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Are Your Prescription Forms Compliant?

The Medical Board of California (Board) has received inquiries from physicians regarding some pharmacies refusing to fill prescriptions written on non-compliant prescription forms. The Board urges physicians to verify their prescription forms are compliant with state law prior to using the form.

California Health and Safety Code Section 11162.1 requires 15 elements to appear on California Security Prescription Forms, the forms which replaced the triplicate prescription form. State law also requires California Security Prescription Forms to be produced by printers licensed by the California Department of Justice (California Security Prescription Printers Program).

Pursuant to California law, prescription forms for controlled substances must be printed with the following features:

1. A latent, repetitive "void" pattern across the entire front of the prescription blank; if a prescription is scanned or photocopied, the word "void" shall appear in a pattern across the entire front of the prescription.
2. A watermark on the backside of the prescription blank; the watermark shall consist of the words "California Security Prescription."
3. A chemical void protection that prevents alteration by chemical washing.
4. A feature printed in thermochromic ink.
5. An area of opaque writing so that the writing disappears if the prescription is lightened.
6. A description of the security features included on each prescription form.
7. (A) Six quantity check off boxes on the form so that the prescriber may indicate the quantity by checking the applicable box where the following quantities shall appear:
   • 1-24
   • 25-49
   • 50-74
   • 75-100
   • 101-150
   • 151 and over.
   (B) In conjunction with the quantity boxes, a space shall be provided to designate the units referenced in the quantity boxes when the drug is not in tablet or capsule form.
8. Prescription blanks shall contain a statement printed on the bottom of the prescription blank that the "Prescription is void if the number of drugs prescribed is not noted."
9. The preprinted name, category of licensure, license number, federal controlled substance registration number, and address of the prescribing practitioner.
10. Check boxes on the form so that the prescriber may indicate the number of refills ordered.
11. The date of origin of the prescription.
12. A check box indicating the prescriber's order not to substitute.
13. An identifying number assigned to the approved security printer by the Department of Justice.
14. A check box by the name of each prescriber when a prescription form lists multiple prescribers.
15. A unique serialized number.

The DOJ Approved List of Security Prescription Printers is available here.

For additional information on new requirements effective January 1, 2019, view the Board's memorandum on AB 1753 (Low, Chapter 479).

Reporting Requirements for Lost or Stolen Prescription Pads

A physician who suspects that their prescription pads have been lost or stolen should take the following steps immediately:

1. First, the theft or loss must be reported to the local law enforcement (police or sheriff's department). A physician should make an incident report with law enforcement in order to be protected. He or she will then have proof that prescriptions written on that pad after the date the theft was reported were not written by him or her. The physician will need a law enforcement agency report number to proceed to the next step.
2. Next, pursuant to Health and Safety Code section 11165.3, the theft or loss of any tamper-resistant prescription forms must be reported by the physician to the Department of Justice (DOJ) Controlled Substance Utilization Review and Evaluation System (CURES) program no later than three days after the discovery of the theft or loss. A law enforcement agency report number is required when submitting a report of lost or stolen prescription forms to CURES. This notification may be accomplished electronically by logging into the physician's CURES account, or by emailing SecurityPrinter@doj.ca.gov to obtain a report to file with the California Department of Justice; CURES Program; P.O. Box 160447; Sacramento, CA 95816. If you have additional questions or concerns regarding lost or stolen tamper-resistant prescriptions forms, please contact the CURES Program at (916) 210-3216 or email the Security Prescription Printer Program at SecurityPrinter@doj.ca.gov.
3. Next, notify the California State Board of Pharmacy at BOPcomplaint@dca.ca.gov. The Board of Pharmacy has a webpage listing physicians whose prescription pads have been reported stolen: http://www.pharmacy.ca.gov/licensees/stolen_fraudulent_rx_forms.shtml. The webpage is available 24/7 to pharmacists, law enforcement, and the public.
4. Physicians should also notify the Medical Board by an email to complaint@mbc.ca.gov or a letter describing the circumstances and actions taken by the physician in response to the suspected theft. The letter should be written on a physician's professional letterhead, signed, and mailed to the Medical Board of California; Central Complaint Unit; 2005 Evergreen Street, Suite 1200; Sacramento, CA 95815.

For additional information, contact the Medical Board's Central Complaint Unit at (800) 633-2322.