NECSI Prescription Form
Treating medical conditions is a complex procedure that involves an array of people with varying areas of expertise. To effectively coordinate the actions of these individuals without confusion, clear channels of communication are essential. With this in mind, NECSI is collaborating on a new prescription form with which we aim to improve communication in the healthcare community and help reduce medical errors.
Truncated unnecessary text, re-arranged elements to make more efficient use of space, reduced refill numbers. (08/16/2010)
Added brief introductory note, increased spacing in patient-identification area, removed "Patient Initials" field, added "Form of Medication" field, renamed "Sig" field to "Instructions (Sig)," made redundant information for instructions conditional, removed redundant refill information, updated form instructions. (06/11/2009)
Added Instructions and an example of a completed form, adjusted length of lines, moved "Medication" and "Dosage" fields to the same line, added an "Sig" field with redundant "Instructions" fields, added redundant field for refill information, moved "Current Date" field to lower portion of form, adjusted positions of various other fields. (06/08/2009)
Dr. Mark Smith, Chair, Emergency Medicine
Department of Emergency Medicine
Washington Hospital Center
110 Irving Street, NW
Suite NA 1177
Washington DC 20010
Dr. Amnon Wachman
1101 Beacon St.
Brookline, MA 02436
Stefan Topolski, MD
Assistant Professor, U. of Massachusetts School of Medicine
Chief Instructor, U. of New England
Founder and Director
Caring in the Community, Inc.
1105 Mohawk Trail
Shelburne Falls, MA