Supply of prescription medicines

The range of valid prescription formats is described below.

In the situation where the patient is not able to obtain a prescription, it is possible that a prescription medicine could be provided under the conditions described below.

Legal forms of prescriptions

1. Handwritten and hand-signed (in prescriber’s handwriting) on paper
2. Computer generated via prescribing software, printed, and signed by hand
3. Conformant electronic prescriptions in community practice
4. Paper-based PBS medication chart prescriptions for private hospitals
5. Paper-based medication chart prescriptions in Residential Care Facilities
6. Electronic medication chart prescriptions in Residential Care Facilities
7. Image-based prescribing (without the need to send the paper-based prescription)
8. Supply of medicines on a telephone, fax, or email order
9. Continued dispensing
10. Emergency 7 day supply by pharmacist
    

Handwritten and hand-signed (in prescriber’s handwriting) on paper

The prescriber handwrites and hand-signs a paper prescription.

Computer generated via prescribing software, printed, and signed by hand

The prescriber generates the prescription using prescribing software, prints the prescription, and hand-signs it.

The prescription must comply with the Criteria for Issuing Non-Handwritten (Computer-Generated) Prescriptions (TG 184). Key criteria include:

• system must prevent anyone but the prescriber from being able to generate/print prescription
• must be hand-signed by the prescriber
• no alterations permitted
• for Schedule 8 medicines, the drug name, strength, quantity, directions for use, number of repeats and repeat intervals must also be hand-written by the prescriber

Prescriptions issued using a public hospital electronic medication management system with Cerner Prescription Output Version 2 comply with TG184. See the Factsheet for Community Pharmacies: Computer generated prescription formats from NSW public health facilities.

Conformant electronic prescriptions in community practice

• Must be issued using a conformant electronic prescribing system (must have a Conformance ID)
• The prescriber must populate the required data fields, including patient's date of birth
• Must be transmitted using a conformant prescription delivery system (must have a Conformance ID)
• Patient receives evidence of prescription (token) to present to his or her chosen pharmacy
• Pharmacist must use a conformant electronic dispensing system (must have a Conformance ID)
• For conformant systems see the Electronic Prescribing Conformance Register
• More on electronic prescribing in NSW.

Paper-based PBS medication chart prescriptions for private hospitals

• Must be on the PBS Hospital Medication Chart published by the Australian Commission on Safety and Quality in Health Care and can include non-PBS items.
• Pharmacist dispenses using a copy of the medication chart prescription
• For more information Prescribing and dispensing using the PBS Hospital Medication Chart

Paper-based medication chart prescriptions in Residential Care Facilities

• Must be on the National Residential Medication Chart (NRMC) or chart with equivalent prescribing data elements to the NRMC
• Cannot be used for Schedule 8 medicines, Schedule 4 appendix B medicines, or Schedule 4 authority-required medicines (clause 37)
• Pharmacist dispenses using a copy of the medication chart prescription
• For more information see Prescribing and Dispensing on a residential medication chart prescription

Electronic medication chart prescriptions in Residential Care Facilities

• Being piloted by software vendors in designated facilities and pharmacies approved under the Poisons and Therapeutic Goods Regulation 2008
• For more information refer to Electronic National Residential Medication Chart trials.

Image-based prescribing

Image-based prescriptions are only valid for dispensing at public health organisations. 

An image-based prescription is an image (photo or scan) of a hand-written and signed paper prescription or a computer-generated (via prescribing software), printed and hand-signed prescription. The original physical paper prescription does not need to be sent to the pharmacist.

The steps for image-based prescribing are : 

• Medical practitioner or nurse practitioner creates and hand-signs a paper prescription
• Medical practitioner or nurse practitioner sends a copy of the prescription (photo or scanned image) directly to the public health organisation pharmacy by fax or email
• The image can only be created by the prescriber and dispensed by the hospital pharmacy. It cannot be sent to the patient or any other third party
• The image cannot be sent by text/SMS or via an App or a website
• Pharmacist must print the image and retain it and any repeats for two years
• Any repeats can be dispensed only from the same public hospital pharmacy.

See also Hospitals.

Supply of medicines on a telephone, fax, or email order

• The prescriber may send a direction for the pharmacist to dispense any medicine (including Schedule 8 and Schedule 4 Appendix D) by telephone (verbally and not via text/SMS), fax, or email which is followed by a valid prescription dispatched to the pharmacist within 24 hours.
• The prescriber must include words on the prescription that a direction was provided by telephone, fax, or email to dispense the medicine.
• The pharmacist must notify the NSW Ministry of Health at MoH-PharmaceuticalServices@health.nsw.gov.au if the valid prescription is not received at the pharmacy within 7 days.
• Note that the supply of unregistered Schedule 8 medicines (such as compounded S8 preparations) requires a valid prescription and cannot be supplied solely on the verbal or written direction of a prescriber. For more information, see Restrictions on unregistered Schedule 8 medicines including compounded medicines.

Continued dispensing

Emergency 7 day supply by pharmacist

Under clause 45 of the Regulation a pharmacist can supply up to 7 days treatment or the smallest standard pack of a liquid, inhaler, cream, or ointment of a prescription medicine (other than Schedule 4 Appendix D and Schedule 8 medicines), without a prescription, for essential treatment, to a patient who has previously been prescribed the medicine, there is an immediate need for continuation of treatment and it is not practicable for the patient to obtain a prescription.

Examples of illegal forms of prescriptions

• Prescriptions on forms pre-populated by someone other than the prescriber (e.g. pharmacy, 'prescription broker', clerical assistant, patient).
  (In public hospitals patient details may be on a pre-printed sticker other than for Schedule 8 medicines).
• Prescriptions sent through companies, websites or apps other than electronic prescriptions using conformant systems with Conformance IDs.
• An image of a prescription provided to a patient.
• An image provided to a pharmacy by anyone other than the prescriber.
• Paper prescriptions with digital signatures.
• Electronic or image-based veterinary prescriptions.

Other illegal/unprofessional scenarios

• Prescriptions requested by the patient in response to websites offering to arrange a supply of Schedule 4 medicines (e.g. contraceptives/infertility treatments). This is contrary to Medical Board standards and telehealth principles (and Medicare rules). See, for example, Telehealth guidance for practitioners.
• The decision whether to prescribe a Schedule 4 medicine for a patient and the choice of which medicine, form, strength and quantity, must be made by the prescriber, not governed by patient request or brokered by a third party such as a pharmacy, medicine sponsor or others who receive financial benefit from the prescribing of the medicine.