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ZFederal Law

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
A few exemptions from DEA registration   Public Health Service Practitioners, Bureau of Prisons Practitioners, Military Service Practitioners (AG can deny)  
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Which form is used for new pharmacy and physician registration?   DEA 224  
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Change of address requires new registration, T/F?   True  
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If there is a transfer of business how many days prior to the move must the DEA be notified?   14 (name address, and DEA # of old business AND new business)  
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DEA # verification AB1357210   1+5+2=8; 3+7+1 =11x2=22 +8 =30; the zero at end is verified by the zero at end of DEA #  
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T/F Records for CII must be kept separate from other records   True  
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3 types of records   Inventory, drugs received( invoices for C3-C5 and DEA222 for C2), and drugs dispersed  
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Which form is used if theft or loss occurs?   DEA 106  
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Form for drugs surrendered for disposal   DEA 41  
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Requires all OTC and prescription drugs be subject to special packing requirements   Poison prevention packaging  
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Established 2 classes of drug, prescription and OTC   Durham Humphrey  
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Required drugs be proven safe and effective   Kefauver harris  
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Mandates increased recordkeeping for physicians and pharmacists who dispense narcotics   harrison narcotic act  
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Individually identifiable health info addressed under the privacy rule   PHI  
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Established a formal definition of dietary supplements using several criteria   DSHEA  
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Official compendia of active ingredients   USP  
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Established a fast track approval process for srugs intended for serious life threatening diseases   FDAMA  
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A key component in OBRA 90 that pharmacists must offer counseling to patients   Prospective DUR  
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Act that provides storage, handling, and recordkeeping for drug samples   Prescription drug marketing  
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Act regarding safety and efficacy of medical devices according to their function   Medical devices  
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Intent was cost savings and better fiscal mgmt   of medicare/ Medicaid  
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Provide tax incentives for manufacturers to develop drugs for rare disease   Orphandrug  
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Established to ensure security and dprivacy of patients medical records when electronically transmitted   HIPPA  
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Authorized batch certification on insulin and penicillin   FDCA  
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Dept of health and human services is an example of what kind of agency?   Federal administrative; responsible for Health Care Financing Admin and FDA  
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Fair Trade Commission is what kind of agency?   Federal administrative; drug advertising  
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US Justice Department   Fed admin agency; DEA  
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State Board of Pharmacy puts in details for legislatures framework   No answer  
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4 types of law   Criminal (person vsgov) ; civil (person vs person);administrative (created/ enforced by gov agencies); common law( no specific statute)  
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A pharmacist who unintentionallyharms a patient through inattentiveness or carelessness can be considered legally negligent “tort”; civil or criminal?   Civil  
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Failing to do something that a reasonable person would do   omission  
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doing something that a reasonable person would not do   Commission  
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a violation of the legal obligation to an individual; ex: misfilling a prescription   Breach of duty  
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a reasonable standard of care while performing any acts that could potentially harm others   Duty owed  
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Proof that pharmacists misconduct caused the alleged damage   Causation  
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Loss or injury to a person or property   Damage  
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4 elements of negligence (all 4 needed to be legally liable)   Duty owed, breach of duty, causation, damage  
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Definition of “drug”   Habit forming OR not safe w/o supervision OR is limited by application to be used under supervision  
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cGMP   Current good manufacturing practices  
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Drugs recognized among experts to be safe and effective   OTC drugs; must contain adequate directions for use and comply with cGMP  
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Obtaining FDA Pre-marketing drug approval; new use for previously approved drugs   New Drug Application  
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once the patent on an approved parent drug product expires, the FDA allows manufacturers of generic products to submit a what? ANDA   ANDA  
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ANDA   Abbreviated New Drug Application; no safety or efficacy data required; have to prove it’s the same bioequivalence  
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Formulation change or change to written material of product goes thru what process?   SNDA (Supplemental New Drug Application)  
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OTC monograph   OTC’s broken down into categories instead of making each go thru FDA process; list of safe products that can be used in a new product  
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11 digit, 3 segment number identifying all drug products   NDC (National Drug Code); required on all OTC AND prescription labels  
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First section of National Drug Code   manufacturer or distributor  
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Second section of NDC   “product”  
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Third section of NDC   “packaging”  
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Concerned with physical condition of drug or device   Adulteration; unsanitary, etc  
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Concerned with representation made by the manufacturer regarding drug or device   misbranding  
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False or misleading label, inadequate directions for use, doesn’t warn of possible habit forming   misbranding  
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Not in conformance with GMP, poisonous container, unsafe color additives, not tamper resistant   Adulteration  
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Insulin or antibiotic that is not batch certified is an example of what?   Misbranding; every batch tested for strength and quality  
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Label vs labeling   Label is attached to actual container and labeling refers to all accompanying info; package inserts etc  
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Patient information program ( 2 parts of program)   MedGuides and Consumer Medication Information (CMI)  
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Manufacturers are required to provide these for drugs that pose a “serious and significant” concern to the public, Requires FDA approval   MedGuides of Patient Info Program; Manufacturer provides to dispenser, dispenser provides to patient  
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Mandated that written information is provided to the patient for every drug every time a new prescription is dispensed   Consumer medication Information (CMI); Patient Information Program  
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Which class of product recall is most serious?   Class I, irreversible damage/ death; class II reversible damage; class III often mislabeling; FDA does tell public which class  
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T/F; Pharmacists have to know which products have been recalled?   True  
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Product recall withdrawal process   Manufacturer contacts seller; seller contacts consumer- manufacturer or FDA may initiate recall  
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set of regulations that establishes minimum requirements for the methods, facilities, or controls used in the manufacture, processing, packing, or holding of a drug product   GMP  
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The intent of the GMP is to do what?   Ensure safety of drug and that it meets quality and purity requirements; adulterated if not in accordance with GMP  
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Manufacturers are inspected by FDA how often?   Every 2 years  
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“Approved Drug Products with Therapeutic Equivalence Evaluations”   Orange book  
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Two-letter coding system for the therapeutic equivalence; first letter is either an A or a B   First letter=A; equivalent- first letter B; not equivalent  
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In the A/B equivalence coding system, the second letter means what?   Gives info about dosing- ex: oil or aerosol  
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MedWatch and VAERS (Vaccine Adverse Event Reporting System) are part of what?   Voluntary Reporting Programs  
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Pharmacists must provide: “Call your doctor for medical advice about side effects; You may report side effects to the FDA at 1-800-FDA-1088”   Voluntary Reporting Programs  
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Clinical trials Phase I   healthy patients; detect adverse side effects; doesn’t determine efficacy  
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Clinical trials phase II   Written consent from patients who have the disease; determine efficacy and dosage  
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Clinical trials phase III   Verbal consent; large studies; strict criteria; risk to benefit analysis  
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Clinical trials phase IV   Post marketing surveillance; FDA can rescind NDA approval  
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1820 first group of physicians gathered info about drugs, created a compendia standard of drugs   US Pharmacopia  
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Monographs of inactive ingredients   NF (National Formulary)  
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USP and NF joined into 1 compendium for drug standards   USP/NF; meet every 5 years to review  
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HPUS is what?   Homeopathic pharmacopeia of the US; compendium for homeopathic (natural) products  
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Prohibited the adulteration/ misbranding of drugs; not required to list ingredients; no authority to ban drugs   Pure Food and Drug Act of 1906;misleading claims were not prevented; only prevented false statements about drugs identity  
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Required prescriptions for narcotics and mandated record keeping for physicians and pharmacists   Harrison Narcotic act of 1914  
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Authorized batch certification AND required new drugs to be proven safe before marketed   Food, drug, and cosmetic act of 1938  
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Established 2 classes of drugs; required drugs to be labeled   durham- Humphrey; must contain “ federal law prohibits dispensing without prescription  
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Adequate info vs adequate directions   OTC require adequate directions for use (clear and specific), prescription meds require adequate information in health care provider lingo  
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Required drugs to be SAFE and EFFECTIVE; established GMP   Kefauver- Harris  
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Established advertising procedures   Kefauver- Harris; legend (prescription drugs)=FDA ; OTC= Federal trade commission  
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Special packaging and child resistant packaging   Poison prevention packaging act (not required if patient request or physician prescribes)  
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Medical Devices Act: 3 classes according to function   Class I, low risk (bandaids, no testing); Class II,must be evaluated (hearing aids); Class III, life supporting devices(pacemaker) pre-market approval  
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Tax/ licensing incentives for manufacturers to develop and market drugs for rare diseases   Orphan drug act  
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Extended patent to 5 years after FDA approval; streamlined generic drug approval process   Drug Price Competition and Patent Term Restoration Act  
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Requirements for samples   Prescription Drug Marketing Act  
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Intent was cost saving/ better mgmt of Medicaid and medicare; required drug use review   OBRA 90 (Omnibus Budget Reconciliation Act)  
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3 components of OBRA90   Rebates, innovation, drug utilization review  
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3 components of DUR   Screening prescriptions prior to dispense, patient counseling, and pharmacist documentation of relevant info (allergies etc)  
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Annual Fees on manufacturers; allowed more FDA employees and faster drug approval   Prescription Drug User Fee Act  
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Definition of dietary supplement   (Dietary Supplement Health and Education); product other than tobacco; vitamin, mineral, herb, amino acid orcombo of these  
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Required labels to say “This statement has not been evaluated by the FDA, not intended to diagnose etc   DSHEA  
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Fast track approval for life threatening disease; data base for clinical trials; panel review; “off-label”uses   FDAMA (Food and Drug Administration Modernization Act  
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Incentives for creating PEDIATRIC clinical studies   FDAMA; also regulates pharmacy coumpounding  
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Designed to stimulate additional research into pediatric data for pharmaceuticals   Best pharmaceuticals for children act  
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FDA requires research on certain drugs before licensing;ex:Pediatric studies prior to marketing   Pediatrics Research Equity Act  
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Gives FDA more authority to remove unsafe dietary supplements (DS) and OTC products   Dietary Supplement and nonprescription drug protection act; also requires manufacturer to submit reports of serious adverse effects  
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Examples of individually identifiable health info   Name, address, ss#, or a combo of things: zip code +DOB+unusual diagnosis  
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Organizations privy to patient PHI   covered entities  
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Covered entities:   health plans, clearing houses(billing etc), electronic transmission by health care provider  
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Enforces HIPPA   Office of Civil Rights; civil penalties 25k,criminal penalties 50k, intent to sell 250k and prison  
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CSA   Controlled Substance Act; enforces by DEA (agency of US dept of Justice)  
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Goal of this act is to trace controlled substances and prevent diversion   CSA  
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Controlled drugs/ scheduled drugs:   Potential for addiction and abuse  
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Narcotic controlled substance is defined as?   Natural or synthetic opium or opiate and any derivative, poppy straw, coca leaves, cocaine; narcotic CS and CS are regulated same way  
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Who has the authority to place a schedule on a drug?   US attorney general  
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Used in research; high potential for abuse; no current accepted medical use   C I (Schedule I)  
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Manufacturers and distributors register with the DEA how often?   Annually  
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Dispensers (doctors and pharmacies) are required to register with the DEA how often?   Determined by AG; 1-3 years. nevada is 2 years  
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Dispense:   to deliver a controlled substance to the ultimate user (patient)  
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Inventory of CII is required how often?   perpetual; actual physical count  
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inventory of CS's is done how?   initial and then every 2 years; doesn't need to be submitted to DEA but needs to be kept in records  
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Estimation can be made of CS inventory if?   opened bottle holds less than 1000 units; must be counted if bottle holds more than 1,000 units  
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Disposal of CS   DEA Form 41; DEA will instruct registrant how to dispose; transfer, deliver to DEA, destroy in presence of DEA, other DEA authorized means  
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If DEA allows, pharmacies can destroy outdated, damaged, unwanted CS; witnesses to destruction can be?   pharmacist, licensed physician, midlevel practitioner, nurse or state/ local law enforcement  
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New pharmacy initially registers to order CS with which form?   DEA form 224  
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DEA form 222   CI CII drugs, triplicate, serial #, states which schedules registrant is allowed to handle  
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Ordering CS   CI and CII- DEA 222; CIII-V- invoice or packing slip with drug name, dosage and strength, number of units/containers; supplier info  
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Form 222 copies   pharmacy keeps copy 3; forward copy 1 & 2 to supplier; supplier sends copy 2 to DEA; valid for 60 days  
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POA   power of attorney designated by person who signed DEA registration; can sign 222 on behalf of the signer (requires 2 witnesses)  
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Pharmacist needs to mark if something not received or can face huge fine   no answer  
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Can still use form 222 if minor error   misspelled drug name, no date, package size (if only 1 package size available), strength (if only 1 strength). Supplier cannot fill in "last line completed"  
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Electronic ordering of CI-CV is allowed if?   Digital certificate  
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CII must be hand written; III-V can be verbal or written   State law more detailed  
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Oral Emergency CII prescription   limited to unspecified period;must have written script from prescriber within 7 days or report dr. to DEA. Check State law  
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Fax requirements   III-V is original as fax  
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CII can be a faxed "original" under what conditions?   compounded for direct admin, LTCF, hospice  
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State Board determines if electronic prescribing is allowed   not allowed for CII  
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Labeling requirements for CII-V   date of dispense, pharmacy name/ address (phone not req), script #,patient/physician name, directions for use, cautionary statements  
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Partial filling: must be able to supply full amount within 72 hours or do what?   notify prescriber, write on script how many were dispensedno further quantity may be supplied w/o a new script  
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partial filling of CII for LTCF patient; script is good for how mong?   60 days form date of issue  
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No refills allowed for CII   no expiration under Federal Law p.61  
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CIII-IV expires?   6 months, no more than 5 refills  
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CV expires?   12 months, can prescribe as needed for refills  
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Multiple CII rx issued if?   not more than 90 day supply; if 3 separate scripts are written for 30 days each, they must have instructions on fill dates  
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CII-CV must be stored where in a pharmacy? In Dr. office?   pharmacy- locked cabinet or mixed in with other meds to deter theft. Dr office must have them in a locket cabinet  
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CII cannot be transferred; no refills   CIII-CV can be transferred 1 time  
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Can a CS be mailed? Which classes?   Any CS can be mailed as long as the package doesnt state whats in it  
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Can CS's be delivered or shipped out of country?   Not without DEA "exporter" registration and export permit  
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OTC ephedrine etc is limited to how much?   3.6 g/ day or 9 g/ month; less if mail order  
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