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NEW PRESCRIPTION REQUEST FORM - StayWell Guam

NEW PRESCRIPTION REQUEST FORM - StayWell Guam 2025

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The document is a prescription request form from LDI Pharmacy, located in Creve Coeur, MO. It is intended for healthcare providers to authorize new prescriptions for patients who have no remaining refills. The form includes fields for patient and doctor information, medication details, and options for refills. It emphasizes confidentiality and provides contact information for further assistance.

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How many tablets can you get on one prescription?

If you are prescribed a repeat medicine your doctor will be prescribing enough of each tablet to last you for 28 days. For example if the dose requires you to take 2 tablets a day you will receive 56 tablets, 3 tablets a day 84 tablets etc.

Can you have more than one item on a prescription?

Information: Prescription charges are for each item not each prescription. For example, if your prescription has 3 medicines on it you will have to pay the prescription charge 3 times. Some items are always free, including contraception and medicines prescribed for hospital inpatients.

How many medications can be written on a prescription?

Only write for one controlled drug per prescription blank. No other medications may be written on the same prescription.

Which type of medicine is only allowed to be supplied via a prescription?

In general, prescription-only medicines are used for conditions that are best diagnosed and managed by health professionals. Examples of prescription-only medicines include antibiotics and medicines for treating epilepsy.

How do you write a prescription?

For a pharmacist to dispense a controlled substance, the prescription must include specific information to be considered valid: Date of issue. Patients name and address. Patients date of birth. Clinician name, address, DEA number. Drug name. Drug strength. Dosage form. Quantity prescribed.

Can you put more than one medication on a prescription?

There is nothing to prevent more than one medication (or animal) being included on a written prescription. However, where multiple medicines and animals are noted on one prescription it must be explicit which medicine is for which animal.

How to write a prescription example?

How to Write a Prescription in 4 Parts Patients name and another identifier, usually date of birth. Medication and strength, amount to be taken, route by which it is to be taken, and frequency. Amount to be given at the pharmacy and number of refills. Signature and physician identifiers like NPI or DEA numbers.

How to check if a prescription is valid?

Telephone the prescriber to confirm whether the prescription has been altered or forged. Use a published telephone number rather than any number given on the suspect prescription unless you are sure it is correct.

NEW PRESCRIPTION REQUEST FORM - StayWell Guam 2025

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