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Altered prescriptions by a patient

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So this patient was given a prescription for 2 sinus meds and the pharmacist called to ask if we had written for Tramadol?  We had not.  They faxed the rx back to us and sure enough it had Tramadol added.  The question is what is our responsibility as the clinician to report this patient and to whom?

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This is drug diversion and is illegal. While it can be reported to HHS, or DEA, as well as local law enforcement, I recommend reporting it to local law enforcement. As a former LEO, local agencies have a faster response time to these isolated incidents of fraud. I personally have received calls for this and made an arrest within a day or two. If you suspect repeated offenses or a larger scale involvement, report to state and/or DEA as well.


Per HIPPA and ACA, these reports do not violate patient confidentiality.

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Our local pharmacist was nice enough to call the patient in to "get" the prescription and the police were waiting.

A faxed copy of altered med was sent to me and I had signed off in my real signature that this was fraudulent.

The patient was arrested on site.

Not sure where we sent the certified firing letter - home or jail.................


Also had a patient steal a bunch of carbon forms for "off work" out of an exam room drawer and start writing herself off work.

She was a county employee.

They faxed me the forms and I showed my real signature and dates the patient had been seen in the office.

No longer a county employee....................... Stupid is as stupid does

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Had a pt turn 15 norco into "150" norco one time; called the cops.  As long as you or the pharmacist recognizes it and reports, you're good. 


Yet another reason that I write out the amount (fifteen), circle the number of meds written on the sheet (1, 2, 3)  AND draw a big "X" through any space at the bottom of my prescriptions.


Gotta use the stick on this type of behavior.




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EHR generated printed prescriptions can be useful but have limitations.

Our ingenious program doesn't spell out the quantity in words. Really??? How basic!!

I have yet to figure out how a wet signature on a printed alterable rx is safer than an e-scribed rx for a control that comes from my computer to the pharmacy on a secure line.

Yes, I am sure some idiot can hack that and make it happen. Just seems illogical that a computer rx is not acceptable.


Years ago, we wrote ER weekend narcotics in 12s - the spelled word TWELVE can't be altered to anything else. 


Not sure what drives folks sometimes or drives our society to think that taking all these crappy controlled substances is a substitute for living......

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