Data Definition Tool - Prescription Renewal
Instructions: Indicate "y" (yes), "N" (No), "A" (Not applicable) for each question below.
Standard
1 I certify that my clinic had no prescription renewals
processed for this reporting period.
2 VUNET ID of RN/LPN being audited.
4 Medical Record Number of prescription being traced.
Was the medication specifically eligible for renewal
on a clinic protocol?
6 Were the standard renewal protocol criteria met?
YES
Submit audit.
3 Date of prescription renewal.
5
Location
CMS 482.23 (c) (2)
CMS 482.23 (c) (2)
7 Were the category specific Criteria for Renewal met as CMS 482.23 (c) (2)
specified by the clinic protocol. (i.e., lab tests, recent
visit status, etc.)?
MyVandy Report
numbers 1443 and
1524
MyVandy Report
numbers 1443 and
1524
MyVandy Report
numbers 1443 and
1524
RxStar - Renewal
Protocol
RxStar - Renewal
Protocol
RxStar - Renewal
Protocol and patient
EMR
Medication is
documented in
protocol as eligible
for renewal.
Letters A through F
on protocol were
met.
Criteria specific for
medication category
were met or no
specific criteria were
specified for this
category of
medication.
8 Was the prescription a valid renewal identical to a
previous prescription in DRUG?
CMS 482.23 (c) (2)
Review Medication
Log in EMR
Identical to a
previous prescription
in drug, dose, route,
schedule and
quantity, issued
pursuant to the
expiration of the
previous prescription
9 Was the prescription a valid renewal identical to a
previous prescription in DOSE?
CMS 482.23 (c) (2)
Review Medication
Log in EMR
Identical to a
previous prescription
in drug, dose, route,
schedule and
quantity, issued
pursuant to the
expiration of the
previous prescription
10 Was the prescription a valid renewal identical to a
previous prescription in ROUTE
CMS 482.23 (c) (2)
Review Medication
Log in EMR
Identical to a
previous prescription
in drug, dose, route,
schedule and
quantity, issued
pursuant to the
expiration of the
previous prescription
11 Was the prescription a valid renewal identical to a
previous prescription in FREQUENCY?
CMS 482.23 (c) (2)
Review Medication
Log in EMR
Identical to a
previous prescription
in drug, dose, route,
schedule and
quantity, issued
pursuant to the
expiration of the
previous prescription
12 Was the prescription a valid renewal identical to a
previous prescription in QUANTITY?
CMS 482.23 (c) (2)
Review Medication
Log in EMR
Identical to a
previous prescription
in drug, dose, route,
schedule and
quantity, issued
pursuant to the
expiration of the
previous prescription
13 Was the prescription a valid renewal identical to a
previous prescription in PRESCRIBER?
CMS 482.23 (c) (2)
Review Medication
Log in EMR
Identical to a
previous prescription
in drug, dose, route,
schedule and
quantity, issued
pursuant to the
expiration of the
previous prescription
No
Complete the enitre
audit.
Medication is not
listed in protocol as
eligible for renewal.
Controlled
substances are
present.
One or more of letters
A through F were not
met.
Specific criteria for
medication category
was not met.
Not Identical to a
previous prescription
and not pursuant to
the expiration of the
previous prescription
Not Identical to a
previous prescription
and not pursuant to
the expiration of the
previous prescription
Not Identical to a
previous prescription
and not pursuant to
the expiration of the
previous prescription
Not Identical to a
previous prescription
and not pursuant to
the expiration of the
previous prescription
Not Identical to a
previous prescription
and not pursuant to
the expiration of the
previous prescription
Not Identical to a
previous prescription
and not pursuant to
the expiration of the
previous prescription