The use of H572M controlled drug prescription forms is restricted to prescribing methadone for patients under the authority conferred by Section 24(2) (d) Misuse of Drugs Act 1975 (i.e. where BOPAS has authorised a prescriber for a specific patient). The form is not used for prescribing of methadone to other patients in other circumstances (e.g. pain relief for a non-BOPAS client); in these cases the general H572 controlled drug prescription is used.
H572 Prescription example:
1. Date prescription written to be no more than 7 days from prescription starting date (point 5).
2. Name and current residential address of patient. It is not acceptable to use the pharmacy address as the patient address.
3. Patient's NHI number.
4. Written dose, in numeric and word form e.g. 80 (eighty) mg. Note, if a patient is undertaking any type of withdrawal from methadone, then the new prescription should state the current dose as the starting dose. The script should then be annotated "adjust for reduction" to allow pharmacist to adjust the starting dose. Annotate with formulation of methadone to be used - BOPAS authorises 5mg/ml (consider isomg a stamp to pre-populate scripts). (2mg/ml can be used in doses under 20mg).
5. Start date (actual date pharmacist is to begin dispensing). Check that the commencement date is a consumption day.
6. Total period of supply up to a maximum of 30 days, however a 28 day cycle is routine to ensure ease of keeping to a regular cycle.
7. Maximum rate of any withdrawal regimen (if any) is specified. eg. Reduce 1mg/week at request.
8. Days for which takeaways are authorised. For example, 'Tuesday, Wednesday, Friday, Saturday and Sunday' for a patient on twice weekly dispensing who collects and consumes doses on Mondays and Thursdays.
9. Name of pharmacy.
10. Prescriber's signature.
11. Prescriber's stamp or print NZMC Reg. No., doctor name and address. Each copy must be stamped.
12. Top three copies to pharmacy (via patient or post). Note: Bottom copy (blue) to be kept on patient file; please do not send to the pharmacy.
These CD pads are requested 3-6 monthly by GPs based on their current number of authorised patients.
Orders are faxed to the Ministry of Health using the approved order form (refer to Forms section). On receipt of the pads, sign the enclosed verification of delivery form and fax to the Ministry of Health as soon as possible.
Ministry of Health contacts:
MedSafe Office - ph. 09 441-3670
These CD pads must be stored in a secure place as for other CD prescription pads. You are advised to keep the receipt for the pads as a record of the prescription pad numbers.
Theft of prescription forms:
If the prescription numbers are known, inform the Ministry of Health MedSafe office. If the prescription numbers are unknown, inform the Ministry of Health and request the prescription numbers of the pads recently sent to the practice. Inform the MOH MedSafe office of the numbers.
Ceasing to prescribe:
Notify the Ministry of Health that you no longer require these pads.
Receipt of excess pads:
Notify the Ministry of Health that you no longer require these pads. Destroy or return any unused pads to the Ministry of Health
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