PHYSICIAN PRESCRIBING PRACTICES

No, except when another prescriber is not available for emergency services. Note: You cannot bill for this service.

For further information refer to the CMA Code of Ethics – Section 20

Yes.

Please refer to the College’s Prescribing: Administration Standard of Practice and Prescribing: Administration Advice to the Profession.

Direct authorization by valid signature is required to verify the authenticity of prescriptions.

Handwritten prescriptions given directly to the patient must be signed manually. EMR-generated prescriptions that are printed and given directly to the patient must be counter-signed with a “wet” signature.

EMR-generated signatures are only acceptable to pharmacists when the prescription is transmitted directly from the EMR to the pharmacy of the patient’s choice, as in the case of a fax. In a closed electronic system where transmission is by secure messaging, the password protocol is considered the prescriber’s direct authorization. The physician must log in and transmit the prescription themselves (i.e. may not delegate) in this case.

Fax direct from a password-protected EMR is currently the recommended electronic method of transmission; the password protocol is the prescriber’s direct authorization. For physicians participating in the PrescribeIT (Canada Health Infoway) pilot, the same considerations apply.

The following scenarios are acceptable:                                             �

• Prescriptions produced by computer, then hand-signed by a physician or with an electronic signature that is hand-initialed by the physician and given to a patient to take to a pharmacy.
• Prescriptions produced by computer, then hand-signed by a physician or with an electronic signature that is hand-initialed by the physician and faxed to a pharmacy of the patient’s choice.
• Prescriptions transmitted in a secure closed electronic system. A digitally captured signature using a hardware device and software for authentication is acceptable. In this case, the EMR’s password protocol is considered direct authorization. However, the physician must log in and transmit the prescription themselves if using this method (cannot delegate).

For best practices, refer to the College’s Prescribing: Administration Advice to the Profession.

A physician may refill a prescription over the phone or fax without seeing the patient in person in most cases. However, some drugs (e.g., Triplicate Prescription Program Medication List) cannot be verbally authorized or refilled.

If a physician does phone in a prescription, he/she may need to follow up with the patient to ensure the prescribed medication is working or to adjust the dosage. The physicians may also want to check if the patient has had any significant changes to their health that might require a change to the prescription.

No. The physician must see the patient before prescribing a new medication. For more information, refer to the CPSA Standard of Practice on Telemedicine.

No. Information about which physicians prescribe which drugs is not public information.

Please refer to the Opioid Dependence Treatment Program for detailed information.

Yes. Physicians may decide whether or not the decision to authorize medical cannabis is appropriate for their patients. The physician must register with the College to authorize cannabis for medical purposes.  This information is not shared with other health care professionals or the public. In all cases, the Cannabis for Medical Purposes Patient Document must be completed. A copy of this form must be sent to CPSA within 7 days of completion.

For more information, please review the CPSA Standard of Practice on Cannabis for Medical Purposes and related Advice to the Profession.

Yes. According to the Office of the Information Privacy Commissioner, the pharmacist is not providing a “health service” and a forged or stolen prescription does not contain “health information”. Fraudulent alteration of a prescription in any material respect means that this form is no longer “health information” and can be disclosed to the police.

Yes. However, there must be no conflict of interest. This means patients cannot feel coerced to purchase from that pharmacy,. A physician’s ownership in a pharmacy must not impact his/her prescribing practices.

For further guidance, please refer to the Prescribing: Administration, Conflict of Interest, Code of Ethics and Relationships with Industry Standards of Practice.