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Rx Pad Guidelines

MEMORANDUM OF AGREEMENT BETWEEN THE FLORIDA DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE
AND
Eagle Creek Printing, Inc.

THIS AGREEMENT is entered into between the Florida Department of Health, Division of Medical Quality Assurance (“the department”), with principal offices as 4052 Bald Cypress Way, BIN BCO-01, Tallahassee, Florida, 32399-3260 and Eagle Creek Printing, Inc. (“the vendor”). This agreement with a non-governmental entity does not involve monetary expenditure or compensation to the entity for services performed. This agreement is in effective on the date it is signed by both parties and is valid through June 30, 2013. The agreement can be renewed by mutual consent.

I. PURPOSE: The purpose of this agreement is to ensure the quality and security of counterfeit-proof prescription pads provided by the vendor and approved by the department for use by authorized prescribers for the prescribing of controlled substances. The vendor agrees to produce counterfeit-proof prescription pads that meet the minimum specifications listed below:

  1. Present a professional format and design. They may be produced in varying sizes and styles and may contain appropriate advertising on the inside front cover and on alternate sheets within the pad. Advertisements shall be restricted to medically related topics and must be professional in nature. No advertisement may appear
    on the actual prescription blank.
  2. Resist erasures and reproductions. The blank must be printed on watermarked paper and shall be 50# white or other quality approved by the department.
  3. Contain blue or green background ink that resists reproduction. The color must be consistent on every blank and listed on the blank as a security feature.
  4. Display the word “VOID” or “ILLEGAL” if the prescription pad is copied. The language shall not obstruct or render illegible any portion of the drug name, quantity or direction for use.
  5. Contain the following information:
    1. The preprinted name, address, and category of professional licensure of the prescribing practitioner and;
    2. A space for the prescribing practitioner’s federal Drug Enforcement Administration registration
      number for controlled substances.
  6. List security features and descriptions on the prescription blanks, preferably on the reverse side, to assist dispensing pharmacists in detecting forgeries. Examples of such feature listings are: the blank resist erasures and alterations, the background color must appear blue (if blue) or green (if green), the words VOID (if void) or ILLEGAL (if illegal) will appear when copied. Additional security features beyond those required are encouraged, but must
    be listed on the blank.
  7. Have a unique tracking identification number for each order which is printed on the front of the blank and readily visible. A unique tracking identification number and the name of the authorized prescriber or health-care facility that purchased the prescription blank must be maintained by the vendor and available to the department upon request. The unique tracking identification number must consist of three subsets: (1) a unique alphabetic prefix that readily identifies the vendor, (2) the date of printing, and (3) a batch number. The alpha characters used to identify the vendor will be assigned by the department and must appear first in the tracking identification number in upper case. The date the blank was printed must immediately follow the vendor’s unique alpha identifier and must be presented in six character numerical field using the format YRMODY (for example, June 3, 2011 would be coded as 110603). The batch number assigned by the vendor must immediately follow the print date. From left to right, the tracking identification number must appear as alpha prefix, print date, and then batch number, with no blank spaces between subsets. For example, ABC1106030001.

 

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 Eagle Creek Printing, Inc. | 905 SE Hillcrest Ave. Stuart, Florida 34994

Phone: 772.223.5373 | Fax: 772.223.8993 | www.eaglecreekprinting.com

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