Prescription Pads Guidelines - Indiana

///Prescription Pads – Indiana
Prescription Pads – Indiana 2017-01-05T18:51:04+00:00

The state of Indiana currently follows federal requirements for prescription pads as set forth by the CMS. In addition to federal requirements the state of Indiana also requires the following:

All controlled substance prescriptions written by licensed Indiana practitioners must contain the following security features:

  • A latent, repetitive “void” pattern in reflex blue must appear across the entire face of the document when the prescription is photocopied;
  • A watermark reading “Indiana Security Prescription” must be printed on the back of the paper; these words must appear at a 45 degree angle, horizontally in a step-and-repeated pattern in 5 lines, using 12-point Helvetica bold type style;
  • An opaque RX symbol must appear in the upper right-hand corner , 1/8 of an inch from the top and 5/16 of an inch from the right side.  This symbol must be 3/4 of an inch and disappear if the prescription copy is lightened;
  • Six (6) quantity check-off boxes and the following quantities must be printed on the form and the appropriate box checked off:  “1-24”, “25-49”, “50-74”, “75-100”, “101-150”, and “151 and over”
  • No advertisements may appear on the front or back;
  • Logos may appear in the upper left one-inch square;
  • Only one prescription may be written per 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.”;
  • Refill options that can be circled must appear below any logos and above the signature lines on the left side of the prescription in the following order:  “Refill NR 1 2 3 4 5 Void after _____”
  • Practitioner full name, address, DEA number, and state issued license number must be preprinted, stamped, or manually printed on the prescription;
  • All prescription blanks must be 4 1/4 inches high and 5 1/2 inches wide;
  • Two signature lines printed at the bottom of the form:  under the blank line on the left side must be printed the words “Dispense as Written”, under the blank line on the right side must be printed the words “May Substitute”.
  • The name of any controlled substance may not be preprinted on any prescription forms at any time prior to the prescription being prepared and executed for presentation to the patient or the patient’s agent.  That includes, but is not limited to, typing prescriptions in anticipation of their need and/or using a rubber stamp or similar means to accomplish the same end.  Commercially printed forms containing names of controlled substances are also prohibited.

State Requirements

All states are required to meet the baseline standards set forth by the CMS. Several states have Prescription Monitoring Programs that require prescription pads to have specific security features.

For in-depth information regarding specific state requirements choose from the list below.

Map-Georgia

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