Talk:Medical prescription

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Definition of Prescriptions[edit]

In the referenced article Belknap et al, the first line of the abstract provides the definition of prescription. This has become garbled with successive edits. I have corrected the cited definition and restored the reference to the article.

The change from the old "compounding prescription" to the new "instructions to the patient" prescription is a matter of historical fact. The sentence about "legal implications" would seem to belong at the end of the paragraph, otherwise the text is garbled. I have restored the text for this section to its previous version. If there is something you disagree with, please post your explanation. Thanks. Sbelknap (talk) 20:52, 5 May 2009 (UTC)[reply]

I note that all attempts to include description of electronic prescriptions, including referenced material are promptly deleted, this time by "medpeds". Given current trends, electronic prescriptions will largely supplant paper prescriptions over the next few years. Is there a reason why "medpeds" is deleting the electronic prescribing description? —Preceding unsigned comment added by Sbelknap (talk • contribs) 21:37, 29 September 2009 (UTC)[reply]

Self-prescribed medication?[edit]

Don't know if this is relevant enough to include in the article, but I was wondering if an MD can write a prescription for his or herself. Are there any limitations as to what can be self-prescribed?

My Jurisdiction (New Zealand), makes it clear that although legal, this is unwise and may produce questions about a doctor's practice. The medical council (regulatory body) has a policy that strongly discourages Doctors from prescribing for themselves and their families, and points out that if they do, then their care must be of the same standard as care of any other patient in terms of keeping notes, appropriate knowledge and experience etc. Egmason 20:46, 3 January 2007 (UTC)[reply]

In the United States, the standard of practice is that a prescriber should have a "provider-patient" relationship with the recipient of any prescription (explicitly regulated for controlled substances, regulated for any drug per most state laws, and implicit everywhere). This means that prescribing for family, friends, and self is a grey area at best. In practice, it is discouraged, but not forbidden, and opens providers up to criminal and civil liability. — Preceding unsigned comment added by Jojousa (talk • contribs) 04:18, 17 September 2014 (UTC)[reply]

In UK this was fairly common practice as recently as 1990s but has become actively discouraged. In part this was to prevent prescription of psychoactive medications for self. Additionally it is frowned upon (or worse the GMC, General Medical Council, may invite you to justify yourself) if you prescribe for relatives. These changes in attitude coincide with the GMC adding " 30 You should be registered with a general practitioner outside your family." to its guidelines for Good Medical Practice.Cite error: The <ref> tag has too many names (see the help page).

4040. (a) "Prescription" means an oral, written, or electronic transmission order that is both of the following:
(1) Given individually for the person or persons for whom ordered that includes all of the following:
(A) The name or names and address of the patient or patients.
(B) The name and quantity of the drug or device prescribed and the directions for use.
(C) The date of issue.
(D) Either rubber stamped, typed, or printed by hand or typeset, the name, address, and telephone number of the prescriber, his or her license classification, and his or her federal registry number, if a controlled substance is prescribed.
(E) A legible, clear notice of the condition for which the drug is being prescribed, if requested by the patient or patients.
(F) If in writing, signed by the prescriber issuing the order, or the certified nurse-midwife, nurse practitioner, or physician assistant who issues a drug order pursuant to Section 2746.51,2836.1, or 3502.1.
(2) Issued by a precribing medical practitioner if a drug order is issued pursuant to Section 2746.51, 2836.1, or 3502.1.
(b) Notwithstanding subdivision (a), a written order of the prescriber for a dangerous drug, except for any Schedule II controlled substance, that contains at least the name and signature of the prescriber, the name and address of the patient in a manner consistent with paragraph (3) of subdivision (b) of Section 11164 of the Health and Safety Code, the name and quantity of the drug prescribed, directions for use, and the date of issue may be treated as a prescription by the dispensing pharmacist as long as any additional information required by subdivision (a) is readily retrievable in the pharmacy. In the event of a conflict between this subdivision and Section 11164 of the Health and Safety Code, Section 11164 of the Health and Safety Code shall prevail.
(c) "Electronic transmission prescription" includes both image and data prescriptions. "Electronic image transmission prescription" means any prescription order for which a facsimile of the order is received by a pharmacy from a licensed prescriber. "Electronic data transmission prescription" means any prescription order, other than an electronic image transmission prescription, that is electronically transmitted from a licensed prescriber to a pharmacy.
(d) The use of commonly used abbreviations shall not invalidate an otherwise valid prescription.
(e) Nothing in the amendments made to this section (formerly Section 4036) at the 1969 Regular Session of the Legislature shall be construed as expanding or limiting the right that a chiropractor, while acting within the scope of his or her license, may have to prescribe a device.

Exhibit B: sample legal requirement for storage of prescriptions[edit]

From the Mississippi Board of Pharmacy:[1]

ARTICLE XIII PRESCRIPTIONS TO BE FILED
1. All prescriptions shall be filed in one of the following ways:
A. Three separate files may be maintained; a file for Schedule II prescriptions dispensed; a file for Schedule III, IV and V prescriptions dispensed; and a file for all other prescriptions dispensed.
B. Two files may be maintained; a file for all Schedule II prescriptions dispensed and another file for all other prescriptions dispensed, including those in Schedule III, IV and V. If this method is used, the prescriptions for Schedule III, IV and V substances must be stamped with the letter "C" in red ink, not less than one inch high, in the lower right-hand corner. This distinctive marking makes the records readily retrievable for inspection. Pharmacies with automatic data processing systems are exempted from marking Schedule III, IV and V controlled substance prescriptions with the red "C".
2. A hard copy of original prescriptions, whether records are maintained manually or in a data processing system, shall be assigned a serial number and maintained by the pharmacy in numerical and chronological order. All prescriptions shall be maintained for at least five years from the date of original dispensing.
3. If a pharmacy utilizes a data processing system for record keeping, all computer generated labels should be affixed to the prescription document in such a manner as not to obscure information on the face of the document.

Exhibit C: sample legal requirements for security and format[edit]

From Indiana Board of Pharmacy:[2]

856 IAC 1-34-2 Security feature requirements
Authority: IC 35-48-7-8
Affected: IC 16-42-19-5
Sec. 2. (a) All controlled substance prescriptions written by licensed Indiana practitioners, as defined by IC 16-42-19-5, must contain the following security features:
(1) A latent, repetitive "void" pattern screened at five percent (5%) in reflex blue must appear across the entire face of the document when the prescription is photocopied.
(2) There shall be a custom artificial watermark printed on the back side of the base paper so that it may only be seen at a forty-five (45) degree angle. The watermark shall consist of the words "Indiana Security Prescription", appearing horizontally in a step-and-repeated format in five lines on the back of the document using 12-point Helvetica bold type style.
(3) An opaque RX symbol must appear in the upper right-hand corner, one-eighth (1/8) of an inch from the top of the pad and five-sixteenths (5/16) of an inch from the right side of the pad. The symbol must be three-fourths (3/4) inch in size and must disappear if the prescription copy is lightened.
(4) Six (6) quantity check-off boxes must be printed on the form and the following quantities must appear and the appropriate box be checked off for the prescription to be valid:
(A) 1-24
(B) 25-49
(C) 50-74
(D) 75-100
(E) 101-150
(F) 151 and over.
(5) No advertisements may appear on the front or back of the prescription blank.
(6) Logos, defined as a symbol utilized by an individual, professional practice, professional association, or hospital, may appear on the prescription blank. The upper left one (1) inch square of the prescription blank is reserved for the purpose of logos. Only logos, as defined by this subdivision, may appear on the prescription blank.
(7) Only one (1) prescription may be written per prescription blank. The following statement must be printed on the bottom of the pad: "Prescription is void if more than one (1) prescription is written per blank.".
(8) Refill options that can be circled by the prescriber must appear below any logos and above the signature lines on the left side of the prescription blank in the following order: Refill NR 1 2 3 4 5 Void after_____.
(9) Practitioner name and state issued professional license number must be preprinted, stamped, or manually printed on the prescription.
(10) All prescription blanks printed under this rule shall be four and one-fourth (4-1/4) inches high and five and one-half (5-1/2) inches wide.
(b) Nothing in this rule shall prevent licensed Indiana practitioners from utilizing security paper prescriptions for the prescribing of any legend drug. (Indiana Board of Pharmacy; 856 IAC 1-34-2; filed Jul 5, 1995, 9:45 a.m.: 18 IR 2782, eff Jan 1, 1996)

Exhibit D: sample requirements on information added by the pharmacist[edit]

Taken from the Ontario's Drug and Pharmacies Regulation Act, [3] paragraph 156.

(1) Every person who dispenses a drug pursuant to a prescription shall ensure that the following information is recorded on the prescription,
(a) the name and address of the person for whom the drug is prescribed;
(b) the name, strength (where applicable) and quantity of the prescribed drug;
(c) the directions for use, as prescribed;
(d) the name and address of the prescriber;
(e) the identity of the manufacturer of the drug dispensed;
(f) an identification number or other designation;
(g) the signature of the person dispensing the drug and, where different, also the signature of the person receiving a verbal prescription;
(h) the date on which the drug is dispensed;
(i) the price charged. R.S.O. 1990, c. H.4, s. 156 (1).

Exhibit E: New Jersey requirements for prescription blanks[edit]

From New Jersey official statutes:[4]

45:14-55 Use of New Jersey Prescription Blanks.
16. a. A practitioner practicing in this State shall use non-reproducible, non-erasable safety paper New Jersey Prescription Blanks bearing that practitioner's license number whenever the practitioner issues prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety.
b. A licensed practitioner practicing in this State shall maintain a record of the receipt of New Jersey Prescription Blanks. The practitioner shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey Prescription Blank in the practitioner's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action, including notification to the Department of Human Services and the Attorney General.
45:14-56 Health care facility prescriptions.
17. a. Prescriptions issued by a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) shall be written on non-reproducible, non-erasable safety paper New Jersey Prescription Blanks. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety. The New Jersey Prescription Blanks shall bear the unique provider number assigned to that health care facility for the issuing of prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items.
b. A health care facility shall maintain a record of the receipt of New Jersey Prescription Blanks. The health care facility shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey Prescription Blank in the facility's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action including notification to the Department of Human Services and the Attorney General.
45:14-57 Requirements for prescription to be filled.
18.A prescription issued by a practitioner or health care facility licensed in New Jersey shall not be filled by a pharmacist unless the prescription is issued on a New Jersey Prescription Blank bearing the practitioner's license number or the unique provider number assigned to a health care facility.
45:14-59 Format for New Jersey Prescription Blanks.
20.The Division of Consumer Affairs in the Department of Law and Public Safety shall establish the format for uniform, non-reproducible, non-erasable safety paper prescription blanks, to be known as New Jersey Prescription Blanks, which format shall include an identifiable logo or symbol that will appear on all prescription blanks. The division shall approve a sufficient number of vendors to ensure production of an adequate supply of New Jersey Prescription Blanks for practitioners and health care facilities statewide.

References

  1. ^ [1][dead link]
  2. ^ "Title 856 Indiana Board Of Pharmacy" (PDF).
  3. ^ [2][dead link]
  4. ^ "New Jersey Board of Pharmacy Laws" (PDF). Retrieved 2010-01-22.

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I just removed the above content again. This kind of material can go on Wikisource but is not right for inclusion into Wikipedia. Blue Rasberry (talk) 19:05, 11 April 2013 (UTC)[reply]

Split out Appendix 1?[edit]

It might be more convenient to split out Appendix 1 into a subsidiary article. This would be partially to facilitate linking to it from the Latin medical phrases category, such that people looking for the translations of these abbreviations don't have to find this page. It seems inelegant to link to the main article from the category page. What do you think? Octopod 10:26, 16 November 2006 (UTC)[reply]

hi

Is splitting out such related content common in Wikipedia? I haven't seen much of that. My only concern is whether or not it would it make it more difficult to find the Appendix if it were moved? I guess if linked prominently it wouldn't hurt. ---J-Mac

  • I recommend splitting out appendix 1 and linking it for better categorization and a direct link to the talbe instead of linking to a long article when only really wanting to link to the table. Tkjazzer 13:55, 31 July 2007 (UTC)[reply]

Globalize tag[edit]

There's plenty this can apply to, and the article does have a very strong US flavour (flavor?) but one little thing that doesn't often get mentioned is that the abbreviation "Rx" is not in everyday colloquial use in the UK. I don't know about within the medical profession, but if you wrote "Rx drugs" you'd get a lot of blank looks from the general population. 86.136.250.133 04:05, 21 July 2007 (UTC)[reply]

That's true, but Rx is widely used in pharmacies and healthcare companies and by doctors in the UK, myself working for one at the moment. Josh 22:56, 30 April 2008 (UTC)[reply]

Fair use rationale for Image:ValiumDAWAd.png[edit]

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BetacommandBot 19:38, 3 December 2007 (UTC)[reply]

Change redirect?[edit]

I'm not sure how to change it, or even if I can, but I think that prescription medicine should redirect to Prescription drugs rather than Medical prescription.58.104.18.126 (talk) 07:44, 29 May 2008 (UTC)[reply]

Done. Thanks for flagging. Samw (talk) 00:57, 30 May 2008 (UTC)[reply]

Physician or other medical practitioner[edit]

Physicians are not the only class of healthcare worker to write prescriptions. Even if you use "prescription" to mean "orders to take a drug", there are many non-physicians that are allowed to write such orders. Dentists, for example, routinely order painkillers and antibiotics. This article should not exclude non-physicians. WhatamIdoing (talk) 01:55, 16 September 2008 (UTC)[reply]

Meaning of Rx[edit]

Rx is not the "order to take a drug" but rather the order to make, package, and/ or dispense a drug. This order is commonly addressed to a pharmacist, as by law, they are the only ones allowed to do so with prescription drugs. In Germany, veterinarians have the same right as Pharmacists -- I don't know if this is true of the US. I'm currently in my 3rd year of vet school in Germany, which is why I have in-depth knowledge of this topic. 85.178.56.164 (talk) 16:50, 26 October 2008 (UTC)[reply]

We need a published reliable source. Do you have a textbook that makes these claims? Is there a regulation somewhere that we can cite? WhatamIdoing (talk) 01:55, 27 October 2008 (UTC)[reply]

Removing Tags[edit]

I am removing the tags at the top of this page, based on my independent judgment that I hold the article is sufficiently worldwide in scope. In the alternative, it can't be helped if it is centrally focusing on the US. But if anyone wishes to dissent, reinstate them. 68.236.154.4 (talk) 06:49, 30 December 2008 (UTC)[reply]

I plan to remove the other tag, I reviewed the article and don't see any glaring errors. But if I am wrong, let me know. 68.236.154.4 (talk) 06:52, 30 December 2008 (UTC)[reply]

Reverts[edit]

Recent edits reverted the article to an older version that clobbered any added or revised text and contains broken and incomplete citations.

Would you please explain why you are clobbering the edits of other users?

Whywhenwhohow (talk) 16:36, 27 January 2010 (UTC)[reply]

abbreviation confusion[edit]

It's certainly true that some abbreviations have become deprecated, some thought might be given to the specific examples cited. While I can accept that the minim symbol does look like an "m" and might conceivably be taken to be an abbreviation for "meters", it's hard to see how this could actually result in any harm (considerable confusion, yes, but "meters" is so obviously nonsensical a unit for anything that might legitimately be measured in minims that the pharmacist would realize it couldn't possibly be the right interpretation). For those not familiar with the units, it's more or less like asking for three feet of gasoline, and would provoke the same kind of "You want WHAT?" response. Ptorquemada (talk) 20:48, 7 March 2011 (UTC)[reply]

"completing the command"?[edit]

What is meant by "completing the command"? --89.204.136.52 (talk) 11:58, 9 November 2011 (UTC)[reply]

Deleted dubious & unsupported statement.[edit]

I boldly deleted as dubious the following, unsupported assertion:

The fact that a prescription instructs someone to "take" rather than "give" is not a trivial distinction, but makes clear it is directed at the patient, and is not directly an instruction to anyone else.

It contradicted the well-supported statements, a few lines earlier,

This symbol originated in medieval manuscripts as an abbreviation of the Late Latin verb recipe, the imperative form of recipere, "to take" or "take thus".[Fn. omitted] Literally, the Latin word recipe means simply "Take...." and medieval prescriptions invariably began with the command to "take" certain materials and compound them in specified ways.[Fn. om.]

Clearly, as others have observed above, "take" is an instruction, not to the patient, but to the pharmacist, who is fancifully still thought of as compounding the medicament prescribed. The assertion that "take" is importantly directed towards the patient smacks of folk-etymology. Why would physicians use a cryptic symbol for a Latin word in any communication directed to the patient, anyway? Prescriptions are obviously not intended for patients to read or understand. J. D. Crutchfield | Talk 17:52, 7 April 2015 (UTC)[reply]

Non-prescription drug prescriptions[edit]

The lede implicitly has two different definitions of "prescription":

  • Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist, physician, other therapist, or by automated equipment
  • the term "prescription" now usually refers to an order that a pharmacist dispense and that a patient take certain medications.

Most of the article uses the second definition, but the section "Non-prescription drug prescriptions" gives some info on the first. Broadening the scope from drugs to all treatments listed on the medical treatment page would need a broader discussion of who is entitled to prescribe what.

Relatedly, I've redirected doctor's prescription to medical prescription, but it formerly had this:


jnestorius(talk) 17:35, 30 April 2015 (UTC)[reply]

  • Good idea The "doctor's prescription" article is better merged here as this article covers the concept and that article was short and had no references. Blue Rasberry (talk) 17:43, 30 April 2015 (UTC)[reply]
  • I agree that "Doctor's Prescription" should be merged with "Medical Prescription", but I think we need expert advice as to whether all the "prescriptions" listed belong under this category. There is also something called "doctor's orders", which I have always understood as being different from a prescription, and as covering treatment modalities other than medication and optical correction. Both the former "Doctor's Prescription" article and the lede to this article seem to suggest that there is no difference between "prescriptions" and "orders", whereas my impression is that they cover different things. Medical and optical prescriptions, strictly speaking, both direct a third party (pharmacist, optician) to prepare a remedy to be supplied to the patient. Orders generally require that something be done to the patient directly, or that the patient herself or himself do something. I think we need help from medical professionals as to their usage concerning these terms. J. D. Crutchfield | Talk 18:58, 30 April 2015 (UTC)[reply]
  • Question Is the use of prescription for anything other than medications or eyeglasses a European thing? In the US, I've never heard it used for anything other than those two categories. In a clinic or hospital setting, prescriptions are drugs. Imaging and lab orders need appointments and are considered other orders. DMEs are DMEs. Anything else, like diet and activity, are instructions and tied into the plan of care or treatment plan. Alaynestone (talk) 14:22, 7 September 2015 (UTC)[reply]
Alaynestone Prescription for Romance Prescription for Murder Not sure about other uses. Blue Rasberry (talk) 13:44, 8 September 2015 (UTC)[reply]
Is there a prescription for butt kicking? Because I can think of someone who needs two tablets rectal STAT. :P Alaynestone (talk) 16:05, 8 September 2015 (UTC)[reply]

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PERscription?[edit]

Completely unsourced pronunciation info, which seems to run contrary to every time I've ever heard the word in ever... It's always been pronounced "PREscription" by anybody who I've ever heard say the word in any country. There are some English regional dialects that say "puh-scription" but it's by no means a common or accepted pronunciation — Preceding unsigned comment added by 84.51.186.222 (talk) 19:05, 3 February 2016 (UTC)[reply]

Should Rx drug recipe be changed to be more secure?[edit]

In Continental part of the article there is a recipe for a drug to be prepared by a pharmacist. I checked the ingredients, and it realised that they are related, as I think. They are probably used for lethal injections in US, when they are mixed in greater amont. I read about it on Wikipedia's article on death penalty, and even if the substances listed about are slighly different, after reading about each one in details and comparing with the lethal injection mix, the may have similar effect. Here's the question - should the substances in recipe be changed for neutral ones? I know every clever preson won't use Wikipedia to mix drugs, but I think these substances are quite serious, and if the recipe is demonstrative only, it may be fake (for example in "Fight Club" the explosive's recipe was not true too). Otherwise this article should have a medical notification in order to avoid using its content (recipe) in real world. What do you think about it?

The listed purpose of that Rx is for sleep (not for lethal injection). It is difficult to get some of these ingredients as a layperson, and even then some responsibility must be taken by the reader for their own actions. For example, should Wikipedia delete articles describing methods of suicide on the chance that someone might try it themselves?
All that being said, if you can find an equivalent Rx that demonstrates the same principles with less risk, go ahead and be bold Myoglobin (talk) 21:15, 19 April 2017 (UTC)[reply]

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Section title: "Contents"[edit]

Can anyone come up with a better title for that section? It is rather meaningless, IMO. --John Maynard Friedman (talk) 21:53, 27 May 2020 (UTC)[reply]

The symbol "℞"[edit]

Regarding

«The symbol "℞", sometimes transliterated as "Rx" or "Rx", is recorded in 16th century manuscripts as an abbreviation of the late Latin instruction recipe, meaning 'receive'. Originally abbreviated Rc, the later convention of using a slash to indicate abbreviation resulted in an R with as a straight stroke through its right "leg". Medieval prescriptions invariably began with the command to "take" certain materials and compound them in specified ways.»

the symbol "℞" has also other meaning in medieval texts: Ratio, Rubrica, Reverendus, Remissio, Reversus. See Adriano Cappelli, «Lexicon Abbreviaturarum», Hoepli, Milan 1999. --Dejudicibus (talk) 10:48, 30 August 2020 (UTC)[reply]

Yes, this is certainly true. But the article is about prescriptions so the abbreviation of recipe is the only one of these than needs mentioning. As a parallel, the abbreviation "Dr." can mean either Doctor or Debtor, according the context. We don't clutter medicine or accounting articles with details about the other kind of Dr. But if you think it interesting, it should go in as a footnote.
More immediately, "recorded in 16th century manuscripts as an abbreviation" is uncited so it would be great if you would add the Cappelli citation. [ping me if you would prefer me to do it, but you found it so you get the honour]. --John Maynard Friedman (talk) 13:13, 30 August 2020 (UTC)[reply]
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