e-Prescribing and Medications FAQs

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A typical medication template can do 3 things (in addition to including text in any section of the note).

• Include the med favorites you would like to select (the actual prescription still has to be created, but saves the step of searching).
• Create a task for the nurse to administer the medication with the exact dosing.
• Automatically add CPT codes when the template is applied.

Here is an example: You can create a template that includes the following (using ceftriaxone as an example).

Orders/Workflow Tab:

• Med Tab: Select med favorite Ceftriaxone 500mg (create entry in medications chart).
• Other Tab: Ceftriaxone 500mg assigned to Nurse and Usage is standing.

Procedure Tab:

• J0696 Ceftriaxone 2 units
• 96732 Injection code 1 unit

Workflow

1. This template can be applied to the note from the Assess/Plan tab (as well as CC and Exam tabs).
2. Select medication on Meds tab and create prescription in chart (this does not create a task for the nurse).
3. The nurse will get the task to administer the medication.
4. Go into the medication entry in the patient's chart and enter:

• information about site of admin if injection
• lot and expiration date

1. The nurse will mark the task as complete.
2. Charges will automatically be sent to the superbill.

Another option is to give your nurses proxy privileges for in-house medications. You would still utilize the same template, but instead of the provider creating the medication the nurse would do so, as the med favorite would be marked as able to be written by proxy. This saves the step of the provider creating the prescription in the medication chart.

The NP will need to select the supervising physician's initials in the Supervising Physician Field when the NP writes the script.

If the supervising physician does not change on a daily basis, you can also set your preference under System Preference, so that you are not required to validate the supervising physician on a daily basis. If the preference is not selected, OP will remember the supervising physician.

To set the preference:

1. Navigate to Admin > Global Preferences > Special tab > Prescribe tab.
2. Select or deselect the checkbox to "Revalidate ERX supervisor on a daily basis" based on whether or not the supervising provider changes daily.

If you are printing the prescription, you will need to select the option of prescription with supervising. If you do not see that option in prescription printing options, please contact Support to get that report added to your system. 

In OP, you cannot as a provider print another provider's prescription. You would have to refill or recreate it so that your name appears on the script. Alternately, if they were truly just a reprint, you could have a nurse who only has Send privileges do so.

Your scribe should always be logged in as themselves, not the main provider, so that their work can be tracked. However, the main provider will ultimately review and sign off on the note.

Here is a review of e-Prescribing privileges:

• If an MA/Nurse is given Send privileges, then the MA/Nurse can send a script that a provider has written without making any changes.
• If an MA/Nurse is given Proxy privileges, then the MA/Nurse can create and send a script for a medication that has been tagged as Available by Proxy. This script will need to be cosigned in the eRx Center. When creating the script, the MA/Nurse will indicate who the Supervisor is and their name will appear on the script.
• Mid-Levels: If the NP has full e-Prescribing privileges and is not writing scripts via Proxy, they cannot send another provider's scripts whether they are a mid-level or a physician. This is because each provider is responsible for their work, and if they make any changes to the prescription their name would need to be on the script. 

• Staff who have Send privileges can only send prescriptions as written.
• Staff with full prescribing privileges could edit the prescription, and if they did it should be assigned to their name.

Prescription levels are set in the Staff/Provider directory, and each person who has Proxy privileges needs to have paperwork filled out with OP. Remember, for all the medications you would like your nurses to write, you must create a favorite for that medication and mark it as a proxy med.

To accomplish this, it is easiest to have your MA/Nurse set up as a provider agent with Proxy Privileges. This way the MA/Nurse can populate the Pharmacy list with your practice's most common favorites when you are starting out (they can do this through a test patient).

Each time a pharmacy is selected from the pharmacy list, it is also added to the Address Book. The Front Desk will be able to select it when checking the patient in from the Coordination of Care tab. Once a pharmacy is in the Address Book, you can also edit it and add notes such as cross streets so you can easily identify it. You can also search the Address Book by Pharmacy ID. If your Front Desk does not do this, then the MA/Nurse can add it to the Coordination of Care tab. By adding it to the Coordination of Care tab it will appear on the patients pharmacy.

OP is set to create all prescriptions in milliliters.

Currently, we do not include refills as part of the favorites.

To record a written prescription for a non-med item such as Durable Medical Equipment (DME) or Therapy orders:

1. Go to:
   Patient's Chart (Chart button) > Medications tab 
   or
   Patient Chart (Chart button) > Encounters Tab > Start a New Note button > Med Review tab.
2. Click the Add a New Prescription button ( button).  The Prescription writer window will appear.
3. Click the Purpose dropdown menu and select Order (non-med) from the dropdown list.
4. Make the appropriate selection in the Type dropdown.
5. Enter the order details.
6. Click the Print button to print the prescription. 

Each time a pharmacy is selected from the pharmacy list, it is also added to the Address Book. The Front Desk will be able to select it when checking the patient in from Clinical Contacts. Once a pharmacy is in the Address Book, you can also edit it and add notes such as cross streets so you can easily identify it. You can also search the Address Book by Pharmacy ID. If your Front Desk does not do this, then the MA/Nurse can add it to Clinical Contacts. By adding it to Clinical Contacts it will appear on the patients pharmacy.

In the event that your practice has questions or issues regarding tokens used for EPCS, you will need to contact DrFirst Support. This would include, but is not limited to, tokens no longer working and the transfer of tokens.

When a provider gets a new phone, the app re-downloads and a new credential ID is created. The provider needs to use the OTP serial number from their old phone to complete the following process: 

1. Navigate to the DrFirst EPCS Gold Invite Consume site.
2. Enter your NPI and passphrase.
3. Click the Next button.
4. Enter the OTP serial number from the old Phone. The EPCS dashboard is displayed.
5. Click Current Tokens. 
6. Select Manage My Tokens. 
7. Click Add New Token. 
8. Enter Semantec for the manufacturer. 
9. Select DrFirst Soft Token for the type of token. 
10. Create a token name. 
11. Input the credential ID (no spaces or dashes). 
12. Input the new OTP serial number from the new phone in the field. 
13. Select Activate.

Once these steps are taken, in OP, a System Administrator must then:

1. Navigate to the Admin tab > EPCS Access Control.
2. Change the grant status from Inactive to Active.
3. Enter their full name as the Granting Administrator.
4. Enter the prescriber's NPI, and click Validate.

The Provider must then:

1. Select token from the Device List.
2. Enter the Passphrase and PIN from the token.
3. Click Authorize.

OP has updated the list for units to reflect the current Surescripts defined values. Older values have been removed from the unit list. See below for the accepted units. The practice will need to update medication favorites that have been saved using a unit value no longer available. For instruction on how to edit medication favorites, click here.

• Applicator
• Blister
• Caplet
• Capsule
• Each
• Film
• Gum
• Gram
• Implant
• Insert
• Kit
• Lancet
• Lazenge
• Mililiter
• Packet
• Pad
• Patch
• Pen Needle
• Ring
• Sponge
• Stick
• Strip
• Suppository
• Tablet
• Troche
• Unspecified
• Wafer Dosing Unit

Version 21.3

In order to create a 90-day supply of an EPCS prescription, the prescriber must forward date the prescriptions. To do so, simply create the prescription with a 30-day supply three times with the Rx start and end date to be reflective of the 30-day periods.

These prescriptions may be sent at the same time. See the Send Multiple EPCS section of the Prescribing with EPCS article for instructions.

Version 21.2

In order to create a 90-day supply of an EPCS prescription, the prescriber must forward date the prescriptions. To do so, simply create the prescription with a 30-day supply three times with the Rx start and end date to be reflective of the 30-day periods.

Each of the three prescriptions must be sent separately through the EPCS system. 

First Databank (FDB) provides the massive Medication Master List of data to Office Practicum. Office Practicum cannot add drugs to the Master List, and individual users cannot add drugs to the Master List (although their Favorites are customizable by the practice.) So OP cannot honor requests to "add a medication" to the FDB database. Only FDB can do that. That said, often when a drug is "reported missing" from the Master List falls is not actually missing, but: 

1. That particular drug is no longer manufactured in the United States, so the NDC has been retired, and FDB has purposely removed it from the Master List.
2. That particular drug is not listed in the Master List, but there is a "synonym" (same drug, dose, delivery method, strength etc) with a parallel NDC that can be used.
3. That particular drug and NDC is there, but the user wasn't searching for it correctly.

Possibility A: Is this drug still manufactured in the US?

Step 1: What's the drug's NDC?

The source of truth for any particular drug is the 11-digit NDC number. If you've prescribed the drug before, look for the NDC in OP here:

If they need help remembering the child to whom it was prescribed, this SQL may be helpful at finding old records of a particular medication. You may also use Internet search engines to help find NDCs of particular drugs.

Step 2: Is this NDC formatted in 11 digits?

If not, convert it to 11 digits with no spaces.

Step 3: Is this NDC currently valid?

If the drug is no longer manufactured, then FDB has removed it and will not add it back until a new manufacturer begins making the product again (with a new NDC number). To see if a particular NDC is valid: 

• Take the 11-digit NDC number (with zero padding and no dashes -- see above) and search for it using either of these search tools:
  • RxNav Search
  • DailyMed
• Alternatively, you can append the NDC to this URL and see if it has a valid RXNORM.
  • For example, let's say you are testing the validity of NDC 00002759701. You would enter this in a browser search bar: https://rxnav.nlm.nih.gov/REST/rxcui.json?idtype=NDC&id=00002759701
  • If the page returns something like {"idGroup":{"rxnormId":["545353"]}} that shows that the NDC code is currently valid and belongs to the RXNORM group 545353.
  • On the other hand, if the page returns something like {"idGroup":{}} the NDC is not part of any valid RXNORM group and thus is probably not a current valid NDC at all.

Possibility B: Are you searching for a "synonym" NDC?

Sometimes, multiple manufacturers market identical generic products. For example, there are at least 15 different manufacturers of amoxicillin 500 mg capsules in 2023 in the United States for human use. Because listing all of these identical products in the master list would make the master list very cumbersome to sort through, FDB typically lists just one of the manufacturers by NDC number. 

If your local pharmacy has any of the amoxicillin 500 mg capsule products in stock, they can legally swap any true "synonym" drug, i.e. any of the other amoxicillin 500 mg capsule products they have in stock -- as long as you have not clicked the "dispense as written" box. Occasionally, a pharmacy may require (or claim that they require) that you list a particular NDC for a particular drug (e.g. a specific NDC is, or is not, on the Medicaid formulary), and the particular NDC present in the Masterlist is not the particular drug on the Medicaid formulary. In this case, add a Pharmacist Note like "Please dispense whatever NDC/brand of this drug is on this patient's payer formulary." (You can add this phrase as an option to your medication Favorites.)

Possibility C: Are you searching using the correct search terms?

When searching for a drug in the Master List, remember that less is more. The sweet spot for maximum returns is generally 4-5 characters. For example, instead of searching for "amoxicillin," search for "amox."

Follow the steps below if you forgot or need to reset your Passphrase for EPCS.

1. Navigate to Admin tab > EPCS Provider Dashboard.
2. Click the Forgot Passphrase link in the Sign in section.
3. Enter your NPI and click the Next Step button.
4. Select your Token from the drop-down menu. 
5. Click the Continue button. The Email confirmation window displays.
6. Click the Done button.
7. Click the Reset Passphrase link in the reset passphrase notification email.
8. Re-enter your NPI, Token and answer your security question. Once complete you will be able to reset your passphrase.

When a drug used for detox or maintenance (e.g., Suboxone) is selected, once you click the Send button, a window is displayed with a Field where the prescriber's NADEAN number will be pre-populated if it is set-up as described above. If it was not previously set-up, you can enter a NADEAN in the field. A NADEAN number must be nine characters, with the first two being alpha and the last seven numeric.

Medications prescribed which contain GHB such as Xyrem require you to enter a reason for prescribing. Like NADEAN, you click the Send button, a window is displayed to prompt you to enter a reason. The reason must be at least 5 characters long.

OP provides you with a report of EPCS Auditable Events. To access the report follow the steps below.

1. Navigate to Admin tab > View > Admin Documents.
2. Select Transaction Type: Audit_EPCS.

OP creates this report automatically on a daily basis and provides the details necessary to inform an administrative user of any suspicious activity.

DrFirst has a new look for tokens used for electronic prescribing of controlled substances (EPCS). Below is a list of features that are included with the token.

• Tokens will have a power button on the front that can be used to turn on or off the token. Turning off the token will not generate a new security code.
• There is a timer displayed on the token that is shown as horizontal lines. The horizontal lines will gradually decrease as time runs out on the security code, which is available for about 30 seconds.
• After time runs out for the security code the token will automatically shut off. The power button can be selected to generate a new security code.
• Serial numbers for the tokens will begin with FT.