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 Dispense Drug Name transmits to the outside/community pharmacy  Sites need to setup standard drug file names.  All sites should avoid special characters.

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Presentation on theme: " Dispense Drug Name transmits to the outside/community pharmacy  Sites need to setup standard drug file names.  All sites should avoid special characters."— Presentation transcript:

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2  Dispense Drug Name transmits to the outside/community pharmacy  Sites need to setup standard drug file names.  All sites should avoid special characters (a list will be provided) in drug file names. ! ” # $ % & ’ ( ) * +, -. / : ; = [ \ ] ^ _ ’ { | } ~ Generic Name + Dose + Dosage Form

3 BeforeAfter LISINOPRIL 5MG TABLET Percocet 5/325MG TABAPAP/OXYCODONE 5/325MG TABLET IBUPROFEN 800mg #30IBUPROFEN 800MG TABLET ALBUTEROL MDI (PYXIS)ALBUTEROL 90MCG HFA INH HUMIRA 40mg/0.8ML INJADALIMUMAB 40MG/0.8ML INJ MULTIVIT W/MINERALS & FA TABMVI MINERALS/FA TABLET CARVEDILOL 6.25MG TABLET N/FCARVEDILOL 6.25MG TABLET

4  It is important to check for any existing entries first BEFORE entering a new entry.  Re-activating and updating the existing entry is usually preferred over simply adding more and more entries.  Entries can NOT be deleted from the drug file, but can be inactivated.  NEVER change one drug to another drug when updating your drug file dispense names.

5 DRUG NUMBER:  This number is automatically assigned by the system (fileman) when entering a new drug for the first time.  Among other things, it is needed for Pyxis/Omnicell Interface setup.  Will be included in E-Rx drug reports to quickly identify drugs that need modifications

6  The VA Classification field controls the EHR medication order checks.  Includes order checks for allergies & drug-drug interactions.  Automatically assigned when matched to the NDF  Those that don’t auto- populate will need to be manually entered until drug is entered into NDF AM110 PENICILLIN-G RELATED PENICILLINS AM115 CEPHALOSPORIN 1ST GENERATION AM300 AMINOGLYCOSIDES BL110 ANTICOAGULANTS CN100 ANALGESICS CN101 OPIOID ANALGESICS CN400 ANTICONVULSANTS CN600 ANTIDEPRESSANTS CN601 TRICYCLIC ANTIDEPRESSANTS CN700 ANTIPSYCHOTICS CN800 CNS STIMULANTS CV100 BETA BLOCKERS/RELATED CV150 ALPHA BLOCKERS/RELATED CV200 CALCIUM CHANNEL BLOCKERS CV701 THIAZIDES/RELATED DIURETICS CV800 ACE INHIBITORS

7 0 MANUFACTURED IN PHARMACY 1 SCHEDULE 1 ITEM 2 SCHEDULE 2 ITEM Will NOT be refillable 3 SCHEDULE 3 ITEM 4 SCHEDULE 4 ITEM 5 SCHEDULE 5 ITEM 6 LEGEND ITEM i.e. a prescription ONLY item 9 OVER-THE-COUNTER L DEPRESSANTS AND STIMULANTS A NARCOTICS AND ALCOHOLS P DATED DRUGS I INVESTIGATIONAL DRUGS M BULK COMPOUND ITEMS C CONTROLLED SUBSTANCES - NON NARCOTIC R RESTRICTED ITEMS S SUPPLY ITEMS B ALLOW REFILL (SCH. 3, 4, 5 NARCOTICS ONLY) W NOT RENEWABLE F NON REFILLABLE  It is VERY important to have the correct codes in this field.  Wrong codes can create invalid prescriptions, affect billing (POS), and impact e-prescribing in the future.  Remember that the report logic for Meaningful Use (MU) will also use this field to EXCLUDE control substances from the final number of prescriptions used to calculate the electronic order entry requirement of 40%.  You can use combinations of codes in order to complete this requirement or you can use a single entry to complete it.  Some fields Impact EHR and the functionality of renewing/refilling

8 Complete Order Units for following Drugs: DrugDEA SPECIAL HDLG CODE Acetaminophen APAP/Oxycodone Lisinopril APAP/Hydrocodone Methylphenidate Syringes Magic Mouth Wash

9 Complete Order Units for following Drugs: DrugDEA SPECIAL HDLG CODE Acetaminophen 9 or 9P APAP/Oxycodone 2A or 2AP Lisinopril 6 or 6P APAP/Hydrocodone 3AB or 3ABP Methylphenidate 2LC or 2LCP Syringes 9S (if state doesn’t require rx) 6S (if State does require rx) Magic Mouth Wash 0M or 0MP

10  Used to designate a drug as non-formulary at the local site.  If utilized, pop-ups will display to provider within EHR.  It is recommended if you mark an entry as non- formulary, then also add an entry under formulary alternative.

11  Remember there are multiple Synonym Fields in Drug File  Under drug Enter/Edit this particular “Synonym” field is for pharmacist and only seen when entering prescriptions via RPMS.  Not useful for provider order entry of medications via EHR. TRADE NAME  Brand Name; multiple entries if necessary QUICK CODE  for pharmacy personnel use DRUG ACCOUNTABILITY  VA Function CONTROLLED SUBSTANCES  VA Function

12  Multiple “Message” prompts in drug file.  Information entered here will display to the pharmacist when entering a prescription via RPMS.  It will display to the Provider as a “pop-up” in EHR too!  It is a Free Text field.  Be aware of “Pop-Up Fatigue.”

13  Multiple “Inactive” Fields in Drug File.  If no longer using an item, then enter a past date in this field to inactive the entry (i.e. T-1).  If this field is blank then it means the entry is ACTIVE.  NDF Updates can sometimes inactivate an active drug.  To re-activate a drug use the symbol.  NEVER put future inactive dates in this field.  Reminder, drug entries are not deleted but rather inactivated.  NOTE: we will be using the Inactive Date Field in our drug file reports

14 ORDER UNIT:BT This is how the drug is supplied from the manufacturer. DISPENSE UNIT: TAB This is the smallest unit that can be dispensed. It is the dose of the order unit (i.e tab, cap, mL, gm) DISPENSE UNITS PER ORDER UNIT: 1000 How many dispense units per order unit? DISPENSE UNIT NCPDP CODE See next slide for more details…

15  National Council for Prescription Drug Programs (NCPDP)  Provides a standard for the exchange between prescribers, pharmacies, intermediaries, payers.  E-Prescribing requirement for new prescription Request, change of new prescription, cancel of prescription, refill/renewals request/response or resupply in long term care.  E-prescribing; It will generally be the same as what is entered for the Dispense Unit field. 12 Packet 00 Not Specified AR Suppository AV Capsule BG Bag BO Bottle BX Box CH Container CQ Cartridge EA Each F2 International Unit FG Transdermal Patch FO Fluid Ounce GR Gram IH Inhaler KT Kit LT Liter ME Milligram ML Milliliter PH Pack PT Pint SZ Syringe TB Tube U2 Tablet UM Million Units UN Unit UU Lozenge VI Vial X4 Drop Y2 Tablespoon Y3 Teaspoon Y7 Gum ZZ Mutually Defined

16 Complete Order Units for following Drugs: DrugOrder Unit Dispense Unit DU/OUNCPDP Acetaminophen Abluterol MDI Advair Amoxicillin Suspension Bacitracin

17 Complete Order Units for following Drugs: DrugOrder Unit Dispense Unit DU/OUNCPDP AcetaminophenBTTAB1000U2 Albuterol MDIPKGM6.7GM Salmeterol / Fluticasone PKBLISTER60IH Amoxicillin Suspension BTML250ML BacitracinTUGM30GM

18  Format Only for proper functioning with POS & NDF Matching.  It may be necessary to use leading zero’s to get the correct format.  For sites that don’t have a pharmacy, you will still need to populate the NDC field.  To acquire an NDC you can search the FDA NDC file search: this site will also display common quantities so you can complete the order unit, dispense unit, and dispense units per order unit.  Search the internet for those that are not on the FDA site

19 PRICE PER ORDER UNIT: If you are a site with a pharmacy please populate the price you pay to McKesson for this drug. If you are a site without a pharmacy you can skip this field. LAST PRICE UPDATE: DEC This will be filled in automatically if you enter a price above. If you are a site without a pharmacy you can skip this field. AWP PER ORDER UNIT: Should fill in automatically if the following information is accurate: Order Unit, Dispense Unit, Dispense Unit per Order Unit, and NDC. Verify that these fields are correct if no data gets populated. If you are a site without a pharmacy you can skip this field. AWP PER DISP UNIT is: Should fill in automatically if the above information is correct. If you are a site without a pharmacy you can skip this field. PRICE PER DISPENSE UNIT: Should be auto-calculated if above fields are correct

20  You MUST match to the NDF to obtain VA Drug Class.  This will allow allergy checking and Drug/Drug interactions to operate correctly.  Without this code your providers will NOT get the appropriate order checks, which can ultimately result in adverse patient outcomes.  NOTE: The attempt to match is based off the NDC code(s), then the Generic Name.  Make sure the drug, dosage form, package size, and package type are accurate

21  There are 2 types of dosages that a drug can be assigned.  Possible dosages are normally assigned automatically when you match the drug to the NDF.  There are some drugs that will not automatically receive a possible dose when matched and in those cases we will optimize the local possible dosage field.  Best practice supports possible dosages over local possible dosages HOWEVER we have already indicated that not all drugs will have possible dosing.

22  When possible dosages are auto-created, the system automatically creates entries for 1 x strength of the dispense unit and 2 x strength of dispense unit.  Keep in mind that this is automatically done for you AND you should always confirm that the dose automatically assigned is therapeutically and clinically appropriate.  If the dose is inappropriate it can be removed by using sign.  If the drug has additional dosing options (1/2 tab, 3 tabs, etc) the package owner may create those in order to optimize dosing options for the provider during CPOE.

23  For drugs that are not automatically assigned a possible dosage you will need to manually create FREE TEXT dosages using Local Possible Dosage option.  Drugs that you will typically need to create local possible dosage include: combination products, ophthalmic products, topical, inhalers, etc.  When creating a local possible dosage keep in mind that they need to “speak” to the patient.  You will also need to be consistent with expanding numeric values in local possible dosage.  Remember best practice supports use of possible dosages over local possible dosages in most cases.

24  Best practice indicates that range dosing should be avoided to prevent drug errors.  For E-Prescribing to be successful every drug should have an assigned dose. Drugs with no dose result in the provider free texting the entry which can increase the risk of transmission failure.

25 Possible DosagesLocal Possible Dosages 1 UNIT DOSE: 10MG PKG: IO 2 UNIT DOSE: 20MG PKG: IO 300 ML 150 ML 1 TEASPOONFUL 2 TEASPOONFULS ENTIRE CONTENTS OF BOTTLE

26  The letters that are available depend on the keys you hold.  Marking a drug “O” authorizes it to be ordered in an Outpatient (aka Ambulatory Setting) and it will be processed through the Outpatient Pharmacy Drug File  Marking a drug “U” authorizes the drug to be ordered on the inpatient ward and is processed through the Unit Dose package  Marking a drug “I” authorizes it for IV drugs and allows for processing in the IV package  Marking a drug “X” allows you to order it as a NON-VA Medication MARK THIS DRUG AND EDIT IT FOR: O - Outpatient U - Unit Dose I - IV C - Controlled Substances X - Non-VA Med A - ALL

27  Can enter package size to assist providers when entering QTY in EHR  Examples : inhaler=6.7gm bottle = 3.5ml tube = 3gm

28  The choice defaults to the first part of the generic name which is usually what you want.  If the default does not meet your needs or you are separating Orderable Items for select drugs you can use the “^” sign to create a new Orderable Item Name.  Most tablets and capsules will share orderable items however there will be times when you will need to separate a dispense drug into its own orderable item and then specify within the OI name dose to guide the providers when ordering.  We will be discussing special circumstances later in this course to review drugs that will require a separate OI to minimize failed prescription transmissions when using E-Prescribing. Matching ENALAPRIL 10MG TAB to ENALAPRIL TAB

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30 Pharmacist order entry PATIENT STATUS: OUTPATIENT// DRUG: LISINOPRIL 30MG TAB CV OK? Yes// (Yes) VERB: TAKE Available Dosage(s) 1. 30MG 2. 60MG Select from list of Available Dosages, Enter Free Text Dose or Enter a Question Mark (?) to view list:  Dispense Drug ◦ Used by Pharmacist when entering new orders via RPMS ◦ Dispense drug is detailed in nature ◦ Pharmacy does NOT use Orderable Items when entering orders

31 Provider order entry  Orderable items: ◦ Used by the provider during CPOE ◦ Generally generic in nature and contain Generic Drug Name and Dosage Form ◦ Dispense Drug does NOT appear in order dialog

32  Free texting doses for Orderable Items: ◦ Tied to drugs with “no” assigned doses ◦ Tied to drugs with defined local possible dosages ◦ Tied to drugs with defined possible dosages  Copy to New Order ◦ Original order contained free text dosages ◦ Original order was a combination drug  Dispense drugs attached to wrong orderable items ◦ Solution vs Suspension ◦ Cream vs Ointment ◦ Immediate Release (IR) vs Sustained Release (SR)

33 Provider free texted dosage in EHR causing a “disconnect” when it crosses to pharmacy for processing Since the provider free texted dosage Pharmacy will be forced to select the dispense drug before they can finish the order

34 Provider free texted dosage in EHR causing a “disconnect” when it crosses to pharmacy for processing Since the provider free texted dosage Pharmacy will be forced to select the dispense drug before they can finish the order

35  Drugs requiring Local Possible Dosages ◦ Combination Products ◦ Topical Medications ◦ Ophthalmic Medications ◦ Inhalers  Drugs where strength is expressed in percent ◦ Topical Medications ◦ Ophthalmic Medications  IV Additives where you carry more than one strength

36  Pyxis, Omincell, PickPoint or Telepharmacy medications ◦ Prevent existing prescriptions from being discontinued when the medication order from EHR is finished ◦ Additional options to prevent these drugs from being renewed, refilled, and ordered through the all other medications menu  Mark Omnicell/Pyxis drugs with DEA Special HDLG: non-renewable non-refillable prescriptions  Restrict the orderable item so that it can only be ordered by providers as a quick order.

37 BEFORE: Orderable Item -> FLUTICASONE/SALMETEROL Dosage Form -> INHL,ORAL Dispense Drugs: FLUTIC./SALMETEROL 100MCG/50 DISKUS FLUTIC./SALMETEROL 250MCG/50 DISKUS FLUTIC./SALMETEROL 500MCG/50 DISKUS AFTER: Orderable Item -> FLUTICASONE/SALMETEROL 100/50 Dosage Form -> INHL,ORAL Dispense Drugs: FLUTIC./SALMETEROL 100MCG/50 DISKUS AFTER: Orderable Item -> FLUTICASONE/SALMETEROL 250/50 Dosage Form -> INHL,ORAL Dispense Drugs: FLUTIC./SALMETEROL 250MCG/50 DISKUS AFTER: Orderable Item -> FLUTICASONE/SALMETEROL 500/50 Dosage Form -> INHL,ORAL Dispense Drugs: FLUTIC./SALMETEROL 500MCG/50 DISKUS

38 AFTER: Orderable Item -> ALBUTEROL 0.083% (PRE-MIX) Dosage Form -> SOLN,INHL Dispense Drugs: ALBUTEROL 0.083% 2.5MG/3ML INH SOLUTION BEFORE: Orderable Item -> ALBUTEROL Dosage Form -> SOLN,INHL Dispense Drugs: ALBUTEROL 0.083% 2.5MG/3ML INH SOLUTION ALBUTEROL 0.5% 5MG/ML INH SOLN AFTER: Orderable Item -> ALBUTEROL 0.5% Dosage Form -> SOLN,INHL Dispense Drugs: ALBUTEROL 0.5% 5MG/ML INH SOLN

39 AFTER: Orderable Item -> CEFAZOLIN 1GM Dosage Form -> INJ Dispense Drugs: CEFAZOLIN 1GM VIAL (INJ) CEFAZOLIN (ANCEF) (A) BEFORE: Orderable Item -> CEFAZOLIN Dosage Form -> INJ Dispense Drugs: CEFAZOLIN 500MG VIAL (INJ) CEFAZOLIN 1GM VIAL (INJ) CEFAZOLIN (ANCEF) (A) AFTER: Orderable Item -> CEFAZOLIN 500MG Dosage Form -> INJ Dispense Drugs: CEFAZOLIN 500MG VIAL (INJ) CEFAZOLIN (ANCEF) (A)

40 Example AExample B Orderable Item -> LISINOPRIL Dosage Form -> TAB Dispense Drugs: LISINOPRIL 10MG TAB LISINOPRIL 10MG TAB U/D LISINOPRIL 20MG TAB LISINOPRIL 10MG TAB (PYXIS) LISINOPRIL 20MG TAB (PYXIS) Orderable Item -> LISINOPRIL (PYXIS) Dosage Form -> TAB Dispense Drugs: LISINOPRIL 10MG TAB (PYXIS) LISINOPRIL 20MG TAB (PYXIS)

41 Example AExample B Orderable Item -> LISINOPRIL Dosage Form -> TAB Dispense Drugs: LISINOPRIL 10MG TAB LISINOPRIL 10MG TAB U/D LISINOPRIL 20MG TAB LISINOPRIL 10MG TAB (PP) LISINOPRIL 20MG TAB (PP) Orderable Item -> LISINOPRIL (PP) Dosage Form -> TAB Dispense Drugs: LISINOPRIL 10MG TAB (PP) LISINOPRIL 20MG TAB (PP)

42 Example AExample B Orderable Item -> LISINOPRIL Dosage Form -> TAB Dispense Drugs: LISINOPRIL 10MG TAB LISINOPRIL 10MG TAB U/D LISINOPRIL 20MG TAB LISINOPRIL 10MG TAB (TPH) LISINOPRIL 20MG TAB (TPH) Orderable Item -> LISINOPRIL (TPH) Dosage Form -> TAB Dispense Drugs: LISINOPRIL 10MG TAB (TPH) LISINOPRIL 20MG TAB (TPH)

43  Optimize dosages ◦ Assign dosages to ALL drugs ◦ Maximize possible dosages  Assign possible dosages to all drugs that will allow ◦ Minimize local possible dosing  Run Orderable Item Dosages Report ◦ Review Orderable Item Name ◦ Review Dosages assigned dispense drugs ◦ Review that “correct” dispense drug has been attached  Follow recommendations to separate “problematic” Orderable Items

44 Example AExample B

45 Example A Example B ALBUTEROL SOLN,INHL Outpatient Dosages: 3ML/2.5MG ALBUTEROL 0.083% 2.5MG/3ML INH SOLUTION 0.25ML/1.25MG ALBUTEROL 0.5% 5MG/ML INH SOLN 0.5ML/2.5MG ALBUTEROL 0.5% 5MG/ML INH SOLN 1ML/5MG ALBUTEROL 0.5% 5MG/ML INH SOLN ALPRAZOLAM TAB Outpatient Dosages: 0.25MG (.5 TABLET) ALPRAZOLAM 0.5MG TABLET 0.5MG (1 TABLET) ALPRAZOLAM 0.5MG TABLET 1MG (1 TABLET) ALPRAZOLAM 1MG TABLET 2MG (1 TABLET) ALPRAZOLAM 2 MG TABLET 4MG (2 TABLETS) ALPRAZOLAM 2 MG TABLET

46 Example AExample B

47 Example A: Example B: PREDNISOLONE SUSP,OPH Outpatient Dosages: 1 DROP PREDNISOLONE ACET (FORTE) 1% OPHTH SUSP 1 DROP PRED MILD 0.12% OPTH SUSP 10ML 2 DROPS PRED MILD 0.12% OPTH SUSP 10ML 1 DROP PRED MILD 0.12% OPTH SUSP 5ML 2 DROPS PRED MILD 0.12% OPTH SUSP 5ML BUPRENORPHINE/NALOXONE TAB,SUBLINGUAL Outpatient Dosages: 1 TABLET BUPRENORPHINE 2MG/NALOXONE 0.5MG TABLET 2 TABLETS BUPRENORPHINE 2MG/NALOXONE 0.5MG TABLET 1 TABLET BUPRENORPHINE 8MG/NALOXONE 2MG TABLET 2 TABLETS BUPRENORPHINE 8MG/NALOXONE 2MG TABLET

48 Example AExample B

49 Example A: Example B: BETAMETHASONE CREAM,TOP Outpatient Dosages: CREAM THINLY BETAMETHASONE DIPR 0.05% CRM (15) CREAM THINLY BETAMETHASONE DIPR 0.05% CRM (45) CLONIDINE PATCH Outpatient Dosages: 1 PATCH CLONIDINE TTS 1 PATCH 1 PATCH CLONIDINE TTS 2 PATCH 1 PATCH CLONIDINE TTS 3 PATCH

50 Example AExample B

51 Option A: Option B: DARBEPOETIN ALFA INJ,SOLN Outpatient Dosages: DARBEPOETIN ALFA 25MCG/ML VIAL DARBEPOETIN ALFA 100MCG/ML VIAL DARBEPOETIN ALFA 150MCG/0.75ML VIAL DARBEPOETIN ALFA 60MCG/0.3ML SYRINGE DARBEPOETIN ALFA 40 MCG/0.4 ML SYRINGE DARBEPOETIN ALFA 200 MCG/ML VIAL EZETIMIBE/SIMVASTATIN TAB Outpatient Dosages: 1 TABLET EZETIMIBE 10MG/SIMVASTATIN 10MG 1 TABLET EZETIMIBE 10MG/SIMVASTATIN 40MG 1 TABLET EZETIMIBE 10MG/SIMVASTATIN 80MG 1 TABLET EZETIMIBE 10MG/SIMVASTATIN 20MG

52 Would you Recommend a Separate Descriptive Orderable Items?

53 BETAXOLOL SUSP,OPH Outpatient Dosages: 1 DROP BETAXOLOL HCL 0.25% OPTH SUSP 2 DROPS BETAXOLOL HCL 0.25% OPTH SUSP 1 DROP BETAXOLOL HCL 0.25% EYE DROPS

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55 NamespaceDepartment RARadiology LRLab PSOOutpatient meds PSOXE-Prescribed meds PSJInpatient (Unit dose) meds PSIVIV meds GMRCConsults ORCPRS (Nursing Orders)

56 BEHO > ORD >MNU > QOC

57 NAME: PSOXZ CAPTOPRIL 25MG PO TID Replace DISPLAY TEXT: Captopril (Capoten) 25mg PO TID #90 May RF x 1 Replace VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Medication: CAPTOPRIL TAB // Complex dose? NO// Dose: 25MG// Route: ORAL// Schedule: TID// Patient Instructions: FOR BLOOD PRESSURE Include Patient Instructions in Sig? YES// Chronic Med?YES// Dispense as Written?// Days Supply: 30// Quantity (TAB): 90// Refills (0-11): 1// Pick Up: ELECTRONIC//

58 Pharmacy:// SureScripts Pharmacy Information Edit? No// (No) APSP REFILL REQUEST entry// Priority: ROUTINE// Comments: No existing text Edit? No// (No) Indication:// Indication ICD9:// Medication: CAPTOPRIL TAB 25MG Instructions: 25MG ORAL TID Patient Instructions: FOR BLOOD PRESSURE Days Supply: 30 Quantity (TAB): 90 Refills (0-11): 1 Pick Up: ELECTRONIC Priority: ROUTINE (P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

59 BEHO > ORD >MNU > MNU

60 Menu Editor May 09, :52:28 Page: 1 of 3 Menu: PSOXZ MEDS MENU Column Width: ___________________________________________________________________________________ | Azithromycin (Zithromax) 500mg PO daily All other meds... | Captopril (Capoten) 25mg PO TID #90 May | Digoxin (Lanoxin) 0.125mg (125mcg) PO d + Docusate (Colace) 100mg PO BID #60 May | Doxazosin (Cardura) 2mg PO daily #30 Ma | Hydrochlorothiazide 50mg PO daily #30 M | Ipratropium (Atrovent) Inhaler 2 puffs | Lisinopril (Zestril) 30mg PO daily #30 1 Spironolactone (Aldactone) 25mg PO QID | Insulin Lispro (Humalog) 100U/ML Pen SQ | Paroxetine (Paxil) 10mg/5ml Oral Susp D | APAP/Hydrocodone (Vicodin ES) 7.5mg/750 | Erythromycin 2% Topical Solution BID + Ranitidine (Zantac) 300mg Tab DAILY Next Screen - Prev Screen ?? More Actions >>> Add... Edit... Assign to User(s) Select New Menu Remove... Toggle Display Order Dialogs... Select Action: Next Screen//

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62 Directions must not exceed 140 characters Comments must NOT exceed 210 characters

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64  Clinical indication ◦ Required for E-Rx  See EHR patch 6 ◦ Each drug that goes must have the correct clinical indication ◦ Each drug should have a clinical indication with a ICD-9 code. ◦ Work with providers to clean-up problem list

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