(1) When prescribing controlled substances, a PA, CRNP, or CNM shall use a prescription form which includes all of the following:
- (a) The name, medical practice site address and telephone number of the supervising/collaborating physician.
- (b) The full name of the PA, CRNP, or CNM;
- (c) The medical practice site address and telephone number of the PA, CRNP, or CNM, if different from that of the supervising/collaborating physician;
- (d) The license number of the PA, CRNP, or CNM.
- (e) The words "Product Selection Permitted" printed on one side of the prescription form directly beneath a signature line;
- (f) The words "Dispense as written" printed on one side of the prescription form directly beneath a signature line.
- (g) The date that the prescription is issued to the patient.
- (h) The patient's full name and address.
- (i) The QACSC and LPSP registration numbers of the PA, CRNP, or CNM.
Author: Alabama Board of Medical Examiners
Statutory Authority: Code of Ala. 1975, §§20-2-50, et seq.; 20-2-260; 34-24-53
History: New Rule: Published December 30, 2022; effective February 13, 2023.