*************E-PRESCRIBING/CONSENT FORM***********
e-Prescribing is defined as a Physician's ability to electronically send an accurate, error-free, and understandable prescription directly to the Pharmacy from the pont of care. Congress has determined that the ability to electronically send prescriptions is an important element in improving the quality of patient care. e-Prescribing greatly reduced medication errors and enhances patient safety. The Medication Modernization Act (MMA) of 2003 listed standards that have to be included in an e-Prescribe program. These include:

  • FORMULARY AND BENEFIT TRANSACTIONS

    Gives the Prescriber information about which Drugs are covered

  • MEDICATION HISTORY TRANSACTIONS

    Provides the Physician with information about medications that the Patient is already taking to minimize the number of adverse Drug-Events.

  • FILL STATUS NOTIFICATION

    Allows the prescriber the receive notice from the Pharmacy telling them if the Patient's Prescriptions have been picked up, not picked up, or partially filled.

  • By signing this consent form, you are agreeing that our staff can request and use your Prescription medication history from other healthcare providers and/or third-party benefit payers for treatment purposes. Understanding all of the above, I hereby provide informed consent to my Physician/Practitioner to enroll me in the e-prescribe program. I have had the opportunity to ask questions and all of my questions have been answered to my satisfaction.

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  • BY CLICKING THE ABOVE BOX, I CONSIDER THIS FORM OFFICIALLY SIGNED BY OR FOR THE PATIENT. THIS BOX CONSTITUES LEGAL SIGNATURE AND FULL UNDERSTANDING OF THE ABOVE INFORMATION.
  • PRINT THE NAME EXACTLY AS IT APPEARS IN THE ABOVE SIGNATURE
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