Help : Medications (Rx)

Medications (Rxs) block

View the patients medications at a glance in the Medications (Rx) block on the patient's dashboard page. Whether expired prescriptions are shown by default in the dashboard view is configurable at the practice level. When you hover the mouse cursor over a prescription, additional information about that prescription is shown.

Rx History: You can pop out a detailed view of the patient's prescription history using the button in the upper right-hand corner of the Medication block. You can sort the patient's Rx History by any column by clicking on the column name. If you hover the mouse cursor over an encounter note title, a snapshot of the note will be shown.

Medications (Rxs) History pop-out

Right click on a prescription in either the Medications block or the Rx History to renew, discontinue, replace, delete, edit, learn more, or create a faxable prescription form. Or use the checkboxes along with the drop down menu at the top of the block (or the Rx History pop-out) to renew, discontinue, or create a faxable form for multiple medication entries at once.

Help: Add New Prescription

Adding a new prescription should almost always be done via the Plan section in an open encounter note. But a prescription may also be added outside of an encounter note (generally for administrative purposes) by clicking on the green plus icon at the upper right-hand corner of the Medications block. The + Add New Rx pop-up will appear with a smart search bar.

Help: Search for Prescription

In the + Add New Rx pop-up, search in the field provided for the drug name, brand, ingredients, strength, delivery method, or form. Partial words or numbers are fine and the system will search as you type. By default, the search will return drugs from your preferred short list. If none match, or if you enter a "+" in the search bar, it will instead return all matching entries from the full VA National Formulary database. When you select "+ Add Rx to Pt Record," another pop-up will appear for you to enter prescription details and notes. 

Help: Add/Edit Prescription Details

Add Prescription Pop-Up

Add or edit prescription details in the + Complete and Add Rx, Edit Rx, Renew Rx, or Replace Rx pop-up, making changes or accepting default values, as needed.

Profiles (dropdown) – apply, delete or create a saved dosing profile. Saved dosing profiles for a drug, if any are available, can be accessed via the Profiles dropdown menu. To save existing settings as a new dosing profile, complete desired changes, then click on the Profiles drop down and select "Save Current Settings as a New Profile." Enter a name, set the scope to be personal (available only to you) or global (available to everyone in the practice), and set the new profile as the default settings for whenever that dosing is used or as a secondary dosing profile. Once created, a dosing profile cannot be edited, but it can be replaced by deleting the original (select "Manage Profiles" in the drop down menu and delete profile(s) as needed) and then creating and saving a modified version.

Administrative Record (checkbox) – adds a medication to the patient's file without ordering a new prescription for that drug. This checkbox is used, for example, to add a drug that was prescribed by another practice so that it appears in the patient's medication history list and in drug-drug interaction checks.

Strength (free text field) – the dose strength being ordered. The database should contain practically every available dose-strength for each medication so that you will almost always select the correct dose-strength when you choose which prescription to add. So, you should only edit the Strength field if, after searching the database, you are certain that the correct dose-strength is not available for that drug.

Method (free text field) – drug delivery method. The VA provides a list of 85 officially-accepted drug delivery methods. Enter one of these, or type something else. Externally, some older electronic systems may recognize only methods from the VA's list, but newer systems generally do not have this limitation.

QD once a day PRN as needed (or other)
BID twice a day QHS before bed
TID three times a day Qweek once a week
QID four times a day Qmonth once a month
PID five times a day QOD once every other day

Frequency (dropdown) – how often the patient should take the drug. Select from the options in the drop down menu or, to enter a frequency that does not appear, select PRN (as needed) and enter special instructions in the Physician's Notes field.

Amount (integer) – the number of units being ordered.

Refills (integer) – the number of refills that will be available.

Dosing Expires (integer) – the number of days after the start date that this prescription expires. While this is initially calculated automatically based on the number of doses times the number of refills, it is not automatically recalculated if either of these inputs are manually changed. Click the calculator icon to recalculate.

Patient Instructions (notes field) – instructions for the patient. Enter instructions, or leave blank for the pharmacist to enter default instructions.

Physician's Notes (notes field) – instructions for the pharmacist. Enter notes about this prescription that will be visible to the pharmacist, such as the drug's DEA number, if applicable, or information about how a prescription for a highly controlled substance was conveyed to the patient.

Chronic Drug (checkbox) – indicates whether the drug is taken for a chronic condition.

Warn me when this Dosing Expires (checkbox) – creates a reminder that will appear on your task list when the prescription expires.

Start Date (calendar) – indicates the date the drug was prescribed (default is the date the prescription is created).

Generic OK (checkbox) – indicates that a generic version of the drug may be used in place of the specific name brand prescribed (checked by default).

Pharmacy (drop down) – indicates which pharmacy the prescription will be sent to. If the patient has a preferred pharmacy, it will automatically appear in the Pharmacy field. If the patient has multiple preferred pharmacies, the primary pharmacy will appear by default and other preferred pharmacies will appear in the drop-down menu below. Also in the Pharmacy drop-down menu are "None/Not in System," which leaves the pharmacy and fax information blank, and "Select Other", which pulls up a pharmacy smart search field. When this is used to select a pharmacy that is not already in the patient's file, you will have the option to add it to the patient's preferred facilities (where it would appear below any existing preferred pharmacy entries).

If the pharmacy that you select is faxable, you will have the option to complete the prescription and create a faxable form with one click. But note that you cannot fax directly from the Edit Rx pop-up. Instead, you must save edits and then create a faxable prescription form.

Warnings will appear at the bottom of the form if the patient has an allergy to the selected drug and/or drug class. Any warnings must be manually overridden before that drug can be added to the note.

Help: Discontinue Prescription

Discontinue a single prescription by right-clicking on the applicable entry in a patient's Medications (Rxs) block or Rx History pop-out and selecting "Discontinue." Discontinue multiple prescriptions by checking the box to the left of each one in a patient's Medications (Rxs) block or Rx History pop-out, clicking on the "Manage Checked Rxs" drop-down menu in the upper right corner of the block (or pop-out) and selecting "Discontinue Checked Rxs".

You will be prompted to indicate whether the patient had an adverse reaction to the medication, or is discontinuing use for some other reason. If you select Adverse Reaction, the medication will be added to the patient's list of allergies and intolerances, along with any explanatory text that you add in the Discontinue pop-up. You will also be prompted to indicate whether the patient has an adverse reaction to any of the medication's parent drug classes, which are listed from most specific to most general. It is unusual, though not impossible, for a patient to have an adverse reaction to a high-level drug class, so you will most likely be indicating a reaction to one or more specific drug classes at or near the top of the list, or just to the specific drug.

The discontinued prescription will continue to appear in the patient's medication list, but will be crossed out and marked as discontinued.

Help: Replace Prescription

Because replacing a prescription adds a new prescription to the patient's file, it should be done in an open encounter note unless the replacement is just for administrative purposes or to keep track of a prescription replacement that happened in the past. In the encounter note screen, restore the Medications (Rxs) block if it is minimized by double-clicking on the Medications (Rxs) title bar.

Replace a prescription by right-clicking on the applicable entry in a patient's Medications (Rxs) block or Rx History pop-out and selecting "Replace."

You will be prompted to select a replacement medication using the rx smart search field provided, and to enter prescription details for the new medication. You will also be prompted to indicate why the old medication is being discontinued. When you click Complete Replacement >> Finalize Discontinue, the old medication will be marked as discontinued and the new drug will be added in the patients Medications (Rxs) block (and to the encounter note if the replacement is done with an encounter note open).

Help: Delete Prescription

If a prescription was added by mistake either (a) in an encounter note that is not yet signed or (b) outside of an encounter note via the Medications (Rxs) block, it can be deleted by right-clicking on the prescription and selecting "Delete." You will be prompted to enter a reason for deleting. Once a prescription is deleted, it will no longer appear in the patients medication history or Medications (Rxs) block.

Help: Edit Prescription

If a prescription was added by either (a) in an encounter note that is not yet signed or (b) outside of an encounter note via the Medications (Rxs) block, it can be edited by right-clicking on the prescription and selecting "Edit." This will bring up the prescription details. Note that there is no option to "+ Complete and Fax to Pharmacy" as there is when you add a prescription. To fax or re-fax an edited prescription, you must save your edits, and then separately create a faxable prescription form.

Help: Create Faxable Prescription Form

Create a faxable (or printable) form for a single prescription by right-clicking on the prescription entry in an encounter note or the Medications (Rxs) block and selecting "Create Faxable Form." Create a faxable/printable form for all of the prescriptions in a particular encounter note by hovering the mouse cursor over the Plan (Rx/Orders/Vaccines) box in the encounter note and selecting "Fax Rxs" from the menu that appears. Or, create a faxable/printable form for multiple prescriptions (whether or not they appear in a single encounter note) by checking the box to the left of each one in a patient's Medications (Rxs) block or Rx History pop-out, clicking on the "Manage Checked Rxs" drop-down menu in the upper right corner of the block (or pop-out) and selecting "Create Faxable Form."

Every part of the form (except for the page header) can be edited by clicking on the text, opening it in a simple text editor. To send the form as a fax, select a pharmacy from the drop down menu above the form, or select A pharmacy can be selected or a fax number manually entered using the dropdown menu above the page. The system can only send faxes within the U.S. and the country code (+1) should not be used. Print or send the fax using the "Print Form" and "Send as Fax" buttons at the top of the screen. Once a fax is sent, a printable copy remains open, stamped with the word "Faxed" shown in red.

See also Fax/Print Forms.

Help: Renew Prescription

Medications (Rxs) right-click menu

Renew a single prescription by right-clicking on the applicable entry in a patient's Medications (Rxs) block or Rx History pop-out and selecting "Renew". Renew multiple prescriptions by checking the box to the left of each one in a patient's Medications (Rxs) block or Rx History pop-out, clicking on the "Manage Checked Rxs" drop-down menu in the upper right corner of the block (or pop-out) and selecting "Renew Checked Rxs."

Renewing one or more prescriptions will automatically create a new encounter note for the patient and pop-up an "+Renew" mini-window for each medication. Cancel any one by clicking on the close button in the upper right hand corner of the mini-window. Or complete the renewal request (see Add Prescription Details).

Clicking on "+ Complete" will add a prescription to the newly-created note. Clicking on "+ Complete & Fax to Pharmacy" will open an editable form suitable for faxing or printing that is pre-filled with prescription information, along with information about the practice, pharmacy, and patient (see also Create Faxable Prescription Form).

Help: Rx Nicknames

You can give a particular dosage of any medication in the database one or more nicknames to make it easier to find by typing the nickname into the relevant search field. Add or edit nicknames by searching in any Rx search bar for the relevant medication, then RIGHT clicking on the medication in the search results and clicking on "Admin: Modify Rx Nicknames." Enter the desired nickname(s) in the field that appears (or edit the nickname(s) that appear there), then click "Accept These Rx Nicknames." You (or, in fact, anyone in your practice) can then type the nickname(s) in any Rx search bar to pull up that particular medication and dosage.

Note: nicknames apply only to the specific dosages for which they are added. If you want multiple dosages of the same medication to share one or more nicknames, you will need to modify nicknames for each dosage accordingly.

Help: Dosing Profiles

Complete and Add Rx ScreenshotFor any prescription, you can save the prescription details - amount, number of refills, instructions, etc. - as a dosing profile so that you can more easily enter those prescription details in the future.

To save a new profile, enter all of the prescription details and then select "Save Current Settings as a New Profile" from the PROFILE drop down menu. You will be prompted to enter a descriptive name, designate whether the dosing profile should be global (available to all in the practice) or personal, and whether it should be the default profile (which will automatically come up whenever that prescription is added) or secondary. Then save the profile to finalize.

You can save any number of dosing profiles for a particular prescription.