Rx E-Log
TM
Evaluate Our Full Version Program For 30 Days
Call Medi-Ez, Inc. For Details
815-838-8885
Pharmacy Picks Payor
Touch Pen Here
For Additional Payors
Print Patient’s Name
Previous Patient-> Will Not Require A Privacy Policy
Tap Electronic Pen To Initial
Of Last Name
Print Prescription Numbers
Touch Pen Here
To Add Additional Prescriptions
Additional Screens For More
Prescription Numbers
A Third Screen Is Available If Necessary
Touch Pen Here
For Additional Payors
Ask Patient About Counseling
and Easy Off Caps
Patient Signs For
Prescriptions
Ask Patient If They Have
Received Your Privacy Policy
Touch Pen Here If Patient
Has Previously Received Privacy Policy
Pharmacy Picks Payor
Print Patient’s Name
New Patient-> Will Require A Privacy Policy
Tap Electronic Pen To Initial
Of Last Name
Necessary To Sort Reports By Last Name
Print Prescription Numbers
Ask Patient About Counseling
and Easy Off Caps
Patient Signs For
Prescriptions
Ask Patient If They Have
Received Your Privacy Policy
Touch Pen Here If This Is a New Patient
Who Has Not Received Privacy Policy
Patient Acknowledges
Receiving Your Privacy Policy
Touch Pen Here If Patient Refuses To Sign
For Privacy Policy Only. Must
Obtain DOB/PIN
This Is Required To Retrieve Signature At A Later Time
This Can Be
The Last Four
Digits Of SS #
Signature Pad Recycles
Waiting For New Input
Document Pseudoephedrine
and Controlled C-V
Print Medication
Print Medication Quantity
Tap Electronic Pen To Initial
Of Last Name
Necessary To Sort Reports By Last Name
Print Patient’s Name
Print Patient’s Address
Print Patient’s Birth Date
Pharmacist Signature
Signature Pad Waiting For
New Input
Print
Report
Hipaa Sig.
3 Sets Of
Rx
Numbers
Report Includes All Payors/Hipaa
Single
Payor
Report
All
Payors
“AARP”
Report Includes Payor/Hipaa
for a Single Payor
Hipaa Signature Only
Hipaa Signature
Verification Report
Date Report Printed
Date Of Acquired
Signature
Individual Hipaa
Acknowledgement
Date Patient Signed
For Prescriptions
Payor Acknowledgement For
All Payors
Single Payor
Report
All Payors
“AARP”
Payor Acknowledgement For A
Payor Acknowledgement
Single Payor For
A Single Payor
Pseudoephedrine/Controlled
C-V Report
Rx E-Log
TM
**Pharmacist in Charge must check with
all Federal and State regulations and 3rd
Party Payors as to acceptance of
Electronic Signatures and acceptable
verbiage. 3rd Party verbiage is available
upon request.**