Why are recipes not 100% accurate

Drug prescription

Abstract

The prescription of medication or aids is an important part of the medical work! The issuing of “health insurance prescriptions” is reserved for resident specialists with health insurance approval. However, any licensed doctor can issue a private prescription for other people.

In addition to the known prescriptions, there are other, special forms that must be used, for example, when prescribing special medicinal substances with a high potential for abuse or teratogenic properties. Certain specifications apply to the form and content of the recipe. It is important to become familiar with the "basic rules" of formulation and, for example, to internalize certain formulations and abbreviations.

Overview

  • Function: Form for the written prescription of drugs or medicinal products
    • Exceptions
      • Partial restriction of the prescribability of individual drugs by the Federal Joint Committee if the inappropriateness of the prescription is proven or more economical alternatives are available[1]
      • Presentation of a doctor's ID when purchasing prescription drugs for personal use
  • Recipe forms commonly used in Germany
    • German health insurance prescription ("Red Prescription")
    • Private prescription ("blue prescription" or "white prescription")
    • Form for recommending non-prescription drugs ("green prescription")
    • Narcotics prescription (BtM prescription, "yellow prescription")
  • Commonly used abbreviations
    • "Rp." (From Latin recipe = "take!"): The wording is usually above the field for the prescription
    • "S." (signature): Instructions for use of the prescription drugs
    • "Aut simile" (Latin for "or similar"): Dispensing of a drug with a similar effect but a different active ingredient by the pharmacy
    • "Aut idem" (Latin for "or the same"): Dispensing of a different preparation by the pharmacy if the active ingredient, pack size, dosage and application form are identical
    • Additional abbreviations on BtM prescriptions: See: Narcotics prescription
  • Possible pack sizes
    • N1: short-term treatment or tolerance assessment; Package content for ∼10 days
    • N2: Long-term therapy under special medical supervision; Package content for ∼30 days
    • N3: long-term therapy; Package content for ∼100 days

If the “aut-idem substitute” is not deselected by ticking the prescription, pharmacies are in most cases allowed to dispense generic drugs that are cheaper for the respective health insurance company and their patients!

Health insurance prescription

Features of the health insurance prescription

  • Form: Red sample form (so-called "template according to sample 16")
  • exhibition
    • For reimbursable drugs for patients with statutory health insurance
    • By resident specialists with health insurance approval
  • Validity: 4 weeks
  • Scope: Max. 3 drugs per prescription
  • Special feature: Patients over the age of 18 usually pay an additional payment of EUR 5–10 per drug

Practical information for issuing a health insurance prescription

The numbering refers to the attached picture of the till prescription.

  • Status fields for copayment (1)
    • Free of charge: tick if the insured person is exempt from co-payments
      • If necessary, this note can be added by the pharmacy if it was not printed by the practice
    • Chargeable: tick if the patient has to make co-payments
  • Payment of an emergency service fee (2)
    • “Noctu”: Tick if the prescription is urgently needed → The patient is exempt from paying an emergency service fee
  • Other (3): Tick if a prescription is charged to other insurance providers
  • (Work) accident (4)
    • Tick ​​in the event of an accident or accident at work
    • In the case of accidents at work, details of the day and location of the accident are also required (16)
  • Patient's insurance data (5)
    • Fund and insurance number as well as the status are automatically printed in clinics / practices
    • In an emergency or during house calls, it is sufficient to give your name and date of birth
  • Practice / clinic and exhibiting doctor
    • Establishment number (6)
    • Doctor number / LANR (7)
  • Date of issue (8)
  • Supplements to the regulation
    • “BVG” (9) = Federal Pension Act: Note number 6 if it is a regulation for beneficiaries under the Federal Compensation Act (BEG) or the Federal Pension Act (BVG)
    • Aids according to § 33 SGB V (10)
      • Note 7 in the case of medical aids ordinances
      • Additional entry of a diagnosis on the prescription is required!
    • Vaccine (11): Note number 8 when prescribing vaccines
    • Consultation hours required (12): Note number 9 if consultation hours are required
  • Exchange with a drug with the same active ingredient (13)
    • "Aut idem": Tick if you want to prevent the pharmacist from exchanging the prescribed drug for another drug with the same active ingredient
    • Attention: At this point it is more a question of “deselecting”, because without the corresponding cross the addition “aut idem” applies and the pharmacist can exchange drugs whose active ingredients are the same!
  • Ordinance field (14): Under the formula "Rp." May be indicated
    • Up to 3 different medicines or aids (no mixed recipes!)
      • For medicinal products: information on the active ingredient, dosage form, dosage and amount
    • 1 recipe
    • In addition, instructions for use are useful
    • Cross out spaces to prevent counterfeiting
  • Contract doctor's stamp or imprint and signature (15): Minimum information
    • Phone number
    • address
    • Doctor's first and last name
    • Job title
  • Further specifications
    • No stickers may be used for the personal data field
    • Prescription imprints, stamp and signature only in blue or black!
    • Handwritten changes to the prescription must be dated and signed
    • Handwritten signature of the doctor whose doctor no. is imprinted

If the patient is to receive exactly the prescribed drug, the addition “aut idem” must be ticked (or rather deselected) so that the exchange is excluded!

Medicines and aids must be prescribed separately from one another - no mixed prescriptions! There are separate forms for visual and hearing aids!

In the case of a prescription for aids, the prescription must also contain a diagnosis!

Private prescription

Features of the private prescription

  • Form: No fixed form or form required
  • exhibition
    • For all drug prescriptions for privately insured patients
    • For patients with statutory health insurance, if the prescribed drug is not included in the scope of benefits of statutory health insurance and has to be paid for yourself
    • Possible by all licensed doctors for other people or for yourself (self-prescription)
  • Validity: 3 months
  • Scope: Max. 3 drugs per prescription

Practical tips for issuing a private prescription

According to the Medicines Prescription Ordinance (AMVV), the private prescription must contain at least the following information (the numbering refers to the attached picture of the private prescription!):

  • Surname, first name and date of birth of the respective patient (1)
  • Date of issue and, if applicable, place (2)
  • Regulation field (3)
    • "Rp." As the traditional formula of a recipe (see also: section overview)
    • For medicinal products: information on the active ingredient, dosage form, dosage and amount
    • Description of the tool
  • Practice / clinic and exhibiting doctor (4)
    • Name and first name of the prescribing doctor
    • Exact job title of the prescribing doctor
    • Practice address, if applicable
    • Handwritten signature of the prescribing doctor
  • Optional markings
    • In case of accidents (5): tick the field "Accident"
    • "Aut idem": Tick if you want to prevent the pharmacist from exchanging the prescribed drug for another drug with the same active ingredient.

Form for recommending non-prescription drugs

  • Form: Green form, which is based on the structure of the health insurance prescription
  • Exhibition: As a “recommendation” and “memory aid” for non-prescription drugs that are to be integrated into the treatment concept and purchased by the patient at their own expense
  • Validity: Unlimited
  • Scope: Any number of prescribed drugs
  • Special feature: Reimbursement by statutory health insurance is usually excluded

BtM prescription

Features of the BtM recipe

  • Form: Yellow special form
  • Issuance: Prescription of drugs that are subject to the Narcotics Act regardless of health insurance affiliation
  • Validity: 7 days
  • Scope: Max. 3 drugs per prescription
  • particularities
    • Indication of instructions for use and the individual and daily dose
    • Details of the prescribing doctor: Name and job title, address, telephone number, personal signature without abbreviations
    • In the case of representation: Specify the comment "i.V."

Common abbreviations of a BtM recipe

  • "A" (exception): In the event of a deviation from the maximum permitted amount or number of the prescribed drug
  • "S" (substitution): When prescribing a drug for self-responsible use as part of a substitution treatment; possibly with the addition "Z" ("additional") when prescribing an amount that is required for the weekend and / or public holidays (so-called "weekend rule")
  • "N" (emergency): In an emergency and if the corresponding form is not available, possibility of prescribing narcotics on a "normal" cash register prescription with the note "emergency prescription" "
  • "K" (Kauffahrteischiff): For the equipping of merchant ships under the German flag with drugs subject to BtM

T prescription

  • Form: Official special form
  • exhibition
    • For the prescription of drugs with a high degree of teratogenic effects
    • By doctors with appropriate knowledge in handling the substances mentioned
  • Validity: 6 days after issue
  • Scope: Max. 1 drug per prescription
  • Specialty
    • It is necessary to specify the area of ​​application
    • Clear information from the prescribing doctor
    • Patients must be informed about the use and the possible consequences as well as about contraception and, if necessary, provided with medical information material before the prescription

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  1. Social Code (SGB) Book Five (V) - Statutory Health Insurance - (Article 1 of the law of December 20, 1988, Federal Law Gazette I, p. 2477) § 92 guidelines of the Federal Joint Committee .
  2. Lüllmann et al .: Pharmacology and toxicology. 15th edition Thieme 2002, ISBN: 3-133-68515-5.
  3. General and Special Pharmacology and Toxicology 2012 .
  4. Ordinance on prescribing, dispensing and providing evidence of the whereabouts of narcotics (Narcotics Prescription Ordinance - BtMVV). Status: May 22, 2017. Accessed on: March 28, 2018.
  5. Ordinance on the prescription of medicinal products (Medicinal Prescription Ordinance - AMVV) .
  6. Medicinal prescription: when is it red, yellow, blue or green?. Status: January 1, 2019. Accessed on: March 25, 2019.
  7. The most important points when writing recipes (sample 16). Status: February 1, 2014. Accessed on: March 25, 2019.
  8. Cash register prescription (Muster16): Tips to fill out. Status: March 1, 2016. Accessed on: March 25, 2019.
  9. DAP recipe check. Status: February 1, 2018. Accessed on: March 25, 2019.
  10. Frequently asked questions about the Narcotics Prescription Ordinance (BtMVV) and the Narcotics Act (BtMG) for doctors, pharmacists and specialists) .