Write Prescriptions

Use the Add Medication window, Write a Prescription tab when you want to write a prescription, print it and give it to a patient to fill outside your health service.

To prescribe medications for a patient in Communicare, you must have a Prescriber number and the user group to which you belong must have Prescription access rights. Restricted providers can prescribe medication that is included in their user group's Scope of Practice.

If Medication > Add Medication is not available, ask your Communicare Administrator to enable Prescribing - Full or Prescribing - Once Off/Short Course for your user group.

If there are no details in the Drug Browser, ask your Communicare Administrator to arrange the import of MIMS Pharmaceutical Database.

You cannot record a medication with a date after a patient's date of death.

When you add a prescription, it always defaults to the date of the service; you cannot change the date of an individual medication. If you need to add an historical medication or backdate a medication, add it using Medication History.

In V22.1 and later, Communicare supports ePrescribing for providers who have opted in and have adequate information recorded in Communicare. ePrescribing replaces paper scripts, so information that was written manually on prescriptions to communicate with the dispenser of the medication must instead all be recorded when prescribing. Use the fields described in Table 1 to record additional ePrescribing information, which is included on the prescription.

Table 1. ePrescribing fields
ePrescribing field	Description
Regulation 49 (Regulation 24)	For medical practitioners, midwives and nurse practitioners, if hardship conditions apply, set Regulation 49 (Regulation 24) to authorise the original and repeat supplies of PBS medications to be supplied to the patient at one time. Regulation 49 was previously Regulation 24. If set: On the Medication Summary, `[Regulation 49]` is appended to the medication in the Current/Regular Medication list On the Detail tab for the medication, `Regulation 49 (Regulation 24) Yes` is included For paper scripts, the following words are printed: For non-RPBS patients, `one supply` For RPBS patients, `hardship conditions apply` For more information, see pbs.gov.au.
Script Retained by Pharmacy	Set if the pharmacist should retain the script for a controlled medication instead of returning it to the patient. For example, for controlled medicines such as Methadone, Dexamphetamine. Note: The patient is not sent an ePrescription token or any repeat tokens. Options to send or resend an ePrescription token by SMS or email are disabled. This medication is excluded from the ASL. The usual workflow would be: The prescriber prints the ePrescribing token and hands it to the patient. The prescriber also relays paper evidence of the prescription to the necessary pharmacy. The patient takes the token to a pharmacy, which becomes the supplying pharmacy. The pharmacy retains the prescription and supplies all repeats of the medication.
Unusual Dosage	Set if the dosage prescribed is outside the recommended therapeutic levels. If set, `Unusual Dosage Yes` is included on the Detail tab for the medication.
Note to Pharmacist (ePrescriptions only)	Use to include prescription notes for the pharmacist, such as details of unusual dosages, staged supply and so on. Any notes you add are included only with electronic prescriptions.
Authority Number for Controlled Substances	For controlled substances, enter the number provided by your state or territory that gives you authority to prescribe controlled substances. The name of this field depends on which state or territory the encounter place from which the prescriber is prescribing is based: NSW and NT - Authorisation Number for Controlled Substances QLD and ACT - Approval Number for Controlled Substances SA - Permit Number for Controlled Substances TAS - Authority Number for Controlled Substances VIC - Warrant Number for Controlled Substances WA - Community Program for Opioid Pharmacotherapy, CPOP Authority Number
Dispensing Pharmacy	NSW only - enter the name of the pharmacy from which the prescription is to be dispensed
Urgent Supply (Script Owing)	For urgent cases where you have telephoned a pharmacist and asked them to supply a medication without a prescription, set Urgent Supply (Script Owing) for the subsequent prescription. The prescriber should also relay paper evidence of the prescription to the necessary pharmacy. The prescriber must then forward the written prescription and duplicate to the pharmacist within seven days of the date of supply. Note: The patient is not sent an ePrescription token or any repeat tokens. Options to send or resend an ePrescription token by SMS or email are disabled. This medication is excluded from the ASL. If set, `Urgent Supply (Script Owing) Yes` is included on the Detail tab for the medication.
Exclude from Active Script List	Set if a patient wants you to exclude this prescription from their Active Script List.

To add a prescription for a patient:

In a patient's Clinical Record, click Medication > Add Medication or press F9.
- If a warning is displayed that there is no adverse reaction information recorded, click Yes and review with the patient.
- To record any problems, on the Main Summary, click New Adverse Reaction. See Adverse Reaction Maintenance for more information.
From the Drug Browser, select the medication you want to prescribe.

Tip: When using generic prescribing, formulation and pack are displayed in a single field. If you are searching for a specific formulation and pack for a specific brand, to display all options for equivalent active ingredient medications that have slightly different packaging or formulation, deselect Show generics not brands.
If there are any pregnancy interactions, condition or procedure interactions, or drug interactions or warnings, they are listed in the Medications Warnings window. If you want to proceed, click Noted, otherwise click Cancel and repeat steps 1-2.
In the Medications Warnings window:
- If a medication contains a generic component for which a patient has a recorded allergic adverse reaction, a reaction is displayed. If you choose to proceed with the prescription, enter your password. The action is logged.
- If the patient is pregnant, the pregnancy banner is displayed.
- If the patient is pregnant or possibly pregnant and there is a pregnancy interaction with the selected drug, ADEC Pregnancy Category warnings are displayed.
- If condition interaction support is available at your health service, and the patient has a condition with which the medication interacts, a condition interaction is displayed.
- If there is an interaction between this medication and the patient's other active medications, a drug interaction is displayed.
- For more information, see Medication Warnings.
Details from MIMS for the selected medication are added to the Add Medication window, including:
- Interactions and warnings - for example, if the patient is pregnant or possibly pregnant, ADEC Pregnancy Category warnings
- PBS information - Strength, Max PBS packs and Max PBS repeats
- Payment Scheme, for example, PBS, RPBS or Private
- LEMI and LMBC information
1. In the Add Medication window, go to the Write a Prescription tab.
- To add adverse reactions, click Add. For more information, see Adverse Reaction Maintenance.
- To check any existing medications, click Medication Overview.
- To prescribe a medication for a patient, the patient must have a data of birth recorded. If a date of birth is not recorded, the Medication field is highlighted in red. Click Cancel, go to the patient's biographics and add a date of birth before proceeding.
For Medication Type, select either Once Off / Short Course or Regular Medication depending on whether this medication is to treat an acute or chronic condition.
Where available, for Prescribed Using, select either Generic name or Brand name.
- For brand name medications, the formulation, strength, pack size and number of packs are displayed, except for items on the LEMI, which display only the brand name.
- These details are not displayed for generic drugs, except:
  - If there are multiple items in the pack, full details are included
  - If the words modified or release appear in the formulation, the generic formulation is shown. For example, Metformin hydrochloride modified release tablet, 500 mg.
Tip: Ensure you read any information banners relating to brand prescribing.
If required, to allow pharmacists to substitute brands, where applicable set Allow brand substitution.
If you want to change medication, in the Medication field, click Choose.

Tip: To add this medication to your list of preferred medications and list it automatically every time you enter the drug browser, click Favourite.
If you want to edit the pack size, in the Pack Size field, enter the required value.
In the Number of Packs field, enter the number of packs you want to prescribe.
In the Repeats field, enter the number of repeats required.
The default value displayed in the Duration field is the total number of packs together with repeats, assuming that each pack lasts 1 month and determines how long once off prescriptions are displayed in the Medication Summary, to a maximum of 12 months. The dosage that you specify does not affect the default calculation. The date in the Until field is calculated from the duration. The duration is used by the drug interactions function to determine if a warning should be displayed. Adjust either the duration or date until if required.
If there are repeats, depending on the medication and your jurisdiction, for Schedule 8 and Schedule 4D drugs, in the Interval Between Repeats field, specify the minimum number of days required before a repeat can be filled:
- Schedule 4D and Schedule 8 - NSW and Tas
- Schedule 8 - ACT, NT, Qld, WA
For DAA Required, if the patient uses a Dosage Administration Aid, click Yes.
1. From the DAA type list, select the type of DAA used.
  
  Tip: If there is a default DAA type set for the patient in the Medication Summary > DAA Type field, this is automatically set for the medication.
2. In the DAA fields, either:
  - In the DAA Breakfast, Lunch, Dinner and Bedtime fields, enter the dosage required at each.
  - If you'd prefer to provide dosage instructions instead of a dosage for each time period, set As per Dosage and specify instructions as described in the next step.
In the Dosage Instructions field, enter dosage instructions for the medication using full text or short codes.
Tip: For ePrescribing, either DAA or dosage information is required. Remember to include both dose and frequency.
To use short codes, for example, BD for twice a day, or CF for with food, start typing the short code:
- Matching short codes are listed as you type. Press Enter or Tab to select a phrase. Use the up and down arrows to move up and down the list.
- If you have completed the short code, press the space bar to select the text that that code represents.
- Click Add shortcode or press F2 to see a list of all short codes available for your health organisation. Use the up and down arrows to move up and down the list.
The Route of Administration field displays the value provided by MIMS. If required, select a new value or delete the default value.

Prescriptions written before Communicare is upgraded to V22.1 will not have a value and the default value from MIMS will only be added when the medication is repeated or represcribed.

Note: For ePrescribing, a route of administration is required. If MIMS does not include a route of administration for a medication, As Directed is added.
From the Payment scheme list, select the payment scheme if it is different to that listed.
If you select RPBS for a medication that is not PBS-listed, but which has been given ad-hoc approval by the DVA for supply to patients with funding from the DVA, also set Unlisted RPBS Authority. In the PBS/RPBS Approval Number field, be sure to also include the RPBS approval number. For more information, see Unlisted repatriation authority.
If this prescription will be sent to the dispenser electronically instead of being printed, use the fields described in Table 1 to record additional ePrescribing information, which is included on the prescription.
If the medication requires authority:
- For Streamlined Authority:
  1. In the PBS/RPBS Approval Number field, click Choose and select the appropriate approval number. This number is printed on the script and checked by pharmacists when they dispense the medication.
  2. From the Approved Indication list, select the indication text.
- For Authority medication:
  1. If you have a previous authority number for this medication, set Previous Authority.
  2. Otherwise, ring the PBS or DVA number provided and provide the patient's details, the PBS/RPBS Authority Number listed and the clinical indication.
  3. In the PBS/RPBS Approval Number field, enter the number provided to you. This number is printed on the script and checked by the pharmacist when they dispense the medication.
    Tip: For emergency provisions, use P9999Rx.
  4. Click Authority Indication Information to check the approved clinical indication that must be met when prescribing this medication.
- If the prescription has repeats and you want the pharmacist to return it to the patient when it is filled, set Return to Patient to print the words Return to Patient on the prescription.
In the Internal Comments field, enter any additional information for other prescribers at your health service, for example, for up-titration notes.

Tip: This information is displayed as a Note on the Medication Summary and if the medication is added to a medication request this information is included.
From the Reason (Clinical Item) list, select from the existing clinical items associated with the patient. If you haven't yet added a clinical item for the condition that the medication treats, click Add Reason and select a new clinical item.
Alternatively, if there is no codified clinical item available, in the Reason (Free Text) field, type a reason for prescribing.
If the patient is registered for CTG PBS co-payment relief and this option is set in their biographics, to print the PBS or RPBS script with a CTG code, set CTG PBS co-payment relief.
If the patient gives their consent to share this information with My Health Record, set Consent to send to My Health Record. If the patient has a My Health Record, this option is automatically set.
Setting this option sets a flag for eRx which tells them whether or not to send the medication information for the patient to My Health Record. Communicare does not send this information to My Health Record separately. For more information, see Electronic Transfer of Prescriptions (ETP).
If required, click Ellipsis and set one or both of the following options:
- Save medication as favourite - add the medication to your list of favourites displayed when you first open the Drug Browser.
- Save medication as default - to save the quantity, repeats, dosage instructions and duration for this medication. This information is automatically included whenever you prescribe this medication for any patient. Set this option for medications that typically require the same dosage instructions for any patient, for example, Yasmin.
  Note: If you have Generic Prescribing set in System Parameters and you save a medication that you have prescribed by brand as default, the medication is still prescribed by generic when you next prescribe it.
If you want to add another medication for the patient, click Add another item to save the first medication and clear all fields. Repeat steps 2-19 to add another medication.
If you are a prescribing a schedule 8 medication, enter your password again to confirm the medication.
Click Save.

If your health service is set up for Real-Time Prescription Monitoring (RTPM), and the medication is a controlled medicine, Communicare sends information to the RTPM service for your state on the internet. RTPM results are then displayed for each drug prescribed. For more information, see RTPM.

The medication and associated condition are recorded in the patient's clinical record.

Medications are listed on the Summary > Medication Summary tab, with complete information on the Detail > Rx - Prescription tab.

On the Medication Summary:

Once-off medications are listed on the Medication Summary only until the specified duration elapses.
Regular medications are listed on the Medication Summary until they are stopped or represcribed.
If the new prescription for a regular medication has the same product, form and pack codes as an existing regular medication, the original medication is stopped, even if it is already expired.
If you save a second prescription for a regular medication with the same product, form and pack codes as a medication that you have already prescribed during the same service, the first medication is deleted. If you have already printed the prescription for the first medication, ensure that you destroy it.

You can edit prescriptions only if the service is still open and the prescription hasn't been finalised.

Note: For enterprise customers, if ETP is enabled for your encounter place and no locality is set for your encounter place or organisation, you can't save new prescriptions. For more information, see Electronic Transfer of Prescriptions.

To generate a script number and send the prescription to your ETP service or print the prescription, finalise the prescription. Finalise the medication from the Medication Summary, or when you close the clinical record.

If you have written a prescription that is part of a medication request, and you need to supply some of the medication to the patient now to cover the period until the medication request is fulfilled by the pharmacy and arrives for the patient, you can create a medication order from the prescription.

To view the medicines that have been uploaded to My Health Record, in the Medication Summary, click View My Health Record icon View My Health Record Medications.