COUNTRY
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OFFICIAL
PRESCRIPTION FORM
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WHICH DATA ARE REQUESTED ON THE PRESCRIPTION
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HOW PRESCRIPTION
IS PROTECTED AGAINST FRAUD
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IS THERE A DIFFERENT PRESCRIPTION FORM FOR MEDICINES THAT ARE NOT REIMBURSED - COULD YOU PROVIDE A SPECIMEN
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IS IT LEGALLY PERMITTED TO DISPENSE A MEDICINE ON THE PRESCRIPTION
FROM OTHER COUNTRY
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COMMENTS/
OTHER INFORMATION
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AUSTRIA
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[See Attachment 1]
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Form for reimbursed Rx medicines
Includes Social Insurance Number of Patient; Adress; information on medicine; if submitted the sick funds bears the costs excl. a co-payment
Forms for narcotics has 3 parts:
Parts I and II are kept by the pharamcy; Part III is kept by prescribing doctor;
In addition to above information the form has to include:
Year of birth of patient, detailed and exact indication of amount of narcotic, pack size , number of packs, own signature of prescribing doctor (first & last name)
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Forms for controlled medicines narcotics): lower part: background is grey
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It is possible to dispense medicines upon presentation of a prescription from from a foreing country with the exception of narcotics;
Information: 43 1 11 0046 53
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BELGIUM
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Only for medicines that are reimbursed by social security
[See Attachment 2.1]
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[See Attachment 2.2]
Data requested on the prescription by public health laws:
- name and address of the prescriber
- authorization number of the prescriber by the social security
- name and firstname of the patient, dosage, and, if necessary, indication that the patient is a child of a baby
- date of prescription
- hand written signature of the prescriber
Data requested on the prescription by social security laws.
 La prescription de médicaments doit (arrêté royal du 8 juin 1994) :
  être imprimée sur papier blanc;
mesurer 10,5 cm sur
20 cm;
contenir les données suivantes sur le médecin prescripteur:
- son code INAMI en chiffres et code-barre (1);
- son nom et son prénom (2).
 Elle est valide pour l'intervention de l'assurance maladie-invalidité jusqu'à la fin du troisième mois calendrier
qui suit :
soit la date de prescription (6);
soit la date à laquelle le médecin souhaite que la prescription soit délivrée si cette inscription est reprise (7).
Le médecin prescripteur doit :
mentionner en toutes lettres le nom et le prénom du patient (3);
inscrire le détail des produits prescrits (4).
Les dispositions relatives à la prescription des médicaments émanent du Ministère de la Santé publique et, en ce qui concerne l'intervention de l'assurance obligatoire, doivent répondre aux conditions reprises dans l'arrêté royal du 21 décembre 2001.
apposer son cachet avec nom, prénom et adresse(5);
dater et signer de sa propre main (6).
Le médecin a la possibilité de mentionner éventuellement une date ultérieure à laquelle la prescription doit être utilisée (7).
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Bar code, autorisation number social security
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YES, free paper with data requested by public health law
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YES, if the prescription comes from an other EU country
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Information:
32 2 227 55 25
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CZECH REPUBLIC
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Information:
42 2 721 858 60
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CZECH REPUBLIC
CONT.
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There is no official prescription form except for the prescription form for narcotic and psychotropic medicines
[See Attachment 3.1]
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Attachment 3.2 is an example of the common prescription form
Prescription form has an identification number.
The prescription form should contain:
Name and surname of patient
Number of assured person
Patient’s address of residence
Proprietary name of the medicine
Dosage form
Strength
Number of prescribed packages
Route of administration and posology
Price of the medicine
Signature of the doctor
Stamp of the doctor with the telephone number
Stamp of the institution where the doctor works
Date of prescription
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identification number
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NO
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NO
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/
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FINLAND
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[See Attachment 4]
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Information:
358 947 334 202
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FRANCE
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Official prescription form: requested on the basis of french Health Act (Code Sante Publique), the name and professional qualification and adress of prescribing doctor, signature and the date of prescription,name and posology of the medicines, instructions how to use the medicine,duration of the treatment, number of package units, If applicable the number of the renewals of the prescription, -first and last name of the patient, gender, age, if necessary weight and height
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Only rx forms for narcotics must be prescribed on a secured prescription, the specifications of the secured form are laid down in a french decree (legal provisions)
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No different forms
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Information:
33 1 55 87 32 84
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GERMANY
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[See attachment 6]
In Germany, there are different types of official prescription forms. The most common one is the pink one attached below, which is for the statutory health insurance.
For private health insurances, there is a similar blue form, but doctor´s may perscribe also on non-standardised forms.
For narcotics, there is a yellow form equal to the pink one, but with three copies for documentation (one for the health insurance, one for the pharmacy, one for the prescriber). They have numbers and are controlled by a central authority, the Bundesopiumstelle, that does as well provide doctors with the forms.
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Information given by the doctor:
- prescribing doctor (doctor´s assurance cipher, Date of prescription) Name and signature of the doctor, stamp of the doctor with the telephone number and adress or stamp of the institution where the doctor works
- patient (name and surname; month and year of the birth; sex, address of residence, patient´s assurance number, co-payment status of the patient)
- assurance (name and cipher of the assurance)
- Information on prescribed medicine
Proprietary name / Name of active ingredient
Dosage form
Strength
Package Size
Number of prescribed packages
Information given by the pharmacist:
Number of pharmacy ( à leading to Name of pharmacist and pharmacy incl. adress)
signature of pharmacist
date of dispensing
number, size and price of medicinal products + co-payment
central number of pharmaceutical products
any amendments of the prescription
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Prescriptions only given to doctors; Prescriptions for narcotics with numbers that refer to the prescriber
Prescriptions forms of insurances belonging to the association of national sick funds are difficult to falsify, wherever “individual – provate” prescriptions are less protected against falsification.
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YES, green form; however, form is not official (provided by pharmacists´ association for marketing reasons); as well other forms may be used (e.g. with addition “not reimbursable”)
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YES, except narcotic and psychotropic medicines; if the pharmacist has any doubts, he is to dispense only after problem is solved
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German pharmacies dispense medicines upon presentation of froeign prescriptions.
Medicines are only dispensed once per prescription. No renewals of prescriptions admitted. This holds true also for prescriptions from other Countries where renewals might be permitted.
Information:
49 22 820 758 32
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HUNGARY
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[See Attachement 7]
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Doctor’s name
Address of doctor’s workplace/clinic/surgery
Phone number of surgery
Date
Patient’s name, address, birth date and Social Insurance Identification number
Proprietary name
Dosage form
Strength
Number of prescribed package
Regardion to the dosage, use and frequency of use concrete direction
Signature of the doctor
Stamp of the doctor
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“National Health Insurance Fund” phrase hides in the prescription
watermark
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There are no different forms
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Yes, except psychotropic and narcotic medicines
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Information:
36 13 17 14 88
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ITALY
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[See Attachment 8 for reimbursed drugs]
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Names (patient, physician); date; prescription. For reimbursed drugs (see image), also addresses and codes for patient and physician are requested.
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Reimbursed Drugs: bar code, identification number
Non Reimbursed Drugs: Identification of physician (name and address)
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Reimbursed drugs – see image; non reimbursed drugs can be prescribed on the physician’s registered paper.
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Not the narcotic and psychotropic medicines
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Information:
39 659 943 763
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LATVIA
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[See Attachment 9.1 and 9.2 for differentiated payment]
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Latvia (according to the legislation acts).
The prescription form has identification number and index number. The preamble should include code, name, address, phone No. of the medical institution or address, phone No. of the prescribing doctor.
Prescriptions should include the following information:
Administrative part of prescription (Inscriptio) should contain:
- date of the prescription,
- patient’s name and surname, identification code, address of residence,
- cipher of diagnosis - Dg. (in special prescription forms and prescription forms for differenciated payment),
- prescriber’s name, surname, the occupation and identification code,
- prescription for children – children’s age is mandatory.
Information on the prescribed medicine should contain:
- the name, dosage and pharmaceutical form,
- the amount to be issued,
- instructions for pharmacy,
- instructions for patient (route of administration and posology),
- payment: part of patient and part of the assurance company (in special prescription forms and prescription forms for differenciated payment),
- signature of the doctor,
- stamp of the doctor or of the institution,
- expire date of the prescription,
- signature and stamp of the pharmacist,
- date of dispension from pharmacy.
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Information:
371 707 84 11
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LATVIA
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[See Attachments 9.1, 9.2, 9.3]
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code, identification number, color of the blank
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YES
[See Attachment 9.1]
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YES, except narcotic and psychotropic medicines
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Different prescription forms
[See Attachments 9.1, 9.2, 9.3]
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PORTUGAL
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Will be completed
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SLOVENIA
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[See Attachment 11.1]
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[See Attachment 11.2]
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bar code, identification number
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YES
[See Attachment 11.3]
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YES, except narcotic and psychotropic medicines
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Information:
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SPAIN
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Prescribers name and surname, address, official identification number or qualification.
Patient name and surname, birth date, medicine name under DCI or under brand name, pharmaceutical form, administration route and dose per unit if applicable, pack size, number of packs, dose, units per dose and day and duration of treatment, place, date and signature.
Instructions for the pharmacist and/or the patient if applicable.
There is a different prescription form for long duration treatments.
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Prescription forms from Health Services are identified by number and bar code.
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YES, the white prescription form to differentiate from green prescription form (common), red (pensioners) or blue (professional disease).
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NO
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SWEDEN
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[See Attachments 13.1, 13.2, 13.3, 13.4, 13.5]
Yes, three different forms. One for regular drugs, one for drugs with a high risk of prescription forgery (e.g. narcotic or psychotropic drugs, growth hormone etc) and one for animals.
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- Patient name, address and birth date
- Prescriber's name, profession, address, phone number, identification number as a bar code (required if prescribing a narcotic or psychotropic drug), bar code identifying prescribers workplace (required for reimbursement), prescribers signature.
- Drug products name (generic prescribing is not allowed), strength, dosage form, amount/treatment time and number of iterations, dosage information and intended use.
- Information about whether reimbursement requirements are met and date of prescription.
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- Official prescription form must be used (yellow paper with green print).
- The prescription form required for drugs with a high risk of prescription forgery is numbered and has a special paper quality so that it should not be possible to change the prescription without it showing.
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NO
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YES, prescriptions from other EU/EEA countries can be dispensed once in Sweden if certain requirements are met (e.g. the drug must be approved in both countries, limitations regarding narcotic or psychotropic drugs).
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Information:
468 466 14 77
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SWITZERLAND
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Information:
41 31 322 05 72
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SWITZERLAND
CONT.
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For narcotic and psychotropic prescriptions
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CH- prescribing doctor (title, name, address)
registered number of the doctor (on narcotic and psychotropic prescriptions)
patient (name, surname, date of birth, sex)
prescribed medicines:
proprietary name of drugs or INN of active substances (possibility for using of generics)
strength,
dosage form,
number of prescribed packages (original packages)
daily doses
art of prescription (repeatable or non-repeatable)
date of prescription
signature of doctor
stamp of doctor
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Identification number of narcotic and psychotropic prescription forms
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Without a special authorisation of agency of therapeutic products it will be not legal
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UNITED KINGDOM
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[See Attachments 15.1 and 15.2]
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Date
Name & address of patient
Age if under 12
Name of drug, quantity and dose (additional information for controlled drugs)
Prescriber’s name, signature and address
Indication of whether prescriber is doctor, dentist, vetinary surgeon, nurse, pharmacist etc.
Must be in ink or otherwise indelible
(Nb. Work under way to introduce electronic transfer of prescriptions to pharmacies, with e-signatures
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Numbered pads stamped with name & address of doctor
Patient signs declaration on back of form, checks made from time to time by counter-fraud service.
Data on all dispensed prescriptions are monitored locally by health authorities and nationally by the Prescription Pricing Authority for unusual patterns of prescribing.
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NO, very few medicines are non-reimbursable in England. These may be prescribed privately, when the patient pays the full cost plus pharmacy fees. There is no standard form for this purpose.
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A prescription from another country may not be dispensed with re-imbursement from the National Health Service (NHS). An NHS doctor may prescribe for EU citizens when the prescription would be dispensed in the normal way.
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Information:
44 20 70 84 25 23
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