Medications

Medication ordering options

E-Rx

This option transmits prescription automatically to the pharmacy selected – use for almost all meds (it is the default for all med orders). Best for all non-controlled substances.

Normal

This option prints the prescription to nearest printer from computer where it was ordered. If ordered in exam room, it will print to the closest printer. If ordered in the back workroom, then prints in the workroom. Used for controlled substances and when you need to print a prescription to be faxed. Note that if you select “Normal” while home or at hospital then a script will print to clinic workroom but you won’t be there to sign it so it won’t do much good.

Phone

Used to document when you have called in a prescription. No prescription will be transmitted or printed. Useful for schedule III-V controlled substances (which you can call in yourself but can’t E-RX. MAs and RNs cannot call pharmacies for controlled substances prescriptions in our clinic.

Not printed

Enters prescription order but doesn’t transmit or print. Functionally equivalent to “Phone” but less useful.

Historical

Allows you to enter a “dummy” prescription without a quantity to add something to the list. Avoid using this–it’s better to use the “Patient-Reported” button because that allows you to document the original prescriber.

Controlled Substances

Controlled substances include opioids, ADHD meds, benzos, non-benzo benzos (like zolpidem), testosterone, pregabalin, and more. These can’t be e-prescribed in Epic (yet). If you try to order them using E-RX you will get an error. Any time you order a controlled substance, you have to go get the prescription from the printer, sign, and hand to patient.

Remember that before refilling any chronic controlled substance prescription, review the Washington State Prescription Monitoring Program (WA-PMP) report, available in Epic. Check to ensure they are receiving the prescriptions you expect at appropriate times, and there aren’t any additional prescribers.

Controlled substances have different restrictions depending on which DEA schedule they are on:

Schedule II: (opioids, some stimulants for ADHD)

These require a paper prescription–they cannot be faxed or phoned in. (Exception: hospice patients can sometimes have prescriptions faxed.) There are also no additional refills permitted on Schedule II medications.
Set expectations with your patients to make an appointment for these refills: it is clinic policy not to refill these outside of appointments for patient safety. If such an order is needed when you are not in clinic, you will need to have someone in clinic order it (ideally at an in-person visit).

Schedule III-V: (Benzos, testosterone, zolpidem, pregabalin)

These can be called in or faxed, and up to five refills are allowed. Refills expire after six months. It’s still best practice to refill in person so that you can reassess need for treatment and review the WA-PMP report, but if needed you can fax or phone in.