UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
Storage of Tamper Resistant Prescription Pads and Paper
Effective Date: April 1, 2008 Approval: See Authorization
Supersedes Protocol: October 1, 2007 Contact: See Author
PURPOSE: To provide guidelines for UWMF Clinics and providers on the storage of
prescription pads and tamper resistant prescription paper.
DEFINITION: Prescription pads and paper are considered tamper resistant as defined
by Centers for Medicare and Medicaid Services (CMS) if it contains the following three
1. One or more industry-recognized features designed to prevent unauthorized
copying of a completed or blank prescription form;
2. One or more industry recognized features designed to prevent the erasure or
modification of information written on the prescription by the prescriber;
3. One or more industry recognized features designed to prevent the use of
counterfeit prescription forms.
POLICY: The clinical staff will utilize the following guidelines to properly store tamper
resistant prescription pads and paper.
A. Prescription Pads
1. Prescription pads will be either in the possession of a licensed prescriber or stored in
a locked cabinet or drawer.
a. The cabinet/drawer will be kept locked at all times.
b. The key shall be kept in an area away from the cabinet/drawer or be in possession
of personnel during all working hours. The key will be locked in an area separate
from the cabinet/drawer during non-working hours.
c. Only prescription pads will be stored in the locked cabinet/drawer.
2. Prescription pads are not to be stored in any area that is not lockable including exam
rooms and lab coats.
B. Tamper Resistant Paper
1. Tamper resistant paper will be used for all prescriptions printed to paper from
2. Tamper resistant paper must be under constant supervision and/or secured at all
a. Tamper resistant paper may be stored in the printer tray if a Versalock lock is
placed on the tray. The key shall be kept in an area away from the printer or
be in the possession of a personnel during all working hours. The key will be
locked in an area separate from the printer during non-working hours.
b. Tamper resistant paper not stored in a secure printer tray, including overstock,
will be stored in a locked cabinet or drawer. They key shall be kept in an area
away from the cabinet/drawer or be in possession of personnel during all working
hours. The key will be kept in an area separate from the cabinet/drawer during
non- working hours.
WRITTEN BY: Carrie Boeckelman, RPh, Mananger, Ambulatory Pharmacy Services
REVIEWED BY: Lori Hauschild, RN, Director of Clinic Operations
1. Center for Medicare and Medicaid Services Operations, August 17, 2007. SMDL
Medical Director Date