Medical prescription

A prescription in the medical context, often abbreviated or Rx, is a formal communication from physicians or other registered healthcare professionals to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatmentthe symbol comes from the first word of a medieval prescription, Latin , that gave the list of the materials to be compounded. Requirements for content, who may prescribe, and how prescriptions are transmitted vary by country; many jurisdictions use electronic prescribing systems.

Definition and symbol

In law, a prescription in the medical context is a written or electronic order for a medicinal product or medical device issued by a health professional—such as a physician, physician assistant, dentist, or veterinarian—who is legally entitled to prescribe within the jurisdiction where it is issued. In pharmacy usage, the term prescription generally refers to instructions for medicines that patients obtain from a pharmacy or doctor's office and take themselves outside the hospital. This contrasts with medication orders, which are recorded in hospital or institutional charts to guide nurses and other staff in administering medicines directly to inpatients.
Prescriptions may be issued on paper, electronically, or, where it is permitted, verbally. Paper prescriptions normally require the prescriber's handwritten signature and the date of issue. In some jurisdictions, a digital signature may be accepted, while prescriptions for controlled drugs often carry additional legal requirements, such as a handwritten signature, specified wording, or security features. Electronic prescriptions are accepted in many jurisdictions, and verbal prescriptions, when accepted, are subject to restrictions and read-back procedures to reduce error. The content of a prescription includes the name and address of the prescribing provider and any other legal requirements, such as a registration number. Unique to each prescription is the name of the patient. In the United Kingdom and Ireland, the patient's name and address must also be recorded. Each prescription is dated, and some jurisdictions may place a time limit on the prescription. Due to the addictive properties of certain drugs, incidents where security hackers have compromised online prescription accounts and employees have forged paper scripts to be sold on the black market have occurred. In the past, prescriptions contained instructions for the pharmacist to use for compounding the pharmaceutical product, but most prescriptions now specify pharmaceutical products that were manufactured and require little or no preparation by the pharmacist. Prescriptions also contain directions for the patient to follow when taking the drug. These directions are printed on the label of the pharmaceutical product.
The word ', from ' and script, refers to the fact that the prescription is an order that must be written down before a drug can be dispensed. Those within the industry will often call prescriptions simply "scripts". The symbol, sometimes transliterated as "R_x" or "Rx", is recorded in 16th century manuscripts as an abbreviation of the late Latin instruction recipe, meaning 'receive'. Originally abbreviated Rc, the later convention of using a slash to indicate abbreviation resulted in an R with a straight stroke through its right "leg". Medieval prescriptions invariably began with the instruction from the physician to the apothecary to "take" certain materials and compound them in specified ways.

Every prescription contains who prescribed the prescription, who the prescription is valid for, and what is prescribed. Some jurisdictions, drug types or patient groups require additional information as explained below.

Drug equivalence and non-substitution

Many brand name drugs have cheaper generic drug substitutes that are therapeutically and biochemically equivalent. Prescriptions will also contain instructions on whether the prescriber will allow the pharmacist to substitute a generic version of the drug. This instruction is communicated in a number of ways. In some jurisdictions, the preprinted prescription contains two signature lines: one line has "dispense as written" printed underneath; the other line has "substitution permitted" underneath. Some have a preprinted box "dispense as written" for the prescriber to check off. In other jurisdictions, the protocol is for the prescriber to handwrite one of the following phrases: "dispense as written", "DAW", "brand necessary", "do not substitute", "no substitution", "medically necessary", "do not interchange". In Britain's National Health Service, doctors are reminded that money spent on branded rather than generic drugs is consequently not available for more deserving cases.

Prescriptions for children

In some jurisdictions, it may be a legal requirement to include the age of child on the prescription. For pediatric prescriptions some advise the inclusion of the age of the child if the patient is less than twelve and the age and months if less than five. Adding the weight of the child is also helpful.

Label and instructions

Prescriptions in the US often have a "label" box. When checked, the pharmacist is instructed to label the medication and provide information about the prescription itself is given in addition to instructions on taking the medication. Otherwise, the patient is simply given the instructions. Some prescribers further inform the patient and pharmacist by providing the indication for the medication; i.e. what is being treated. This assists the pharmacist in checking for errors as many common medications can be used for multiple medical conditions. Some prescriptions will specify whether and how many "repeats" or "refills" are allowed; that is whether the patient may obtain more of the same medication without getting a new prescription from the medical practitioner. Regulations may restrict some types of drugs from being refilled.

Writing prescriptions

Legal capacity to write prescriptions

National or local legislation governs who can write a prescription. In the United States, physicians have the broadest prescriptive authority. All 50 US states and the District of Columbia allow licensed certified Physician Assistants prescription authority. All 50 US states and the District of Columbia, Puerto Rico and Guam allow registered certified nurse practitioners and other advanced practice registered nurses prescription power. Many other healthcare professions also have prescriptive authority related to their area of practice. Veterinarians and dentists have prescribing power in all 50 US states and the District of Columbia for animals and for human diseases of the mouth, respectfully. Clinical pharmacists are allowed to prescribe in some US states through the use of a drug formulary or collaboration agreements. Florida pharmacists can write prescriptions for a limited set of drugs. In all US states, optometrists prescribe medications to treat certain eye diseases, and also issue spectacle and contact lens prescriptions for corrective eyewear. Several US states have passed RxP legislation, allowing clinical psychologists who are registered as medical psychologists and have also undergone specialized training in script-writing, to prescribe drugs to treat emotional and mental disorders.
In August 2013, legislative changes in the UK allowed physiotherapists and podiatrists to have independent prescribing rights for licensed medicines that are used to treat conditions within their own area of expertise and competence. In 2018 this was extended to paramedics.
In Australia, registered nurses may prescribe under collaborative arrangements with an authorized prescriber, while in the United Kingdom, nurses, midwives, and pharmacists may prescribe if they complete an approved course and register their qualification. In other countries, such as Japan and South Korea, prescribing is restricted to physicians, dentists, and veterinarians. In South Korea, both physicians and pharmacists could prescribe and dispense medicines until July 2000.

Standing orders

Some jurisdictions allow certain physicians to write "standing orders" that act like a prescription for everyone in the general public. These orders also provide a standard procedure for determining if administration is necessary and details of how it is to be performed safely. These are typically used to authorize certain people to perform preventive, low-risk, or emergency care that would be otherwise logistically cumbersome to authorize for individual patients, including vaccinations, prevention of cavities, birth control, treatment of infectious diseases, and reversal of drug overdoses.

Legibility of handwritten prescriptions

Doctors' handwriting is a reference to the stereotypically illegible handwriting of some medical practitioners, which sometimes causes errors in dispensing. In the US, illegible handwriting has been indirectly responsible for at least 7,000 deaths annually.
Some jurisdictions have legislatively required prescriptions to be legible—Florida specifies "legibly printed or typed"—and the Institute for Safe Medication Practices advocated the elimination of handwritten prescriptions altogether. There have been numerous devices designed to electronically read the handwriting of doctors, including electronic character recognition, keyword spotters, and "postprocessing approaches", though the gradual shift to electronic health records and electronic prescriptions may alleviate the need for handwritten prescriptions altogether. In Britain's NHS, remaining paper prescriptions are almost invariably computer printed, and electronic communication between surgery and pharmacy is increasingly the norm.