It is the prescriber’s responsibility to ensure ordered forms meet the requirements established in California Health & Safety Code sections 11162.1 The prescription forms must be printed with the following features:
(1) A latent, repetitive “void” pattern is printed across the entire front of the prescription form; 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 printed on the backside of the form; 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 shall be printed 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 (for example, “ml”).
(8) A statement printed on the bottom of the prescription form that the “Prescription is void if the number of drugs prescribed is not noted.”
(9) The preprinted name, category of licensure, license number, DEA registration number, and address of the prescribing practitioner.
(10) Checkboxes are printed on the form so that the prescriber may indicate the number of refills ordered.
(11) A line or space for the prescriber to write 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 uniquely serialized number, in a manner prescribed by the Department of Justice.
Each batch of controlled substance prescription forms shall have the lot number printed on the form and each form within that batch shall be numbered sequentially beginning with the numeral one. Licensed healthcare facilities or clinics with 25 or more prescribers have additional requirements with regard to prescription forms. Refer to the applicable Health & Safety Code section.