P&T News: August 2001

Guidelines for Complete, Safe, and Accurate Discharge and Outpatient Prescription Writing

Pharmacy and Therapeutics Subcommittee of the University Hospital Advisory Committee and the Department of Pharmaceutical Care
Peer Review Status: Internally Peer Reviewed

DUPLICATE PRESCRIPTION SYSTEM
The Duplicate Prescription System at UIHC is structured to produce an original and exact copy of the medication order. Under this system, the Department of Pharmaceutical Care is authorized to dispense a take-home supply of medication from the copy of the prescription and return the original prescription to the patient to obtain continuing supplies in the local community. The use of other, nonstandard prescription blanks within UIHC is not authorized.

The "essential elements" of a prescription are depicted in the preceding figure of a UIHC prescription and described below:

A. Patient Name, Address, Hospital Number, Birthdate, and Date Prescription Is Written
This information may be transmitted to the prescription by using the patient's addressograph plate. The hospital number is essential to ensure that the intended patient receives, and is billed for, the correct medication.

B. Name and Strength of Drug
Medications should be ordered by the generic name, not by the proprietary or trade names. Hospital policy and the Joint Commission on Accreditation of Healthcare Organizations standards permit the use of drug name abbreviations in medication orders only if the abbreviation has been specifically approved by the hospital and it appears on a published list. "Coined" abbreviations such as HCTZ, AZT, T3, and ddC are not acceptable medical abbreviations, may be misinterpreted, and may cause drug errors. Medication orders that contain nonapproved drug name abbreviations are not valid. Pharmacists are authorized to withhold dispensing of medications ordered via nonapproved abbreviations. The approved drug name abbreviations are provided on the on-line Formulary and Handbook -- -- www.vh.org/Formulary /Form/16ApprovedDrug.html (see Table 1); approved medical abbreviations are available at www.vh.org/formulary/Hand/11MedAbbr.html.

A separate prescription blank must be used for each drug prescribed. Multiple prescriptions on a single blank are unsafe and greatly increase the potential for medication errors.

C. Quantity to Be Dispensed
The quantity of drug to be dispensed should be indicated. Outpatient prescriptions should be written for no more than a 30-day supply with continuing supplies to be prescribed as refills. In order to minimize patient delays, the pharmacist is authorized to round the quantity dispensed to the nearest available prepackage quantity (usually a one-month supply) only for prescriptions with refills authorized.

For Drug Enforcement Administration (DEA) designated controlled substances, including narcotics and anabolic steroids, the quantity should be written in words as well as numbers to prevent alteration of the prescription.

Outpatient Prescription Medication Supply and Refill Limits Supply quantities are generally limited to a 30-day supply except where health plan benefits allow a greater supply. Patients being discharged from the hospital may receive an initial supply of medications. Refills are limited to the cases noted below. Refill prescriptions may be processed for: Patients receiving their on-going primary care from UIHC (i.e., generally local area residents as refills must be picked up from UIHC). Hospital staff and dependents at the same address. Prescriptions for medications which are not commercially available. Prescriptions for verified state paper (indigent) patients (as defined by UIHC policy). These patients are eligible for a maximum 90-day supply with a single refill of specific maintenance medications (see guidelines).

D. Directions to the Patient
Clear and concise directions will assist your patient in the appropriate use of the medication. "Take as directed" should be avoided. Your patient may forget or confuse verbal directions or lose a separate note. The Department of Pharmaceutical Care will complete a patient medication calendar for tapered or intermittent dosage schedules. The "PRN" designation should include the purpose of the medication (e.g., PRN sleep, PRN pain).

E. Signature, Printed Name, Physician Code
In addition to signing the prescription, print your name legibly below your signature along with your UIHC 4-digit prescriber code, and indicate your practitioner status by circling the appropriate initials to the right of the signature line. This will facilitate communications with health care practitioners throughout the state who have a need to accurately identify the prescriber, and it will also decrease the possibility of forgery. Additionally, Board of Pharmacy rule 657 I.A.C. 8.14(1) requires that the name of the prescriber appear on the prescription label. If the prescriber's signature is illegible and the identity of the prescriber is unknown, the prescription cannot be filled until the prescriber has been identified. This provision will result in telephone calls to your department and delays to patients. To prevent illegal drug diversion, supplies of prescription blanks may not be signed by the prescriber in advance of use. Prescriptions must only be signed by the prescriber at the time prescriptions are written for a specific patient. Physician assistants must also indicate the name of their supervising physician in the designated space.

F. DEA Number
Your personal Drug Enforcement Administration (DEA) registration number (or the UIHC DEA registration number for eligible practitioners) with your personal 4-digit prescriber code must be included on all prescriptions for drugs classified as controlled substances. This step is a safety mechanism to prevent prescription forgery because each DEA number can be checked to verify its validity. When your DEA number is omitted, it is illegal for any pharmacy to fill the prescription. Pharmacy does not have a list of every prescriber's DEA number; therefore, this omission causes your patient to be inconvenienced until the deficiency is corrected.

Physician assistants and advanced registered nurse practitioners are authorized to prescribe controlled substances after obtaining a mid-level practitioner's registration from the DEA. However, physician assistants are not authorized to prescribe Schedule II substances listed as stimulants or depressants in Iowa.

Application forms for personal DEA registration at UIHC and instructions for completion are available at the Pharmacy Administrative Office, Room CC-101 GH. For additional information, see the on-line Formulary and Handbook -- www.vh.org/formulary/Form/FedDEARegistrationProcess.html.

G. Drug Allergies
The patient's medication allergies should be specified in this space on one of the prescriptions for each set of prescriptions. If there are no known allergies, please check the box next to "NKA." The pharmacist will obtain or confirm allergy information with the patient as necessary at the time the prescription is presented to the Ambulatory Care Pharmacies.

H. Containers Without Safety Closures
"Childproof" containers with safety closures are used for dispensing all prescription medications (with limited exceptions) in accordance with the Federal Poison Prevention Packaging Act of 1970. You may indicate the need for nonsafety closures for a patient for whom childproof containers may cause difficulty by checking the designated box.

I. Refill Designation
Always circle "no refills" or specify the number of times and/or the last date the prescription may be refilled. "PRN" is not a valid refill designation.

Prescriptions may be refilled at the Department of Pharmaceutical Care ONLY if certain criteria are met (click here). Prescriptions for this eligible patient group (excluding controlled substances) may be refilled a maximum of 11 times or for 18 months - whichever is less. Prescriptions for DEA controlled substances in Schedules III, IV, and V may be refilled a maximum of 5 times or for 6 months - whichever is less. Prescriptions for Schedule II controlled substances may not be refilled. State-paper eligible patients may receive a single refill of specific maintenance medications (click here).

J. Indication for Use
The indication for use should be specified in this space for each prescription. This information permits the pharmacist to reinforce physician instructions with the patient and helps the patient understand the purpose for the medications. Federal regulations require the pharmacist to obtain information on the patient's disease state(s) so that appropriate utilization review and counseling can occur.

Table 1. Drug Name Abbreviations Approved for Use at UIHC
Abbreviation	Generic Name
Medications
ASA B & O Suppository ECASA ETOH INH MOM MSO4 Nitropatch Nitropaste NPH NSAID NTG PVP-Iodine SSRI	Aspirin Belladonna and Opium Suppository Enteric Coated Aspirin Ethyl Alcohol Isoniazid Milk of Magnesia Morphine Sulfate Nitroglycerin Patch Nitroglycerin Ointment Insulin Isophane Insulin Suspension Nonsteroidal Anti-inflammatory Drugs Nitroglycerin Povidone-Iodine Selective Serotonin Reuptake Inhibitors
Intravenous Fluids*
D5W NS LR D5 1/4NS D5 1/2NS D5 LR D5 1/2NS with 20 mEq KCl/L *Note: Other combinations of the above abbreviations may be used.	Dextrose 5% in water 0.9% NaCl in water Lactated Ringer's Injection Dextrose 5% and NaCl 0.2% in water Dextrose 5% and NaCl 0.45% in water Dextrose 5% in Lactated Ringer's Injection Dextrose 5% and NaCl 0.45% and KCl 20 mEq per liter
Vaccines, Toxoids, Skin Tests
BCG Vaccine DTaP Vaccine DTP Vaccine DT Vaccine Hep A Vaccine Hep B Vaccine Hib Vaccine IPV Vaccine MMR Vaccine OPV Vaccine PPD Skin Test Td Vaccine	BCG Vaccine Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Diphtheria and Tetanus Toxoids and Pertussis Vaccine Diphtheria and Tetanus Toxoids (for pediatric use) Hepatitis A Vaccine Hepatitis B Vaccine Haemophilus influenzae b Vaccine Polio Virus Vaccine, Inactivated Measles, Mumps, Rubella Virus Vaccine Live Poliovirus Vaccine Live, Oral Tuberculin Purified Protein Derivative Diphtheria and Tetanus Toxoids (for adult use)
Vitamins
Vit A Vit B12 Vit B6 Vit B2 Vit B1 Vit C Vit D2 Vit E Vit K1	Retinol Cyanocobalamin Pyridoxine Riboflavin Thiamine Ascorbic Acid Ergocalciferol Tocopherol Phytonadione
Standard International Chemical Formulas (e.g., MgSO4, NH2, KCl) are also acceptable.

Table 2. Dangerous Abbreviations When Prescribing Medications
Abbreviation / Dose Expression	Intended Meaning	Misinterpretation	Correction
AU	Each ear	Mistaken for OU -- each eye.	Use "each ear."
BT	Bedtime	Mistaken as "BID" (twice daily).	Use "bedtime" or "hs."
cc	Cubic centimeters	Misread as "U" (units).	Use "ml."
D or d	Days; doses	Duration of therapy is misunderstood; unclear whether drug should be given for specified number of days or doses.	Use "days" or "doses."
D/C or d/c	Discharge;	Discontinue Premature discontinuation of medications when D/C (intended as "discharge") has been misinterpreted as "discontinue" when followed by a list of drugs.	Use "discharge" or "discontinue."
IU	International unit	Misread as IV (intravenous).	Use "units."
o.d. or OD	Once daily	Misinterpreted as "right eye" and administration of oral medications in the eye.	Use "daily."
q.d. or QD	Every day	Mistaken as q.i.d., especially if the period after the q or the tail of the "q" is misinterpreted as an "i."	Use "daily" or "every day."
qhs	Nightly at bedtime	Misread as every hour.	Use "nightly" or "daily at bedtime."
q.o.d.	Every other day	Mistaken as q.i.d., especially if the "o" is poorly made and resembles an "i."	Use "every other day."
ss	Sliding scale	Mistaken for "55."	Spell out "sliding scale."
TIW or tiw	Three times a week	Mistaken as "three times a day."	Don't use this abbreviation. Use "three times a week."
U or u	Unit	Read as a zero (0) or a four (4), causing a 10-fold overdose or greater (4U seen as "40" or 4u seen as 44").	Unit has no acceptable abbreviation. Use "unit."
x3d	For three days	Mistaken for "three doses."	Use for "three days."
mg	Microgram	Mistaken for "mg" when handwritten.	Use "mcg."
Zero after decimal point (e.g., 1.0 mg)	1 mg	Misread as 10 mg if the decimal point is not seen.	Do not use terminal zeros for doses expressed in whole numbers.
No zero before decimal dose (e.g., .5 mg)	0.5 mg	Misread as 5 mg.	Always use a zero before a decimal when the dose is less than a whole unit.
*Taken from ISMP Medication Safety Alert newsletter, Institute for Safe Medication Practices, May 2, 2001.

HANDWRITING LEGIBILITY
Several national organizations, including the American Medical Association, the Institute of Medicine, the Institute for Safe Medication Practices, and the Joint Commission for Accreditation of Healthcare Organizations, have warned healthcare providers about the association between poor prescriber handwriting and medical errors. Prescription orders written hurriedly and illegibly force other care providers to seek order clarifications or inadvertently lead the care provider to erroneously interpret the order and give medication in a manner not intended by the prescriber. To avoid errors caused by illegibly written orders, the following should be observed:

• All aspects of handwritten prescription orders must be clearly written using a ballpoint pen. Felt tips and fountain pens do not generate sufficient pressure to transmit the order to the duplicate copy of the UIHC prescription blank.
• Care should be taken when prescribing drugs with look-alike names, especially when handwritten (examples include Inderal vs. Isordil, Navane vs. Norvasc, or Humulin vs. Humalog). Drug names should be legibly printed.
• Avoid the use of drug name abbreviations and minimize the use of medical abbreviations as these may be misread or misinterpreted (for example, U [for unit] may be mistaken for a zero in the dose; or "qod" may be misinterpreted as "qid," resulting in a significant drug overdose). Write instructions in complete English versus abbreviations. See Table 2.
• Prescriber signatures and CLP codes should be clearly legible, not simply recognizable.

Additional information about safely writing medication orders may be reviewed at the Institute for Safe Medication Practices web site (www. ismp.org).

ELECTRONICALLY GENERATED PRESCRIPTIONS
The INFORMM Patient Record (IPR) allows UIHC prescribers to generate prescriptions electronically by using the Medication List function. Prescriptions can be printed out locally or sent electronically to the ambulatory care pharmacy-of-choice. These prescriptions maintain the duplicate system (original and copy) that has been employed at UIHC for nearly 25 years.

Several features of the IPR system are advantageous: 1) prescriptions generated by IPR are later accessible in the patient's profile under Medication List; 2) legibility is clear by virtue of the prescriptions being type-printed; and 3) prescriber signatures are "electronically" provided, therefore also legible. The legibility of both the prescription information and the signature promotes patient safety and convenience for patients and results in fewer follow-up phone calls to prescribers.

The system also affords several security features. In addition to the electronic signature, each prescription has its own printed security number. This number is generated by IPR and can later be entered into INFORMM by a UIHC ambulatory care pharmacist to verify the prescription's authenticity. Additionally, the paper stock used is watermarked. Finally, outside pharmacies may call the Department of Pharmaceutical Care (phone number is provided on the prescription) to verify the authenticity of the prescription.

Prescriptions for controlled substances can be generated by the IPR Medication List function, although electronic signatures are prohibited. Prescribers must provide a handwritten signature on the original portion and on the "copy" portion if refills have been indicated. Controlled substance prescriptions cannot be sent electronically to the ambulatory care pharmacies; rather, they must be printed out locally so that the prescriber can sign them.

DISCHARGE PRESCRIPTIONS FOR INPATIENTS
Prescriptions for discharge medications should be in writing as all patients must be given the option of taking their prescriptions to their community pharmacy or having an initial supply filled by the UIHC Ambulatory Care Pharmacies. This should be determined 24 hours prior to discharge to allow time for the prescriptions to be filled at the UIHC Ambulatory Care Pharmacies and returned to the patient's bedside if the patient chooses this option. Failure to determine the need to have prescriptions filled at UIHC until the day of discharge can lead to delays in the patient's discharge and dissatisfaction with their stay. If prescriptions are filled by the UIHC Ambulatory Care Pharmacies, the patient will be billed by the hospital for the medications. The patient is responsible for filing any insurance claims for these take-home medications.

TELEPHONED PRESCRIPTIONS
All UIHC physicians, dentists, physician assistants, and advanced registered nurse practitioners may telephone prescriptions for UIHC clinic patients to the UIHC Ambulatory Care Pharmacies during normal clinic operating hours. In order to provide optimal service to our patients and minimize the potential for transcription errors, only small groups of prescriptions should be phoned to the pharmacy. Larger groups (more than 4) should be in writing or via the IPR Medications List function.

The majority of patients being discharged from UIHC will not utilize the UIHC Ambulatory Care Pharmacies as their primary pharmacy and will require a written or verbal prescription for their local pharmacy. Prescriptions for patients being discharged from the hospital must be in writing, as this ensures patients their legal right to choose where to have their prescriptions filled. Should the patient choose to have an initial supply of medications filled at UIHC, the inpatient pharmacist following the patient will review the patient's medication profile and counsel the patient about any prescribed home-going medication therapy at bedside before discharge from the hospital.

Registered nurses and pharmacists acting as an agent of a physician may also transmit prescription orders for clinic patients to the UIHC Ambulatory Care Pharmacies.

UNUSED SUPPLIES OF MEDICATION
Iowa law mandates that for the protection of the public health and safety, medications that have been dispensed to outpatients may not be accepted for return, exchanged, or resold. Therefore, the Department of Pharmaceutical Care may not accept medication returns or issue credit to patients who request return of unused supplies of medication. If the patient's reaction to a newly prescribed medication cannot be anticipated, it may be prudent to initially prescribe less than a 30-day supply. Continuing supplies may then be obtained as refills once it is determined that the patient can tolerate the medication.

SELF-PRESCRIBING CONTROLLED SUBSTANCES
State regulations prohibit practitioners from self-prescribing or self-dispensing controlled substances and from prescribing or dispensing controlled substances to members of the practitioner's immediate family for an extended period of time. This applies to all controlled substances in all DEA Schedules. Another authorized prescriber with a valid DEA registration number should write the prescription for the practitioner or members of his/her immediate family, and this should be properly documented in the appropriate medical record.

PRESCRIPTIONS FOR HOUSE STAFF
The UIHC medical care program permits house staff physicians and dentists to write prescriptions to a maximum of a 30-day supply of medications as deemed appropriate based upon the package insert, if medically necessary, for themselves and members of their immediate family (defined as a spouse or child living with the house staff member) at no cost. Only medications on formulary may be prescribed. All prescriptions must be in writing, except in cases of an emergency. Certain high-cost medications within specific therapeutic classes may be restricted, requiring a clinical faculty signature. Self-prescribing of these agents will result in the house staff member being billed the acquisition cost of the high-cost medication. All prescriptions must reflect the name of the patient for whom the medication is being prescribed. Prescriptions will be monitored for appropriateness.

To minimize waiting time for clinic and discharge patients, house staff are asked to plan ahead so that refills and new prescriptions for nonurgent medications are presented one day and picked up the following day. This will allow Pharmacy staff to fill house staff prescriptions at less busy times.

STORAGE OF PRESCRIPTION BLANKS
To reduce the incidence of theft of UIHC prescription blanks and to reduce illegal drug diversion, access to UIHC prescription blanks is limited. Prescription pads and single prescription blanks are stored only in secure centralized locations (e.g., medical conference rooms or medication preparation rooms) of the ambulatory care clinics and inpatient care units. Patients, visitors, and unauthorized hospital staff members should not have access to these locations. Prescription blanks must not be stored in patient examination rooms. Authorized prescribers may carry prescription blanks in their jacket/coat pockets.

In addition to controlled storage, prescription blanks are serialized, and dispersal of all prescription pads and storage destination is documented by Pharmacy staff. These procedures permit a trace of lost or stolen prescription blanks.

MEDICATION ORDERS WRITTEN BY PHYSICIAN ASSISTANTS AND ADVANCED REGISTERED NURSE PRACTITIONERS
Physician assistants and advanced registered nurse practitioners may write medication and treatment orders only when acting pursuant to policies or protocols approved by the Clinical Service Head and reviewed and approved by the Professional Practice Subcommittee. Copies of established protocols shall be provided to the Department of Pharmaceutical Care by the Clinical Service Heads or the Professional Practice Subcommittee.

Physician assistants and advanced registered nurse practitioners shall not have the authority to limit substitution or standardization pursuant to Pharmacy and Therapeutics Subcommittee protocols and shall not be authorized to override protocol or restricted drug indications.

For further information on prescribing discharge and outpatient medications, please see the on-line Formulary and Handbook -- www.vh.org/formulary/Form/17TakeHome.html or call the Department of Pharmaceutical Care at 6-2577.

Effective, Thursday, September 13, 2001, products containing the compound dichloralphenazone (contained in headache products such as Midrin® and Migratine®) will be handled as Schedule III-IV-V controlled substances within the UIHC.

This change is being made because dichloralphenazone is now listed in Schedule IV of the Federal Controlled Substances Act. Thereafter, pharmacies and hospitals must follow federal regulations covering C-IV substances for the storage, inventory, and record keeping of dichloralphenazone-containing products. In addition, authorized prescribers must provide a valid DEA registration number for all prescriptions written for dichloralphenazone-containing products. A maximum of five refills may be authorized; if refills are indicated, the prescription expires six months from the date written.

On September 13, floorstocked and patient-specific supplies of acetaminophen, isometheptene and dichloralphenazone capsules will be handled like other C-III, IV, and V controlled substances. These capsules will need to be placed into locked storage, and dose-by-dose accountability maintained for all supplies of this medication.

If you have questions about this change, please contact David Weetman, Assistant Director for Acute Pharmaceutical Care Services (inpatient) or Robert Avakian, Assistant Director for Ambulatory Pharmaceutical Care Services.

Thank you for your assistance and cooperation with this necessary change.

The Ambulatory Care Pharmacies may fill prescriptions for patients with quota state papers for a greater than 30-day supply according to the following guidelines:

• Patients must have current (verified) quota state papers. (NOTE: This program excludes patients with county-pay papers.) Prescribers will identify these patients on new prescriptions (or one of a group of new prescriptions) to be filled by the Ambulatory Care Pharmacies. Patients not listed with a status of verified quota state papers on the INFORMM System when prescriptions are presented to the Ambulatory Care Pharmacies are not eligible for this program.
• Prescriptions must be written by authorized UIHC prescribers on UIHC prescription blanks.
• A maximum 90-day supply of maintenance medications may be dispensed to patients eligible for this program. The therapeutic categories of medication that may be dispensed for more than 30 days of therapy are limited to those indicated for the treatment of chronic disease (see Table 3).
• Only medications available on the UIHC Formulary are available for a 90-day supply. Special order (i.e., nonformulary) medications may be processed for acute conditions if a formulary alternative is not available. These medications will be limited to a 30-day supply. Chronic use of nonformulary medications will require a new prescription every 30 days, and hence, a physician visit at least once a month as per current procedures.
• Formulary medications in the acute category that are being prescribed for a chronic condition must have the specific indication for use documented on the prescription blank in the designated location to be eligible for a 90-day supply.
• The maximum duration for which a prescription will be valid for this program (including a single refill) is six months.
• Patients must have a visit with the prescriber or the prescriber's clinical service at least every 180 days (six months).
• One refill will be processed to complete up to a 180-day supply (if authorized by the prescriber). Refills may be provided by mailout service from the UIHC Ambulatory Care Pharmacies. Only refill supplies will be mailed to patients in the Indigent Patient Care Program. Nonformulary (special order) medications will not be eligible for this service. To avoid stockpiling of medications by patients, refills will only be provided 75 days after the patient last received a supply of the same medication from UIHC.
• OTC medications not covered under the UIHC State Paper OTC Formulary will not be provided (see Table 4 for covered medications).
• Prescribers must include explicit patient directions on all prescription orders to be filled by the Ambulatory Care Pharmacies for this program. Orders with "Take as directed" will not be processed via this program.

 

Table 3. Medication Dispensing Limits for Patients in the Indigent Patient Care Program
Maximum Supply Limits of Medication Which May Be Dispensed No more than a 30-day supply of medication will be dispensed for these medications.
Medications for the treatment of ACUTE (short-term) medical conditions, including: Alprostadil urethral suppositories (MUSE) (maximum 6 suppositories per month) Anti-infective agents Antineoplastic agents and colony stimulating factors Clozapine Controlled substances Dihydroergotamine nasal spray Erythropoietin Interferons	OTC cough and cold preparations Otic preparations Ophthalmic preparations (for acute conditions) Naratriptan Proton pump inhibitors Rebetron® kits Sedative / hypnotics Sildenafil (Viagra®) (maximum of 6 tablets per month) Sumatriptan nasal spray, tablets, and injection Topical preparations (for acute conditions)
Maximum Supply Limits of Medication Which May Be Dispensed A 90-day supply of maintenance medications may be dispensed for these medications.
Medications for the treatment of CHRONIC medical conditions; the patient must be stabilized on a particular drug and dose for at least 30 days. These categories include: Anticoagulants Anticonvulsants Antihistamines Anti-infective agents (for long-term use, e.g., osteomyelitis, endocarditis, TB, PCP) Arthritis drugs Asthma drugs Cardiovascular drugs, including: Antilipemics Antianginal agents Antiarrhythmics Antihypertensives Calcium channel blockers Diuretics Diabetes drugs	Gastrointestinal drugs (e.g., antacids, mesalamine, sucralfate, sulfasalazine, H2RAs) Glaucoma drugs HIV / AIDS drugs Hormone replacements Oral contraceptives Organ transplantation drugs Parkinson's disease drugs Prostate disease drugs Psychiatric drugs Topicals (for chronic dermatologic conditions) Thyroid drugs Tramadol Vitamins

 

Table 4. State Papers Patients Over-The-Counter (OTC) Medication Formulary

Open Formulary Acetaminophen Tablets, Chewable; 80 mg Acetaminophen Tablets; 325 mg Acetaminophen Oral Solution; 160 mg/5 ml Acetaminophen Suppositories; 120 mg Aluminum Hydroxide Oral Suspension; 600 mg/5 ml Aquaphilic Ointment Aspirin Tablets, Chewable; 81 mg Aspirin Tablets; 325 mg Aspirin Tablets, Enteric Coated; 325 mg Aspirin Tablets, Buffered; 325 mg Benzoyl Peroxide Lotion; 5%, 10% Benzoyl Peroxide Gel; 5%, 10% Bisacodyl Enteric-Coated Tablets; 5 mg Calcium Carbonate: Vitamin D Tablets; 1250 mg:125 I.U. Calcium Carbonate Tablets, Chewable ; 500 mg Capsaicin Topical Cream; 0.025% Chlorpheniramine Tablets; 4 mg Diphenhydramine Capsules; 25 mg Diphenhydramine Oral Solution ; 12.5 mg/5 ml Ferrous Sulfate Tablets ; 300 mg or 324 mg or 325 mg Ferrous Sulfate Oral Solution; 300 mg/ 5ml Ferrous Sulfate Oral Drops; 125 mg/ml Ferrous Gluconate Tablets; 300 mg or 324 mg or 325 mg Ferrous Fumarate Tablets; 200 mg Guiafenesin: Dextromethorphan Oral Soln.; 100 mg:10 mg/5 ml Hydrocortisone Topical Ointment; 1% Ibuprofen Tablets; 200 mg Insulins Magnesium/Aluminum/Simethicone Antacid; High Potency Magnesium Citrate Oral Solution Meclizine Tablets; 12.5 mg Meclizine Tablets, Chewable; 25 mg

Miconazole Topical Cream; 2% Multivitamin Tablets, Prenatal Multivitamin Tablets Multivitamin with Mineral Tablets Niacin (Nicotinic Acid) Tablets; 50 mg, 500 mg Nicotine Polacrilex Gum; 2 mg, 4 mg Nicotine Transdermal Patches; 7 mg, 14 mg, 21 mg Permethrin Topical Liquid (Nix); 1% Pseudoephedrine Tablets; 30 mg, 60 mg Pseudoephedrine Oral Solution; 30 mg/5 ml Senokot Tablets; 187 mg Sodium Chloride Inhalation Solution; 0.9% Terbinafine Cream Triple Antibiotic Ointment, Topical Restricted Prescribing Lactobacillus Capsules; 2.5 billion, 10 billion organisms (diagnosis of antibiotic-associated diarrhea) Bismuth Subsalicylate Tablets; 262 mg (diagnosis of H. pylori ulcer) Bismuth Subsalicylate Oral Suspension; 262 mg/5 ml (diagnosis of H. pylori ulcer) Artificial Saliva Substitute (Radiation Oncology patients) Artificial Tears (prescribing by Ophthalmology) Loperamide Capsules; 2 mg (severe and/or chronic diarrhea) Docusate Capsules; 100 mg (chronic opioid therapy) Devices Insulin Needles Insulin Syringes Blood glucose test strips Lancets

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