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NEW JERSEY REGISTER
VOLUME 34, NUMBER 17
TUESDAY, SEPTEMBER 3, 2002
RULE PROPOSAL

LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF MEDICAL EXAMINERS
EXAMINATION OF PATIENT'S CONDITION REQUIRED PRIOR TO DISPENSING DRUGS OR
ISSUING A PRESCRIPTION; EXCEPTIONS; FACSIMILE TRANSMITTED PRESCRIPTIONS;
ELECTRONICALLY TRANSMITTED PRESCRIPTIONS

Proposed New Rules: N.J.A.C. 13:35-7.1A, 7.4 and 7.4A

Authorized By: State Board of Medical Examiners, William Roeder, Executive Director.

Authority: N.J.S.A. 45:9-2 and 45:1-15.1.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2002-308.

Submit comments by November 2, 2002 to:

William Roeder, Executive Director

State Board of Medical Examiners

140 East Front Street

PO Box 183

Trenton, New Jersey 08625-0183

The agency proposal follows:


Summary

Pursuant to its general rulemaking authority set forth at N.J.S.A. 45:9-2 and 45:1-15.1, the State Board of Medical Examiners (the Board) is proposing new rules which regulate the transmission of facsimile and electronic prescriptions by prescribers to licensed pharmacies. The Board notes that the proposed new rules do not encompass procedures for the transmission of facsimile and electronic medication orders in health care facilities. The Board intends to propose separate rules for medication orders transmitted by facsimile and/or electronic means by its licensees in such facilities in the future. The Board believes that separate rules regarding the transmission of facsimile and electronic prescriptions in private practice and in health care facility settings are necessary so as to ensure that the Board's rules are responsive to the different needs of licensees practicing in these diverse settings.

The Board is proposing a new rule at N.J.A.C. 13:35-7.1A which will memorialize the existing standard of practice and require practitioners to conduct a thorough patient examination prior to the dispensing of medications or the issuing of prescriptions. The examination must be appropriately documented in the patient record. N.J.A.C. 13:35-7.1A(a) requires a practitioner to take a patient history, to perform a physical examination, and to make a diagnosis based upon the examination and any accompanying tests performed or ordered by the practitioner. A practitioner must also formulate a therapeutic plan and discuss the risks and benefits of the various treatment options with the patient. Lastly, the practitioner must ensure that he or she is available to provide follow-up care for the patient or, in the alternative, he or she must ensure that another practitioner is available to provide such care for the patient. N.J.A.C. 13:35-7.1A(b) permits a practitioner to dispense medications or issue prescriptions without first conducting an examination under the following circumstances: in admission orders for newly hospitalized patients; for a patient of another physician for whom the practitioner is taking calls; for continuation medications on a short term basis for a new patient prior to the patient's first appointment; for an established patient who the practitioner believes does not require a new examination; for a patient examined by a health care professional who is in collaborative practice with the practitioner; and when treatment is provided for an emergency medical condition. Subsection (c) of N.J.A.C. 13:35-7.1A provides a definition for the term "emergency medical condition." The Board is proposing new rule N.J.A.C. 13:35-7.1A in order to ensure that practitioners are aware of their obligation to conduct a thorough examination of the patient prior to the issuance of any type of prescription, whether it be a written, verbal, facsimile or electronic prescription.

Proposed new rule N.J.A.C. 13:35-7.4, which sets forth requirements for prescriptions transmitted by facsimile, and N.J.A.C. 13:35-7.4A, which sets forth requirements for prescriptions transmitted electronically, will help to protect the health, safety and welfare of New Jersey consumers by ensuring that proper procedures are followed in the transmission of such prescriptions. In addition, the Board believes that the proposed new rules will benefit consumers by promoting the filling of prescriptions in a more efficient and timely manner. Moreover, the Board believes that the increased use of facsimile and electronic prescriptions may result in a decrease in medication errors that are caused by misread or illegible prescriptions.

Proposed new rules N.J.A.C. 13:35-7.4 and 7.4A authorize practitioners to transmit facsimile and electronic prescriptions to licensed pharmacies. For clarification purposes, N.J.A.C. 13:35-7.4(a) and 7.4A(a) provide definitions for the terms "facsimile prescription" and "electronic prescription." N.J.A.C. 13:35-7.4(b) and 7.4A(b) require a practitioner to comply with all requirements set forth in subchapter 7, concerning prescriptions for and dispensing of medications, and to ensure that all information required to be included on a written prescription is provided on a facsimile or electronic prescription. The only requirement with which a licensee need not comply is the requirement that the prescription be on an official New Jersey prescription blank.

Proposed N.J.A.C. 13:35-7.4(c) requires a practitioner to ensure that the transmission of any facsimile prescription contains the identification number of the facsimile machine used to transmit the prescription, the date and time of the transmission, and the name, address, telephone number and facsimile number of the pharmacy to which the prescription is being sent. If an authorized agent transmits the facsimile prescription, the transmission must also include the agent's full name and title.

Proposed N.J.A.C. 13:35-7.4A(c) provides that if a practitioner is transmitting an electronic prescription, his or her electronic signature, or other secure method of validation, must be provided with the prescription. The practitioner must ensure that the electronic system he or she is utilizing has adequate security and system safeguards designed to prevent and detect unauthorized access, modification or manipulation of the prescriptions, pursuant to N.J.A.C. 13:35-7.4A(d). Proposed N.J.A.C. 13:35-7.4A(e) provides that if the authorized agent electronically transmits a prescription, the practitioner must ensure that the full name and title of the agent is included on the transmission. The practitioner must also ensure that the authorized agent does not sign the electronic prescription.

Proposed N.J.A.C. 13:35-7.4(d) and 7.4A(f) require a practitioner to provide verbal verification of a facsimile or electronic prescription whenever a pharmacist has a question regarding the authenticity, accuracy or appropriateness of the prescription. A practitioner may allow an authorized agent to verify the prescription only when the pharmacist has a question regarding the authenticity or legibility of the prescription.

Proposed N.J.A.C. 13:35-7.4(e) and 7.4A(g) provide that a practitioner may transmit, by facsimile or electronic device, a prescription for a Schedule II controlled substance, provided the patient is given the original signed prescription to present to the pharmacy prior to dispensing. The facsimile prescription under N.J.A.C. 13:35-7.4(e), however, will be treated as the original written prescription if the prescription is for a Schedule II substance prescribed for pain management for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion (paragraph (e)1), or if it is for a resident of a long term care facility (paragraph (e)2) or for a patient receiving services from a hospice (paragraph (e)3). Under current Federal law, these options for filling prescriptions for pain management are permitted by facsimile only and may not be filled electronically. In the event the Federal government in the future permits the filling of Schedule II controlled substances electronically, the Board has provided for such eventuality by including an "unless otherwise permitted by Federal law" provision in N.J.A.C. 13:35-7.4A(g). In addition, the Board has provided in N.J.A.C. 13:35-7.4A(g) that if a practitioner chooses to send a prescription for a Schedule II controlled substance electronically once permitted to do so by Federal law, the electronic prescription shall serve as the original prescription and the practitioner may not provide the patient with a signed, written prescription for the medication, in order to prevent duplicate filling of the prescription.

Proposed N.J.A.C. 13:35-7.4(f) provides that practitioners may also transmit a facsimile prescription for a Schedule III, IV or V controlled substance and the facsimile serves as the original written prescription. However, under N.J.A.C. 13:35-7.4A(h), a practitioner may only transmit an electronic prescription for a Schedule III, IV or V controlled substance if the patient is given the original signed prescription to present to the pharmacy, or the practitioner calls in an oral prescription or sends a facsimile to the pharmacy. In the event the Federal government adopts changes to otherwise permit the electronic transmission of Schedule III, IV or V controlled substances, the proposed subsection provides for such additional options by the inclusion of an "unless otherwise permitted by Federal law" clause. If a practitioner chooses to send a prescription electronically once permitted to do so by Federal law, he or she may not provide the patient with a signed, written prescription for the medication. The electronic prescription shall serve as the original prescription. Similarly, N.J.A.C. 13:35-7.4(g) provides that if a practitioner prescribes by facsimile any Schedule III, IV or V controlled substance, or a Schedule II substance for pain management for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion, or for a resident of a long term care facility or for a patient receiving services from a hospice, the practitioner may not provide the patient with a signed, written prescription, in order to prevent duplicate filling of the prescription. The Board is proposing N.J.A.C. 13:35-7.4(e), (f) and (g) and 7.4A(g) and (h) in order to make the Board's rules on the transmission of prescriptions for controlled substances consistent with the Federal requirements set forth in 21 C.F.R. § § 1306.11 and 1306.21.

Proposed N.J.A.C. 13:35-7.4(h) and 7.4A(i) prohibit a practitioner from entering into any agreement with a pharmacy which requires that facsimile or electronic prescriptions be transmitted to a particular pharmacy. The Board proposes subsections (h) and (i) in order to safeguard a patient's right to have his or her prescriptions transmitted to a pharmacy of the patient's choice.

The Board has determined that the comment period for this proposal shall be 60 days; therefore, pursuant to N.J.A.C. 1:30-3.3(a)5, this proposal is excepted from the rulemaking calendar requirement.

Social Impact

The Board believes that the proposed new rules will have a positive impact upon prescribing practitioners licensed by the Board to the extent that the rules establish guidelines for the transmission of prescriptions in facsimile and/or electronic format. The proposed new rules will provide licensees with direction and guidance as to how such prescriptions must be transmitted. The Board also believes that the proposed new rules will have a positive impact upon consumers to the extent that the increased use of facsimile and electronic prescriptions may increase the efficiency and accuracy with which prescription medications are prepared and dispensed, and may also lead to a decrease in the number of medication errors which occur as a result of illegible prescriptions.

Economic Impact

The Board believes that the proposed new rules may have an economic impact upon prescribing practitioners licensed by the Board who wish to transmit facsimile and/or electronic prescriptions, to the extent that such practitioners will have to purchase the necessary equipment, which may include facsimile machines, computer devices and the computer software necessary to run the electronic prescription programs. The costs of complying with the proposed new rules will vary depending on whether the practitioner chooses to transmit such prescriptions, and on the type of equipment the practitioner chooses to purchase.

Federal Standards Statement

A Federal standards analysis is not required because the proposed new rules are governed by N.J.S.A. 45:9-1 et seq., and, therefore, are not subject to any Federal standards or requirements. The Board notes, however, that the proposed requirements for the facsimile and electronic transmission of prescriptions for controlled substances set forth at N.J.A.C. 13:35-7.4(e) and (f) and 13:35-7.4A(g) and (h) are consistent with the Federal DEA standards articulated at 21 C.F.R. § § 1306.11 and 1306.21.

Jobs Impact

The Board does not believe that the proposed new rules will result in the creation or the loss of jobs in the State.

Agriculture Industry Impact

The Board does not believe that the proposed new rules will have any impact upon the agriculture industry in the State.

Regulatory Flexibility Analysis

The Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq., requires the Board to provide a description of the types and an estimate of the number of small businesses to which the proposed new rules will apply. If, for purposes of the Act, the 34,573 practitioners licensed by the Board are considered "small businesses," then the following analysis applies.

The Act requires the Board to set forth the reporting, recordkeeping and other compliance requirements of the proposed new rules, including the kinds of professional services likely to be needed to comply with the requirements. The Act further requires the Board to estimate the initial and annual compliance costs of the proposed new rules, to outline the manner in which it has designed the proposed new rules to minimize any adverse economic impact upon small businesses, and to set forth whether the proposed new rules establish differing compliance requirements for small businesses.

The proposed new rules do not impose any reporting requirements upon Board licensees. Proposed N.J.A.C. 13:35-7.1A(a), however, imposes a recordkeeping requirement upon practitioners, to the extent that practitioners must appropriately document in the patient record all findings made during the practitioner's examination of the patient. Such documentation is already required by N.J.A.C. 13:35-6.5(b)1iv.

The proposed new rules also impose various compliance requirements upon prescribing practitioners. N.J.A.C. 13:35-7.1A requires all practitioners to conduct an examination of the patient prior to dispensing any medications or issuing prescriptions to the patient. As part of this examination, the practitioner must perform an appropriate history and physical examination. The practitioner is required to make a diagnosis based upon the examination and to formulate a therapeutic plan. The practitioner must discuss the plan with the patient, along with the risks and benefits of various treatment options. The practitioner is also required to ensure his or her availability to provide follow-up care to the patient, or in the alternative, to ensure that another physician will be available to provide such care.

Proposed new rules N.J.A.C. 13:35-7.4 and 7.4A will also impose various compliance requirements upon prescribing practitioners licensed by the Board. N.J.A.C. 13:35-7.4(a) and 7.4A(a) allows a practitioner, or the practitioner's authorized agent, to transmit a facsimile or electronic prescription to a pharmacy, provided the pharmacy has been approved by the patient, the patient's guardian or the patient's authorized representative. N.J.A.C. 13:35-7.4(b) and 7.4A(b) require a practitioner to comply with all requirements set forth at N.J.A.C. 13:35-7, and to ensure that all information required to be included on a written prescription pursuant to N.J.A.C. 13:35-7.2(d) is provided on the facsimile or electronic prescription. N.J.A.C. 13:35-7.4(c) requires the practitioner to ensure that a facsimile prescription transmission contains the identification number of the facsimile machine used to transmit the prescription, the date and time of the transmission, and the name, address, telephone number and facsimile number of the pharmacy to which the prescription is being transmitted. If an authorized agent transmits the facsimile prescription, the transmission must also contain the agent's full name and title.

Pursuant to N.J.A.C. 13:35-7.4A(c), if a practitioner is transmitting an electronic prescription, his or her electronic signature, or other secure method of validation, must be provided with the prescription, unless an authorized agent transmits the prescription. The practitioner must also ensure that the electronic system he or she is utilizing has adequate security and system safeguards designed to prevent and detect unauthorized access or manipulation of the prescriptions, pursuant to N.J.A.C. 13:35-7.4A(d). If the authorized agent electronically transmits the prescription, pursuant to N.J.A.C. 13:35-7.4A(e), the practitioner must ensure that the full name and title of the agent is included on the transmission. The practitioner must also ensure that the authorized agent does not sign the electronic prescription.

Proposed N.J.A.C. 13:35-7.4(d) and 7.4A(f) require a practitioner to provide verbal verification of facsimile or electronic prescriptions whenever a pharmacist has a question regarding the authenticity, accuracy or appropriateness of the prescription. A practitioner may allow an authorized agent to verify the prescription, however, when the pharmacist has a question regarding the authenticity or legibility of the prescription.

N.J.A.C. 13:35-7.4(e) and 7.4A(g) require a practitioner who is transmitting a facsimile or electronic prescription for a Schedule II controlled substance to provide the patient with the original signed prescription. Under N.J.A.C. 13:35-7.4(e), however, if the prescription is for a Schedule II substance prescribed for pain management for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion, or is for a resident of a long term care facility or for a patient receiving services from a hospice, the facsimile shall serve as the original signed prescription. In addition, pursuant to N.J.A.C. 13:35-7.4A(g), if permitted by Federal law, a practitioner may have an electronically transmitted prescription for a Schedule II controlled substance serve as the original signed prescription. Practitioners may also transmit a facsimile or electronic prescription for a Schedule III, IV or V controlled substance, pursuant to N.J.A.C. 13:35-7.4(f) and 7.4A(h). Pursuant to N.J.A.C. 13:35-7.4A(h), however, the practitioner must provide the patient with the original, signed prescription to be presented to the pharmacy, or the practitioner must provide the pharmacy with an oral or facsimile prescription, unless Federal law provides otherwise. Pursuant to N.J.A.C. 13:35-7.4(g) and 7.4A(g) and (h), if a practitioner prescribes, by facsimile or electronic means, any Schedule II, III, IV or V controlled substance under circumstances where the facsimile or electronic prescription is deemed to be the original prescription, the practitioner is prohibited from providing the patient with a signed, written prescription.

Proposed N.J.A.C. 13:35-7.4(h) and 7.4A(j) prohibited a practitioner from entering into any agreement with a pharmacy which requires that facsimile or electronic prescriptions be transmitted to a particular pharmacy. Practitioners are also prohibited from entering into any agreement that denies a patient the right to have his or her prescription transmitted to a pharmacy of the patient's choice.

No additional professional services will be needed to comply with the proposed new rules. The costs of compliance with the proposed new rules are discussed in the Economic Impact statement above. Since the Board proposes the new rules in order to promote the health, safety and welfare of New Jersey consumers in obtaining prescription medications, the proposed new rules will be uniformly applied and, therefore, no differing compliance requirements for any prescribing practitioners are provided based upon the size of the business.

Smart Growth Impact

The Board does not believe that the proposed new rules will have any impact upon the achievement of smart growth or upon the implementation of the State Development and Redevelopment Plan.

Full text of the proposal follows:

<< NJ ADC 13:35-7.1A >>

<<+13:35-7.1A Examination of patient's condition required prior to dispensing drugs or issuing a prescription; exceptions+>>

<<+(a) Except as provided in (b) below, a practitioner shall not dispense drugs or issue prescriptions to an individual, pursuant to the requirements of this subchapter, without first having conducted an examination, which shall be appropriately documented in the patient record. As part of the patient examination, the practitioner shall:+>>

<<+1. Perform an appropriate history and physical examination;+>>

<<+2. Make a diagnosis based upon the examination and all diagnostic and laboratory tests consistent with good medical care;+>>

<<+3. Formulate a therapeutic plan and discuss such plan, along with the basis for the plan and the risks and benefits of various treatment options, with the patient; and+>>

<<+4. Ensure the availability of the physician or coverage for the patient for appropriate follow-up care.+>>

<<+(b) Notwithstanding (a) above, an examination of the patient's condition shall not be required prior to the dispensing of drugs or the issuance of a prescription under the following circumstances:+>>

<<+1. In admission orders for a newly hospitalized patient;+>>

<<+2. For a patient of another physician for whom the practitioner is taking calls;+>>

<<+3. For continuation medications on a short term basis for a new patient prior to the patient's first appointment;+>>

<<+4. For an established patient who, based on sound medical practice, the physician believes does not require a new examination before issuing a new prescription;+>>

<<+5. For a patient examined by a healthcare professional who is in collaborative practice with the practitioner; and+>>

<<+6. When treatment is provided by a practitioner for an emergency medical condition.+>>

<<+(c) For purposes of this section, the term "emergency medical condition" as used in (b) above means:+>>

<<+1. A medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:+>>

<<+i. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;+>>

<<+ii. Serious impairment to bodily functions; or+>>

<<+iii. Serious dysfunction of any bodily organ or part.+>>

<< NJ ADC 13:35-7.4 >>

13:35-7.4 <<-Electronically transmitted prescriptions (Reserved)->> <<+ Facsimile transmitted prescriptions+>>

<<+(a) A practitioner, acting within his or her scope of lawful practice and after an examination of the patient's condition, consistent with the requirements of N.J.A.C. 13:35-7.1A, may transmit, or have an authorized agent transmit, a facsimile prescription to a pharmacy which has been approved by a patient, a patient's guardian, or a patient's authorized representative, consistent with the requirements of this section. For purposes of this section, "facsimile prescription" means a prescription issued by the practitioner which is transmitted by a device which sends an exact image to the receiver.+>>

<<+(b) A practitioner shall comply with all requirements set forth in this subchapter, and shall ensure that all information required to be included on a written prescription pursuant to N.J.A.C. 13:35-7.2(d) is provided on each facsimile prescription, except that an NJPB shall not be required for the prescription.+>>

<<+(c) The transmission of a facsimile prescription shall contain the following:+>>

<<+1. The identification number of the facsimile machine which is used to transmit the prescription to the pharmacy;+>>

<<+2. The time and date of the transmission of the prescription;+>>

<<+3. The name, address, telephone number and facsimile number of the pharmacy to which the prescription is being transmitted; and+>>

<<+4. If an authorized agent transmits the facsimile prescription, the full name and title of the transmitting agent.+>>

<<+(d) A practitioner shall provide verbal verification of the facsimile prescription upon request of the pharmacy when the pharmacist has a question regarding the authenticity, accuracy or appropriateness of the prescription. A practitioner's authorized agent may provide verbal verification of the facsimile prescription to the pharmacy when the pharmacist has a question regarding the authenticity or legibility of the prescription.+>>

<<+(e) A practitioner or his or her authorized agent may transmit a facsimile prescription to a pharmacy for a Schedule II controlled substance, provided that the patient is given the original signed NJPB which is presented to the pharmacist prior to the dispensing of the controlled substance, except as provided in (e)1, 2 and 3 below:+>>

<<+1. A prescription for a Schedule II substance prescribed for pain management to be compounded for the direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion may be transmitted by the practitioner or the practitioner's agent to the dispensing pharmacy by facsimile. The facsimile shall serve as the original written prescription.+>>

<<+2. A prescription for a Schedule II substance prescribed for pain management for a resident of a long term care facility may be transmitted by the practitioner or the practitioner's agent to the dispensing pharmacy by facsimile. The facsimile shall serve as the original written prescription.+>>

<<+3. A prescription for a Schedule II substance prescribed for pain management for a patient receiving services from a hospice certified by Medicare under Title XVIII or licensed by the State may be transmitted by the practitioner or the practitioner's agent to the dispensing pharmacy by facsimile. The practitioner or the practitioner's agent shall note on the facsimile prescription that the patient is a hospice patient. The facsimile shall serve as the original written prescription.+>>

<<+(f) A practitioner or his or her authorized agent may transmit a facsimile prescription to a pharmacy for a Schedule III, IV, or V controlled substance consistent with the requirements of this section. The facsimile shall serve as the original written prescription.+>>

<<+(g) If a facsimile prescription is provided for a Schedule II substance prescribed for pain management to be compounded for the direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion, or for a resident of a long term care facility, or for a patient receiving services from a hospice certified by Medicare under Title XVIII or licensed by the State, or for a Schedule III, IV or V controlled substance, the practitioner shall not provide the patient, the patient's guardian, or the patient's authorized representative with the original written prescription.+>>

<<+(h) A practitioner shall not enter into any agreement with a pharmacy that requires facsimile prescriptions be transmitted to that particular pharmacy or in any way denies a patient the right to have his or her prescription transmitted by facsimile to a pharmacy of the patient's choice.+>>

<< NJ ADC 13:35-7.4A >>

<<+13:35-7.4A Electronically transmitted prescriptions+>>

<<+(a) A practitioner, acting within his or her scope of lawful practice and after an examination of the patient's condition, as defined in N.J.A.C. 13:75-7.1, may transmit, or have an authorized agent transmit, an electronic prescription to a pharmacy which has been approved by a patient, a patient's guardian, or a patient's authorized representative, consistent with the requirements of this section. For purposes of this section, "electronic prescription" means a prescription which is transmitted by a computer device in a secure manner.+>>

<<+(b) A practitioner shall comply with all requirements set forth in this subchapter, and shall ensure that all information required to be included on a written prescription pursuant to N.J.A.C. 13:35-7.2(d) is provided in each electronic prescription, except that an NJPB shall not be required for the prescription.+>>

<<+(c) A practitioner's electronic signature, or other secure method of validation, shall be provided with the electronic prescription unless the prescription is transmitted by an authorized agent as provided in (e) below.+>>

<<+(d) To maintain confidentiality of electronic prescriptions, the practitioner shall ensure that the electronic system used to transmit the electronic prescription has adequate security and system safeguards designed to prevent and detect unauthorized access, modification or manipulation of such records, and shall include, at a minimum, electronic encryption.+>>

<<+(e) A practitioner may authorize an agent to electronically transmit a prescription provided that the full name and title of the transmitting agent is included on the transmission, and provided that the practitioner's authorized agent does not sign the electronic prescription.+>>

<<+(f) A practitioner shall provide verbal verification of an electronic prescription upon request of the pharmacy when the pharmacist has a question regarding the authenticity, accuracy or appropriateness of the prescription. A practitioner's authorized agent may provide verbal verification of the electronic prescription to the pharmacy when the pharmacist has a question regarding the authenticity or legibility of the prescription.+>>

<<+(g) A practitioner or the practitioner's authorized agent may transmit an electronic prescription to a pharmacy for a Schedule II controlled substance, provided that the original signed prescription is presented to the pharmacist prior to the dispensing of the controlled substance. If permitted by Federal law, and in accordance with Federal requirements, the electronic prescription shall serve as the original signed prescription and the practitioner shall not provide the patient, the patient's guardian, or the patient's authorized representative with a signed, written prescription.+>>

<<+(h) A practitioner or his or her authorized agent may transmit an electronic prescription to a pharmacy for a Schedule III, IV, or V controlled substance, provided that the original signed prescription for presentation at the pharmacy, an oral prescription, or a facsimile prescription is provided. If permitted by Federal law, and in accordance with Federal requirements, the electronic prescription shall serve as the original signed prescription and the practitioner shall not provide the patient, the patient's guardian, or the patient's authorized representative with a signed, written prescription.+>>

<<+(i) A practitioner shall not enter into any agreement with a pharmacy which requires that electronic prescriptions be transmitted to a particular pharmacy or in any way denies a patient the right to have his or her prescription transmitted electronically to a pharmacy of the patient's choice.+>>

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Posted September 3, 2002