apap 5/325), then I'll interpret it as the first thing that comes to mind. As long as the Sig checks out, the dosing is below or equal to the maximum dosages allowed, I'll fill it.

Yeah that's what I was kind of thinking.

Does it affect the patient?
Is it reckless/negligent?

If both are no then who cares. I've seen pharmacists switch inhalers and stuff like that for years without an issue and others that go out of their way to make their day miserable at no benefit to the patient or themselves.

 

[owlegrad]

...others that go out of their way to make their day miserable at no benefit to the patient or themselves.

Yeah, I hate that. Why oh why would you make more work for yourself? Craziness. I used to have a PIC who always had a stack of scripts that needed "clarifying". I would say a solid half the time I would just go through and "fix" them myself. But you know, to each their own.

 

[ldiot]

Yeah, I hate that. Why oh why would you make more work for yourself? Craziness. I used to have a PIC who always had a stack of scripts that needed "clarifying". I would say a solid half the time I would just go through and "fix" them myself. But you know, to each their own.

Yeah I always just do what I'm told because it's not my license... but calling back on voicemails because the nurse didn't leave her last name... waste of time.

 

[CetiAlphaFive]

In that case, I would consistently dispense the 5/325 strength without calling the prescriber. I've concluded that stressing over minor stuff like this is not worth my time or my health. Doctors need to take some of that "corresponding responsibilities" too by writing complete medication names and strengths. If they go with the short-handed way (writing hydrocodone/apap 5 instead of hydrocodone/apap 5/325), then I'll interpret it as the first thing that comes to mind. As long as the Sig checks out, the dosing is below or equal to the maximum dosages allowed, I'll fill it.

A Target pharmacist in Houston got nailed by TSBP because the ER M.D. wrote a brand name that necessitated a certain strength, but the nurse told them it should be 5/325.

Can't change name = can't change strength or do "the usual" in some cases.

 

[swatchgirl]

A Target pharmacist in Houston got nailed by TSBP because the ER M.D. wrote a brand name that necessitated a certain strength, but the nurse told them it should be 5/325.

Can't change name = can't change strength or do "the usual" in some cases.

So you mean that nurse gave out the wrong strength? It's best to talk to the MD directly if the CII script is lacking a strength?

 

[CetiAlphaFive]

So you mean that nurse gave out the wrong strength? It's best to talk to the MD directly if the CII script is lacking a strength?

Nope, it was a triplicate from the ER.

This M.D. would always write for "Vicodin 5mg" to increase the cost and deter gomers from trying him.

One resourceful RPh called the ER to double check the strength and encountered the charge nurse "Ida Givvacrap" who said "yeah, 5/325 who cares"

M.D. later finds out that 5/325 was dispensed instead of 5/300 and files a complaint with the board.

Board took a dump on the RPh claiming he had changed the name of the drug by dispensing a generic for norco or lortab instead of vicodin.

 

[swatchgirl]

Nope, it was a triplicate from the ER.

This M.D. would always write for "Vicodin 5mg" to increase the cost and deter gomers from trying him.

One resourceful RPh called the ER to double check the strength and encountered the charge nurse "Ida Givvacrap" who said "yeah, 5/325 who cares"

M.D. later finds out that 5/325 was dispensed instead of 5/300 and files a complaint with the board.

Board took a dump on the RPh claiming he had changed the name of the drug by dispensing a generic for norco or lortab instead of vicodin.

I thought brand "Vicodin 5" only comes as 5/300, why did the pharmacist need to call the nurse about it? And what happened to the RPh? Did he get fined? Did the charge nurse not share some of that responsibility? Since it's always so difficult to get ahold of the MDs, if the doctors' nurses are the doctors' designated speakers then these nurses should be on the same page as the doctors. If not, then whose fault is that?

 

[catalyzt]

I imagine the nurse probably didn't get penalized by the board. The pharmacist likely called about the strength because doctors (at least in my area) are notorious for getting Norco and Vicodin mixed up (i.e. not realizing that Vicodin now only comes as 5/300 and not 5/325).

 

[CetiAlphaFive]

I thought brand "Vicodin 5" only comes as 5/300, why did the pharmacist need to call the nurse about it? And what happened to the RPh? Did he get fined? Did the charge nurse not share some of that responsibility? Since it's always so difficult to get ahold of the MDs, if the doctors' nurses are the doctors' designated speakers then these nurses should be on the same page as the doctors. If not, then whose fault is that?

That I'm not sure of. This is all a third hand account, and I'm sure I got some of the details wrong.

However, when I called compliance at my board, they confirmed the base concept:
In Texas, if brand A is drug X in N mg, you cannot change the mg to that of Brand B, even though it is also drug X simply in a different mg.