TRANSITIONAL PHARMACY BENEFIT NOTE (1266)    TIU DOCUMENT DEFINITION (8925.1)

Name Value
NAME TRANSITIONAL PHARMACY BENEFIT NOTE
PRINT NAME TRANSITIONAL PHARMACY BENEFIT NOTE
TYPE TITLE
CLASS OWNER CLINICAL COORDINATOR
STATUS INACTIVE
BOILERPLATE TEXT
This patient has been identified as a new patient waiting for care from
Allergies/Adverse Reactions:
|ALLERGIES/ADR|

Rx(s):
|TIU TPBN ACT OUT MEDS|

Over-the-counter drugs or drugs not issued by VA but currently taking 
(Please List):


the VA and is eligible for the transitional pharmacy program.

Non-formulary Rx requested, not filled:



Formulary Alternatives Recommended:



Next appointment(s):

|TIU TPBN FUTURE APPTS|


Counseling:

The patient and/or the patient's caregiver was offered counseling on
drug, dosage, schedule, route of administration, storage, potential 
side effects, significant drug interactions, and the procedure for 
obtaining refill prescriptions.

Patient Name:  |PATIENT NAME|
Counseling was [] Provided     [] Refused
SSN:           |PATIENT SSN|
Age:           |PATIENT AGE|

Primary Care Provider:  |TIU TPBN PCP|

OK TO DISTRIBUTE YES
TIMESTAMP 2003-09-12 18:18:52