Welcome To DrFirst!
Transcription
Welcome To DrFirst!
Welcome To DrFirst! Rcopia E-Prescribing Registration Packet Thank you for choosing Rcopia, the award-winning e-prescribing system from DrFirst! This packet contains all of the registration forms needed to get your practice up and running with Rcopia. Please fill out and fax these forms, as well as a copy of the DEA and WA DOH license for each practitioner to Jack Choi at 206-686-4889. Below you will find definitions for the different roles within Rcopia. Take a moment to familiarize yourself with these roles and their respective functions. You will be asked to assign these roles to staff members within your office. If you have more than one Provider, simply photocopy the Provider Registration and Provider Agent Forms found on the next page so that each Provider has his or her own forms to sign. Role Typical User Primary Functions Electronically create, sign & send prescriptions Physician Provider Nurse Practitioner Physician Assistant Approve renewals Delete patients from the practice's account Add, delete, or edit patients' medication and allergy lists Capable of performing Provider Agent, Clinical Staff, and Non-Clinical Staff functions as well Electronically send prescription on behalf of provider; copy is sent to provider for signature Create prescriptions for provider to sign Provider Agent Nurse Approve renewals, copy is sent to provider for signature Add pharmacies to the Rcopia practice list Capable of performing Clinical Staff and Non-Clinical Staff functions as well Nurse Clinical Staff Medical Assistant Create prescriptions for provider to sign Add or edit patients' medication and allergy lists Capable of performing Non-Clinical Staff functions as well Add patients to the practice account Non-Clinical Staff Edit patient demographic information Front desk staff Designate patients' default pharmacy View prescription report 0128 09 Questions? Please contact Jack Choi at [email protected] Provider Registration Form Rcopia E-Prescribing Registration Packet Date Sales Rep Please provide the contact information for the individual responsible for administering e-prescribing in your office. Practice Name Contact Name Physician Name Title Phone Title MD DO PA CNP Address Email Address 2 DEA number City State Zip Medical License Number Office Phone NPI Number Office Fax Specialty Exp Exp State Physician Email Provider Signature Please provide your signature in the box below so that we can include it on your prescription when a signature is required. Be sure to fill the entire box with your signature, but without touching the edges. During the deployment process, you will be assigned a unique password that will be required for you to authorize the submission of a prescription to the pharmacy. Authorizing a prescription with your password will attach the signature below to the electronic prescription. To protect yourself, please do not share your password with others or write down where other may possibly find it. Dispense As Written Statement Some states require the phrase “Dispense As Written" written in the prescriber's handwriting to be included on prescriptions that cannot be filled generically. Please sign “Dispense As Written" in the bow below. 012809 Questions? Please contact Jack Choi at [email protected] Provider Agent Agreement Who qualifies as a Provider Agent?Anyone in your office that currently calls in prescriptions on behalf of the provider. Rcopia E-Prescribing Registration Packet I _____________________________ , hereby affirm that except as set forth in this paragraph, I will personally prescribe and order the medications using the user identifier (“user ID") and password provided to me by DrFirst. To the extent that someone other than myself uses the Rcopia system to order medications that I prescribe for patients who are under my care (for purposes of this agreement such person is referred to as the “Provider Agent") such person will be acting pursuant to my express written instructions and I agree that I am solely responsible for insuring that adequate documentation exists verifying that I am the prescribing physician and that such documentation will be provided to the Pharmacy dispensing such medication, and/or DrFirst, if requested. Physician Signature Practice Name Physician Name Address Date Address 2 Email City State Zip Please list all Provider Agents Name 012809 Signature Questions? Please contact Jack Choi at [email protected] Date Staff Registration Rcopia E-Prescribing Registration Packet Practice Name Address Address 2 012809 Phone Questions? Please contact Jack Choi at [email protected] Non Clinical Staff Email Zip Clinical Staff Staff Member Name State Provider Agent City