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How to Create a New Prescription – Send Immediately

To prescribe a medication we first need to have our client’s chart open within SmartCare and then we need to go to the CalMHSA Rx transition page.

  1. Have your client’s chart open in SmartCare.
  2. Search for CalMHSA Rx and then Select CalMHSA Rx.
  1. You will land on CalMHSA Rx transition screen. Select Client Summary. 

NOTE: You could have selected any one of the three icons at the top, Client Summary, Pharmacy Messages, and Prescription Summary, and been taken to a page where you could start a new prescription.  Selecting Client Summary takes you to the Patient/Client Info screen within CalMHSA Rx which has the most information about the client.

You should land at the Patient/Client Info screen.

    1. At the top of the Client Info screen, you will see your clients name and some demographic information along with the Create NewRx

Locations and Pharmacies

Before we begin, we need to make sure our Locations is correct and that our client has a Pharmacy set.

Locations

Before starting the process of creating a new prescription, you will want to make sure you have set the correct location/program.  If you start the prescription and then go back to change the location it will wipe out your current progress and make you start over.

  1. Locations can be found at the top right of your screen. The list for you will be set by your system administrator. Select dropdown for Location.
  2. Choose Location from the list if required.

Pharmacies

You will want to verify that the client has a pharmacy listed or choose one from the drop down.  If there isn’t one listed, you can search and select one for your client.

  1. Select drop down to choose pharmacy.
  2. If client has no pharmacy, Select magnifying glass and search for the pharmacy.
  3. All Lists should be selected.
  4. Retail is selected by default.
  5. Select EPCS enabled if requiring pharmacy to handle controlled substances.
  6. Choose State, California entered for example.
  7. Enter Zip Code, zip code entered for example.
  8. Select Search. A list of pharmacies should populate. Select the one you desire, and it should take you back to the screen and populate the pharmacy field. 

In this example I searched using state and zip codes fields.  You can choose the ones you want to narrow it down more.

How to Create a New Prescription to Be Sent: Manually

  1. Select Create New Rx
  1. Enter the first several letters of the drug you wish to prescribe in the search field. The results will begin to auto-populate.  In our example, we entered lith, for lithium carbonate capsule.
  2. Select desired medication. In our example, lithium carbonate capsule.
  1. The next window will show you the strengths for the selected medication. Select desired strength.  In our example, 600mg.

This will bring you to the Prescription Medication widget.  This is where you will complete the sig for this medication.

Prescription Medication Widget

  1. Patient Observation – Shows fields for client’s height and weight. This section contains data fields for Height (ln & cm) and Weight (Lb and Kg). However, this data is not pulled from SmartCare and hence, needs to be entered manually. Please make sure that accurate data is filled and current Height and Weight of Client is documented in these fields.
  2. Drug Sig details –Section shows current drug being prescribed. Here you will add patient directions, add additional direction to patient (free text), and view
  3. Pharmacy – Section shows pharmacy receiving prescription. There is the option to choose another from the drop down.  You can also split the prescription to another pharmacy.  You can adjust refills, substitution allowances, and do not fill before dates.
  4. Primary Diagnosis – Primary diagnosis can be chosen from the drop down. These diagnoses should pull from Smartcare.
  5. Provider ­– If you are the prescriber your name should automatically be set. If you are queuing a medication or prescribing on behalf of another prescriber, you can choose their name from the drop down.  Being able to send a medication on behalf of another prescriber will require specific “Provider Agent” rights.  Office Use Only allows for comments to be left which will only be seen internally.
  6. Review/Cancel ­– If the prescription is set your next step is to Select Review, otherwise if you want to just stop this process Select Cancel.

Filling in Sig Details – Continuing Manual Prescription

  1. Patient Observation – Confirm height and weight are entered. These values are not pulling in from SmartCare. Please add them here to complete the prescription, but they won’t push back to SmartCare. You will need to go back into the client’s chart in SmartCare to enter this information.
  1. Drug – confirm the drug and strength are as desired. If you want to change the strength select the dropdown.
  2. Select Alerts – selecting this will show you the alerts generated for the drug you are prescribing in relation to the clients documented allergies, other prescribed medications, and other factors.
  3. Select the dropdowns of each field to show the list of choices for Action, Dose, Unit, Route, Frequency, and Other. Enter the days’ supply for the medication.
  4. Select Add to begin if you are creating a complex drug order such as a titration.
  5. Enter Additional Directions To Patient – this is a free text field that allows you to enter more directions to the client. Be aware there is no character limit but if you exceed 140 characters the prescription will automatically be sent by fax. It will not be transmitted electronically.
  1. Provider and Office Use Only – If you are the prescriber your name should be displayed. If you are prescribing on behalf of another prescriber, you can select the dropdown to choose that prescriber.  Further permissions may need to be granted for this to occur. Enter notes in Office Use Only if desired.
  1. Confirm Pharmacy or choose a new one from the dropdown. You can also split the order if you desire.
  2. Verify Days Supply and
  3. Enter Refills if there are to be any.
  4. Chose Substitution permitted or Dispense as written.
  5. Enter Do Not Fill Before date if desired.
  6. Add Additional Notes To Pharmacist if there are to be any.
  7. Select Primary Diagnosis from the dropdown if one is necessary.
  8. At this point, you can Select Review to proceed to the next screen to save and queue the order or prescribe immediately, or you can Select Cancel if you want to withdraw from the prescription.

In case the prescriber wants to calculate the dose of medication before prescribing medication (e.g. in instances of pediatric medications or patients suffering from hepatic/renal failure), it can be done in two ways

  1.  Using the Height and Weight, manual calculations can be done outside the system.
  2. Use the ‘Dose Calculator’ indicated by an icon next to Patient Directions (As shown below).

Clicking on the ‘Dose Calculator’ icon will result in a pop up window where the following data needs to be entered in the fields provided

  1.  Patient Weight
  2. Drug Amount/Unit
  3. Guideline
  4. Desired Dose Frequency
  5. Desired Units


When all the above data fields are completed, the result is displayed in the bottom of ‘Dose Calculator’ window (as shown below) and this can be applied to Rx, as appropriate.

Review Prescription

Selecting Review will send us to a new screen to review the medication and acknowledge any alerts.  The alert window will pop up on the right side of the screen.  Depending on county requirements, you may be required to acknowledge alerts by selecting or typing in a reason. Select a reason from the drop down or free text your own reason.
  1. For this example, we Selected ‘Select or enter your own below’.
  2. For this example, we Selected ‘Patient requires this medication, provider aware of interaction.
  3. For this example, we Selected ‘Acknowledge Alerts.’
After acknowledging alerts, we are taken to the final Review screen to sign off on our prescription and in our example, send the prescription.
  1. Verify client information, drug information, provider information, and pharmacy information.
  2. Select Favorite icon (star) if this is a prescription you will enter often and would like to make it a favorite so that it can be selected from our favorites list and prescribed much easier and quicker in the future.
  3. Select Send. This is an immediate action that will send the prescription to the pharmacy. Some organizations require a signature password before sending a prescription. If the Signature Password field is visible, then it is required.  If it is not there, then it isn’t required, and you can just select send.
 

At this point, the prescription has been completed and sent. At the end, we could have chosen different options. 

  • Another immediate action we could have chosen was Send & Print. This would have sent the prescription to the pharmacy and allowed us to print the script to a chosen printer.
  • Save Pending Rx would have queued the prescription for us to later sign and send.
  • Save and Add Rx would have allowed us to queue the medication and open a new Create Rx Screen.
  • Print don’t Send would have allowed us to print the prescription to a local printer and not send it.
  • Sign don’t Send would have allowed us to sign off on the prescription and queue it to be sent later.

Checking on the Status of the New Order

To check on the status of the order you can do the following.
  1. Go to the top of the screen and Select Prescription Summary.
  1. Narrow down list of medications. Select dropdown for Status and Select Completed.  You also could have selected All but you would have had more orders to search through.
  2. Select the Prescription for which the status you want to see.
  1. A new window will pop open. Go to bottom left of screen to see Transmission History for the details of the transaction.
  2. Select Close when done.
If the prescription was undeliverable, you would eventually see an alert/message of this event appear at the top right of your screen at the Bell Icon.  You would see a red circle with a number in the middle.
  1. Select the Bell Icon.
  2. If there was an undeliverable alert it would show for Rx Sent Undeliverable. You would select that link and it would take you to a page to view the undeliverable prescription.

Selecting Favorite Icon

If we had selected the Favorite Icon it would have opened a popup window giving us the details of the prescription and asking us to modify it or save it in our favorites list.