Prescriptions serve as the primary communication tool between prescribers and pharmacists, and they can come in various formats, including traditional hand-written orders, oral (phoned-in) instructions, faxed transmissions, and increasingly, electronic prescriptions (e-prescriptions). For PharmD students and practicing pharmacists, understanding the legal requirements, specific considerations, advantages, and potential pitfalls associated with each prescription format is crucial for ensuring patient safety, maintaining compliance with pharmacy law, and ensuring the efficient and accurate dispensing of medications. This quiz will test your knowledge on the nuances of different prescription formats encountered in pharmacy practice.
1. Which of the following is NOT generally considered a primary format for transmitting a prescription from a prescriber to a pharmacy?
- a) Hand-written prescription given to the patient.
- b) Oral prescription phoned in by the prescriber.
- c) Text message from the prescriber’s personal cell phone.
- d) Electronic prescription sent via a certified e-prescribing system.
Answer: c) Text message from the prescriber’s personal cell phone. (While used informally for communication, it’s generally not a secure or legally sound primary method for new prescriptions, especially controlled substances, compared to certified systems).
2. A key advantage of electronic prescribing (e-prescribing) over traditional handwritten prescriptions is:
- a) Elimination of the need for pharmacist verification.
- b) Reduced risk of medication errors due to improved legibility and clinical decision support.
- c) Lower cost of medications for the patient.
- d) Faster transmission than a fax.
Answer: b) Reduced risk of medication errors due to improved legibility and clinical decision support.
3. When a pharmacist receives an oral (phoned-in) prescription from a prescriber, the pharmacist is generally required to:
- a) Tell the prescriber to send a written copy instead.
- b) Promptly reduce the oral prescription to writing (or enter it into an electronic system) and include all necessary information.
- c) Only fill it if it’s for an OTC medication.
- d) Have the patient call the prescriber back for verification.
Answer: b) Promptly reduce the oral prescription to writing (or enter it into an electronic system) and include all necessary information.
4. Which of the following elements is essential for the validity of any prescription, regardless of its format?
- a) The patient’s email address.
- b) The prescriber’s authorized signature (or secure electronic equivalent).
- c) The time of day the prescription was generated.
- d) The pharmacy’s NPI number.
Answer: b) The prescriber’s authorized signature (or secure electronic equivalent).
5. For a faxed prescription to be valid, it generally must:
- a) Be faxed directly from the patient’s home.
- b) Originate from the prescriber’s office and contain the prescriber’s signature.
- c) Be printed on plain paper with no letterhead.
- d) Be for an OTC medication only.
Answer: b) Originate from the prescriber’s office and contain the prescriber’s signature.
6. A significant concern with handwritten prescriptions is:
- a) They are too slow to write.
- b) Illegibility, which can lead to dispensing errors.
- c) They cannot be used for controlled substances.
- d) They always cost the patient more.
Answer: b) Illegibility, which can lead to dispensing errors.
7. Computer-generated prescriptions that are printed out and manually signed by the prescriber are typically treated legally as:
- a) Electronic prescriptions.
- b) Oral prescriptions.
- c) Handwritten prescriptions.
- d) Faxed prescriptions.
Answer: c) Handwritten prescriptions.
8. When receiving an oral prescription for a controlled substance, specific federal and state regulations apply. For Schedule II drugs, an oral prescription is generally only permitted:
- a) For any quantity the patient requests.
- b) In emergency situations, with a follow-up written/electronic prescription required within a specified timeframe.
- c) If the patient is a close friend of the pharmacist.
- d) Never, under any circumstances.
Answer: b) In emergency situations, with a follow-up written/electronic prescription required within a specified timeframe.
9. The “pharmacists’ responsibilities with regard to prescriptions presented to pharmacies in each of the following formats: electronic prescriptions (i.e. e-prescribing) faxed prescriptions, hand-written prescriptions, computer-generated prescriptions, and phoned-in prescriptions” primarily involve ensuring:
- a) The pharmacy makes the maximum profit.
- b) The prescription is dispensed as quickly as possible, regardless of other factors.
- c) The authenticity, legality, safety, and appropriateness of the prescription before dispensing.
- d) The patient has the correct insurance information.
Answer: c) The authenticity, legality, safety, and appropriateness of the prescription before dispensing.
10. Which prescription format is generally considered to have the highest level of security and built-in checks against fraud when implemented correctly with certified systems?
- a) Handwritten on a plain pad.
- b) Phoned-in to a busy pharmacy.
- c) Electronic prescriptions (e-prescribing).
- d) Faxed from a public fax machine.
Answer: c) Electronic prescriptions (e-prescribing).
11. If a pharmacist has doubts about the legitimacy of a prescription, regardless of its format, they should:
- a) Dispense it anyway to avoid conflict.
- b) Attempt to verify it with the prescriber’s office.
- c) Ask the patient to verify it.
- d) Modify the prescription to what seems reasonable.
Answer: b) Attempt to verify it with the prescriber’s office.
12. For an electronic prescription for a controlled substance (EPCS) to be valid, it must comply with:
- a) Only state laws.
- b) Only federal DEA requirements.
- c) Both federal DEA requirements (including specific software security and prescriber identity proofing) and any applicable state laws.
- d) The pharmacy’s internal policies only.
Answer: c) Both federal DEA requirements (including specific software security and prescriber identity proofing) and any applicable state laws.
13. One advantage of faxed prescriptions is that they provide a:
- a) Guaranteed secure transmission.
- b) Written record of the prescription as sent by the prescriber.
- c) Method that requires no pharmacist verification.
- d) Way to bypass DUR checks.
Answer: b) A written record of the prescription as sent by the prescriber.
14. A potential disadvantage of faxed prescriptions is:
- a) They are never legible.
- b) Poor transmission quality can lead to illegibility or missing information.
- c) They cannot be used for refills.
- d) They are illegal in all states.
Answer: b) Poor transmission quality can lead to illegibility or missing information.
15. When a pharmacy intern takes an oral prescription, it must typically be:
- a) Verified by the patient before entry.
- b) Done under the direct supervision of a licensed pharmacist, who may also need to verify the accuracy.
- c) For non-controlled substances only, regardless of state law.
- d) Transcribed only after the intern’s shift ends.
Answer: b) Done under the direct supervision of a licensed pharmacist, who may also need to verify the accuracy.
16. Which of the following is typically required information when a pharmacist reduces an oral prescription to writing?
- a) The name of the pharmacy technician on duty.
- b) The date and time of the call, the name of the individual calling it in (if not the prescriber), and the pharmacist who received it.
- c) The patient’s preferred method of payment.
- d) The pharmacy’s hours of operation.
Answer: b) The date and time of the call, the name of the individual calling it in (if not the prescriber), and the pharmacist who received it.
17. A prescription written on a hospital’s internal blank or order sheet for a patient being discharged may be valid if it:
- a) Is only for a 1-day supply.
- b) Contains all legally required elements of a prescription, including the prescriber’s signature and DEA number if for a controlled substance.
- c) Is stamped by the hospital administrator.
- d) Is verbally confirmed by a nurse.
Answer: b) Contains all legally required elements of a prescription, including the prescriber’s signature and DEA number if for a controlled substance.
18. What is a key security feature of tamper-resistant prescription pads often required for handwritten Medicaid prescriptions?
- a) They are bright pink.
- b) They contain features designed to prevent unauthorized copying, erasing, or modification.
- c) They can only be used by specialist physicians.
- d) They dissolve in water.
Answer: b) They contain features designed to prevent unauthorized copying, erasing, or modification.
19. Can a pharmacist legally fill a prescription written by an out-of-state prescriber?
- a) No, never.
- b) Yes, generally, as long as the prescriber is licensed in their state and has a valid patient-prescriber relationship, and the prescription meets all requirements of the dispensing state and federal law.
- c) Only if it is for an OTC medication.
- d) Only if the patient is a resident of the dispensing state.
Answer: b) Yes, generally, as long as the prescriber is licensed in their state and has a valid patient-prescriber relationship, and the prescription meets all requirements of the dispensing state and federal law.
20. If a faxed prescription for a Schedule II drug is received, a community pharmacy generally cannot dispense it unless:
- a) The patient picks it up within 24 hours.
- b) It meets specific exceptions (e.g., for LTCF patients, hospice patients, or for emergency situations where the original written prescription is presented prior to actual dispensing or as per state regulations).
- c) It is co-signed by a pharmacist.
- d) The fax is in color.
Answer: b) It meets specific exceptions (e.g., for LTCF patients, hospice patients, or for emergency situations where the original written prescription is presented prior to actual dispensing or as per state regulations).
21. What is a “standing order” or protocol-based prescription?
- a) A prescription that is always kept standing upright on the counter.
- b) An order that allows a pharmacist to dispense a specific medication to a predefined group of patients meeting certain criteria, under a collaborative practice agreement or protocol with a prescriber.
- c) A prescription that can never be refilled.
- d) An illegal form of prescribing.
Answer: b) An order that allows a pharmacist to dispense a specific medication to a predefined group of patients meeting certain criteria, under a collaborative practice agreement or protocol with a prescriber.
22. The transmission of prescription information from one pharmacy to another for refill purposes is known as a:
- a) Prescription renewal.
- b) Prescription transfer.
- c) Prior authorization.
- d) Therapeutic interchange.
Answer: b) Prescription transfer.
23. When transferring a prescription (non-controlled), the transferring pharmacist must typically:
- a) Destroy the original prescription immediately.
- b) Provide the receiving pharmacy with all required prescription information and cancel or void the original prescription or note the transfer details.
- c) Get approval from the patient’s insurance company first.
- d) Only transfer it if the patient is moving out of state.
Answer: b) Provide the receiving pharmacy with all required prescription information and cancel or void the original prescription or note the transfer details.
24. Which prescription format is generally not permissible for transferring refills of Schedule II controlled substances?
- a) Electronic transfer between pharmacies sharing a real-time online database (if allowed by DEA and state law).
- b) Schedule II prescriptions are generally not refillable, so “transferring refills” is not applicable. A new prescription is needed.
- c) Fax transfer.
- d) Oral transfer.
Answer: b) Schedule II prescriptions are generally not refillable, so “transferring refills” is not applicable. A new prescription is needed.
25. A prescription generated by a computer but not electronically signed and transmitted, rather printed and given to the patient, is a:
- a) Valid e-prescription.
- b) Written prescription.
- c) Faxed prescription.
- d) Oral prescription.
Answer: b) Written prescription.
26. Which of the following is a risk associated with oral prescriptions?
- a) They are always more accurate than written prescriptions.
- b) Misunderstandings due to sound-alike drug names or poor phone connection.
- c) They eliminate the need for a pharmacist’s judgment.
- d) They take longer to process than e-prescriptions.
Answer: b) Misunderstandings due to sound-alike drug names or poor phone connection.
27. To minimize errors with oral prescriptions, pharmacists should employ techniques such as:
- a) Rushing the prescriber off the phone.
- b) Repeating back the prescription information to the caller for verification and obtaining the caller’s name.
- c) Guessing any unclear information.
- d) Asking the patient to confirm the details later.
Answer: b) Repeating back the prescription information to the caller for verification and obtaining the caller’s name.
28. Federal law and many state laws require that prescription records, regardless of format, be maintained for a specific period, typically:
- a) 6 months.
- b) 1 year.
- c) At least 2 years (federal for many records, state laws may vary or require longer).
- d) Indefinitely.
Answer: c) At least 2 years (federal for many records, state laws may vary or require longer).
29. If an e-prescription transmission fails or is incomplete, the pharmacy should:
- a) Guess the missing information.
- b) Contact the prescriber’s office to resolve the issue or obtain a new prescription via another valid format.
- c) Dispense a partial fill.
- d) Tell the patient the system is down and they cannot get their medication.
Answer: b) Contact the prescriber’s office to resolve the issue or obtain a new prescription via another valid format.
30. A prescription written “Take as directed” is generally:
- a) Acceptable if the pharmacist knows the patient well.
- b) Unacceptable unless accompanied by clear, specific directions from the prescriber (e.g., on a tapering dose schedule sheet provided to the patient and pharmacy).
- c) The preferred way to write directions.
- d) Only used for OTC medications.
Answer: b) Unacceptable unless accompanied by clear, specific directions from the prescriber (e.g., on a tapering dose schedule sheet provided to the patient and pharmacy).
31. Prescriptions originating from telemedicine encounters are:
- a) Always invalid.
- b) Valid if the telemedicine practice and prescribing comply with all applicable federal and state laws and regulations, including requirements for a valid patient-prescriber relationship.
- c) Only valid for non-controlled substances.
- d) Not subject to pharmacist verification.
Answer: b) Valid if the telemedicine practice and prescribing comply with all applicable federal and state laws and regulations, including requirements for a valid patient-prescriber relationship.
32. A key element for the legality of a phoned-in prescription is that it is communicated by:
- a) The patient.
- b) The prescriber or their authorized agent (where permitted by law).
- c) Any staff member at the clinic.
- d) The patient’s spouse.
Answer: b) The prescriber or their authorized agent (where permitted by law).
33. When dealing with prescriptions for compounded medications, the order must specify:
- a) Only the desired flavor.
- b) The specific ingredients and quantities or a recognized formula, along with directions for use.
- c) That the medication should be compounded as cheaply as possible.
- d) The patient’s preferred color.
Answer: b) The specific ingredients and quantities or a recognized formula, along with directions for use.
34. If a prescription lacks the quantity to be dispensed, the pharmacist should:
- a) Dispense a 30-day supply.
- b) Contact the prescriber to obtain the intended quantity.
- c) Dispense the smallest available package size.
- d) Refuse to fill the prescription.
Answer: b) Contact the prescriber to obtain the intended quantity.
35. What is a “digital signature” in the context of e-prescribing?
- a) A scanned image of a handwritten signature.
- b) A secure, encrypted electronic identifier that verifies the identity of the sender and ensures message integrity.
- c) The prescriber typing their name at the end of the e-prescription.
- d) A password known only to the pharmacist.
Answer: b) A secure, encrypted electronic identifier that verifies the identity of the sender and ensures message integrity.
36. Can a patient request their electronic prescription be sent to a specific pharmacy?
- a) No, the prescriber chooses the pharmacy.
- b) Yes, patients generally have the right to choose their pharmacy for e-prescriptions.
- c) Only if the pharmacy is part of a specific network.
- d) Only if the prescriber agrees in writing.
Answer: b) Yes, patients generally have the right to choose their pharmacy for e-prescriptions.
37. If a pharmacy’s computer system is down, how might they handle new prescriptions?
- a) Refuse all new prescriptions until the system is back up.
- b) They may need to rely on manual/paper-based procedures for receiving, processing, and documenting prescriptions, ensuring all legal requirements are still met.
- c) Ask patients to come back next week.
- d) Only fill prescriptions for established patients.
Answer: b) They may need to rely on manual/paper-based procedures for receiving, processing, and documenting prescriptions, ensuring all legal requirements are still met.
38. What does “Surescripts” refer to in the context of prescription formats?
- a) A type of tamper-resistant paper.
- b) A health information network that facilitates the electronic transmission of prescriptions between prescribers and pharmacies.
- c) A government agency regulating prescriptions.
- d) A brand of pharmacy software.
Answer: b) A health information network that facilitates the electronic transmission of prescriptions between prescribers and pharmacies.
39. Alterations or additions to a handwritten prescription by the patient are:
- a) Acceptable if the patient initials the change.
- b) Generally invalid and may render the prescription void or require prescriber verification of the alteration.
- c) Permitted if the change is to a lower dose.
- d) Only allowed for non-controlled substances.
Answer: b) Generally invalid and may render the prescription void or require prescriber verification of the alteration.
40. When verifying a faxed prescription, the pharmacist should pay attention to:
- a) The type of fax machine used by the prescriber.
- b) The header information to confirm it came from the prescriber’s office, the clarity of the prescription, and the presence of a valid signature.
- c) Whether the fax was sent during business hours.
- d) The color of the ink used in the original signature.
Answer: b) The header information to confirm it came from the prescriber’s office, the clarity of the prescription, and the presence of a valid signature.
41. Which prescription format, when properly implemented, offers the best audit trail for tracking the prescription from creation to dispensing?
- a) Oral prescriptions.
- b) Handwritten prescriptions on standard pads.
- c) Certified electronic prescribing systems.
- d) Faxed prescriptions with no confirmation.
Answer: c) Certified electronic prescribing systems.
42. If a prescriber issues multiple Schedule II prescriptions on the same day for a patient to receive a total of up to a 90-day supply, each separate prescription must:
- a) Be post-dated to when it can be filled.
- b) Have the actual date of issue and may include an earliest fill date indicated by the prescriber (e.g., “Do not fill before X/X/XXXX”).
- c) Be faxed directly to the pharmacy.
- d) Be for a maximum 10-day supply.
Answer: b) Have the actual date of issue and may include an earliest fill date indicated by the prescriber (e.g., “Do not fill before X/X/XXXX”).
43. The use of pre-signed prescription blanks is:
- a) A common and accepted practice.
- b) Generally illegal and considered unprofessional conduct.
- c) Only allowed for non-controlled substances.
- d) Permitted if the prescriber is very busy.
Answer: b) Generally illegal and considered unprofessional conduct.
44. What is the pharmacist’s responsibility if they receive a prescription in a format that does not meet legal requirements (e.g., a texted image of a Schedule II prescription)?
- a) Fill it quickly to help the patient.
- b) Inform the patient/prescriber that the format is invalid and request a valid prescription.
- c) Convert it to an oral prescription in their mind.
- d) Report the patient to the DEA.
Answer: b) Inform the patient/prescriber that the format is invalid and request a valid prescription.
45. Can a family member or caregiver phone in a request for a refill of an existing, valid prescription with authorized refills?
- a) No, only the patient can request refills.
- b) Yes, generally, if they can provide sufficient identifying information for the patient and prescription.
- c) Only if they have power of attorney.
- d) Only for OTC medications.
Answer: b) Yes, generally, if they can provide sufficient identifying information for the patient and prescription.
46. When a prescription is transferred, the receiving pharmacy must record:
- a) Only the drug name and strength.
- b) All original prescription information, transfer date, names of transferring/receiving pharmacists/interns, and sending pharmacy details.
- c) The patient’s preferred payment method.
- d) The weather conditions on the day of transfer.
Answer: b) All original prescription information, transfer date, names of transferring/receiving pharmacists/interns, and sending pharmacy details.
47. The primary benefit of using standardized prescription formats and elements is:
- a) To make prescriptions look aesthetically pleasing.
- b) To improve clarity, reduce ambiguity, and enhance patient safety.
- c) To increase the workload for prescribers.
- d) To make it easier for insurance companies to deny claims.
Answer: b) To improve clarity, reduce ambiguity, and enhance patient safety.
48. If a prescriber wants to authorize refills for a prescription that originally had no refills, they generally must:
- a) Tell the patient to inform the pharmacist.
- b) Issue a new prescription or provide a new authorization directly to the pharmacy (e.g., orally, electronically, faxed).
- c) Send a letter to the patient’s home.
- d) Assume the pharmacist will add refills if needed.
Answer: b) Issue a new prescription or provide a new authorization directly to the pharmacy (e.g., orally, electronically, faxed).
49. A pharmacist’s ability to accurately interpret prescription abbreviations (Sig codes) is crucial regardless of the prescription format. If an abbreviation is unclear, the pharmacist must:
- a) Use their best guess.
- b) Consult an online abbreviation dictionary and proceed.
- c) Clarify with the prescriber.
- d) Ask the patient for interpretation.
Answer: c) Clarify with the prescriber.
50. Ultimately, the choice of prescription format used by a prescriber may be influenced by:
- a) Only their personal preference.
- b) The type of medication (e.g., controlled vs. non-controlled), available technology, state laws, and pharmacy capabilities.
- c) The patient’s age.
- d) The time of year.
Answer: b) The type of medication (e.g., controlled vs. non-controlled), available technology, state laws, and pharmacy capabilities.