Faxed Transmission of Prescriptions

April 30, 2020: Important update regarding the novel coronavirus (COVID-19) pandemic

Prescribers who are working away from their regular premises, without access to their usual fax or EMR/e-prescribing system, may be using email to communicate prescribing directions to pharmacy professionals. Please refer to the guidance Temporary Method for Transmitting Prescriptions via Unsecure Email During COVID-19 for more information.

Similarly, a prescriber working remotely from a hospital may not be able to provide discharge prescriptions in the usual manner. Registrants receiving these prescriptions should assess them as a whole, including the content and appropriateness specific to the patient, and use their professional judgment to determine their authenticity and validity to dispense. If there is uncertainty that the prescriber has authorized the order, the pharmacy professional may decide to follow up with the prescriber or hospital directly.

POLICY

Published: March 2007

Revised: June 2015

Legislative References:

Additional References:

College Contact: Pharmacy Practice

Definitions

Facsimile Transmission

A prescription received by facsimile transmission (“fax”) means transmission of the exact visual image of a document by way of electronic equipment. (1)

Policy

Considerations When Receiving a Prescription by Fax

Authenticity

A member must evaluate the prescription as a whole when determining whether to dispense a prescription. When assessing a prescription the member must consider the content of the prescription and its appropriateness given the patient’s condition and prescription history, as well as who transmitted the prescription, and the location from which a prescription was transmitted. If, upon assessing the prescription as a whole, a member is unsure of a prescription’s authenticity, it is the responsibility of the member to confirm the prescription with the prescriber prior to dispensing the medication.

Prescribers and Drugs

All prescriptions, including those written for narcotic, controlled drugs, and targeted substances may be accepted by fax. Additionally, a fax transmission can be accepted from a practitioner registered to practice in any province or territory of Canada. Regular e-mail (i.e. not a secure web mail portal) is not considered equivalent to receiving a prescription by fax and is not a secure medium for prescription transmission, therefore legislation does not permit prescriptions to be transmitted through e-mail. (2)

For any prescription received by fax members must ensure the following:

  1. All prescription authorizations transmitted by fax, must originate with the prescriber and be sent directly from a device authorized by the prescriber. Pharmacists are reminded that fax-header information can be manipulated and should be verified where appropriate by checking the number against a known fax number for the prescriber.
  2. If a prescription written by a prescriber is faxed to the pharmacy by a patient or a patient’s agent, the original prescription must be obtained before the medication is dispensed.
  3. The process of receiving faxed transmissions must maintain patient confidentiality. Fax equipment must be located within a secure area where the transmission is received and handled only by pharmacy staff, to protect the confidentiality of patient information. (3)
  4. If any document containing personal health information is received in error, the pharmacy should notify the sender that the fax was received in error and destroy the information in a secure manner. (4)
  5. Patient choice must be protected; that is the patient must determine the pharmacy where the prescription is to be filled.
  6. The pharmacy has policies and procedures for the regular maintenance and cleaning of fax machines to ensure optimal transmission of medication-related information. (5)
References
  1. National Association of Pharmacy Regulatory Authorities. Fax Prescription Model Policy. Retrieved on August 29, 2014 from http://napra.ca/
  2. Information and Privacy Commissioner Ontario. Privacy Protection Principles for Electronic Mail Systems (1994). Retrieved at https://www.ipc.on.ca/wp-content/uploads/2016/09/Health-Fact-Sheet-Communicating-PHI-by-Email-FINAL.pdf
  3. Cavoukian, A. Information and Privacy Commissioner Ontario. Guidelines on Facsimile Transmission Security. Retrieved on September 16, 2014 from https://www.ipc.on.ca/wp-content/uploads/Resources/fax-gd-e.pdf
  4. Cavoukian, A. Information and Privacy Commissioner Ontario. Guidelines on Facsimile Transmission Security. Retrieved on September 16, 2014 from https://www.ipc.on.ca/wp-content/uploads/Resources/fax-gd-e.pdf
  5. Institute for Safe Medication Practices Canada. ISMP Canada Safety Bulletin ALERT: Medication Mix-up with a Faxed Prescription. Retrieved from http://ismp-canada.org/download/safetyBulletins/2012/ISMPCSB2012-06_Alert-MedMixupwithFaxedPrescription.pdf on October 14, 2014.