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Disclaimer: The English language text below is provided by the Translation and Terminology Centre for information only; it confers no rights and imposes no obligations separate from those conferred or imposed by the legislation formally adopted and published. Only the latter is authentic. The original Latvian text uses masculine pronouns in the singular. The Translation and Terminology Centre uses the principle of gender-neutral language in its English translations. In addition, gender-specific Latvian nouns have been translated as gender-neutral terms, e.g. chairperson.

Text consolidated by Tulkošanas un terminoloģijas centrs (Translation and Terminology Centre) with amending regulations of:

26 June 2007 (No. 435)5 February 2008 (No. 77);

2 June 2008 (No. 392).If a whole or part of a paragraph has been amended, the date of the amending regulation appears in square brackets at the end of the paragraph. If a whole paragraph or sub-paragraph has been deleted, the date of the deletion appears in square brackets beside the deleted paragraph or sub-paragraph.

Republic of Latvia

CabinetRegulation No 175

Adopted 8 March 2005

Regulations for Manufacture and Storage of Prescription Forms, as well as Writing out and Storage Prescriptions

[26 June 2007]

Issued pursuant to Section 60 of the Medical Treatment Law and Section 36, Paragraph one of the Law On Procedures

for the Legal Trade in Narcotic and Psychotropic Substances and Medicinal Products

[26 June 2007]

I. General Provisions

1. These Regulations prescribe the manufacture and storage of prescription forms (except veterinary prescriptions), as well as procedures for writing out prescriptions.

2. There are the following prescription forms:2.1. a prescription form for ordering medicinal products to be issued for payment in

full and medical devices, except narcotic, psychotropic medicinal products and medicinal products which the State Agency of Medicines has recognised as narcotic analgesic agents (hereinafter – ordinary prescription form) (Annex 1); and

2.2. a prescription form for ordering narcotic and psychotropic medicinal products, also medicinal products, which the State Agency of Medicines has recognised as narcotic analgesic agents, as well as medicinal products and medical devices the purchase expenses of which partly or in full shall be compensated (hereinafter – special prescription form) (Annex 2).

3. Advertising is prohibited on a prescription (also on the reverse side of a prescription).

Translation © 2008 Tulkošanas un terminoloģijas centrs (Translation and Terminology Centre)

II. Manufacture and Storage of Prescription Forms

4. Prescription forms shall be printed typographically in accordance with Annexes 1 and 2 of these Regulations. Prescription series and sequence number shall also be printed typographically, ensuring that the series of the prescription forms, as well as the sequence numbers within a series do not repeat.

5. The size of a prescription form shall be 12 x 18 cm. The prescription form shall be printed on white-coloured paper with watermarks. The printed text shall be in black.[26 June 2007]

6. The margins of the ordinary prescription form and the part to be completed by the pharmacy shall be coloured in light blue. The margins of the special prescription form and the part to be completed by the pharmacy shall be coloured in light red.[26 June 2007; 2 June 2008]

7. The State Mandatory Health Insurance Agency (hereinafter – Agency) shall distribute the prescription forms to the medical treatment institutions. In accordance with the regulatory enactments regarding procurement for State needs the Agency shall organise the manufacture of prescription forms, as well as typographic printing thereof, providing for the incorporation of the safeguards referred to in Paragraphs 5 and 6 of these Regulations in order to prevent the possibility of forgery of the prescription forms.

8. A merchant, which typographically prints the prescription forms in accordance with an agreement entered into with the Agency, shall ensure the storage of the prescription forms and originals of photo materials used for the manufacture of the prescription forms so as to prevent unauthorised persons from accessing them. The merchant shall transfer to the Agency the typographically printed prescription forms together with an invoice, as well as the originals of photo materials used for the manufacture of the prescription forms. The merchant shall transfer to the Agency prescription forms rejected as defective by drawing up a act of transfer.

9. The director of the Agency shall assign an official (hereinafter – responsible official) who shall be responsible for:

9.1. the receipt of prescription forms from the merchant, which prints the prescription forms, the registration thereof, the storage and issuing to medical treatment institutions and medical treatment practitioners;

9.2. the receipt and storage of the originals of photo materials used for the manufacture of the prescription forms, taking into account that the originals of photo materials used for the manufacture of ordinary prescription forms shall be stored for one year, but originals of photo materials used for the manufacture of special prescription forms – for three years; and

9.3. the registration and destruction of defective and withdrawn from circulation prescription forms.

10. The manager of a medical treatment institution shall ensure and shall be responsible for the storage, registration of prescription forms and issuance to medical treatment practitioners who work for the relevant medical treatment institution, as well as for the registration, storage and destruction of unused special prescriptions, which, in accordance with Paragraph 25 of these Regulations, have been returned from patients (hereinafter – unused prescription), and

Translation © 2008 Tulkošanas un terminoloģijas centrs (Translation and Terminology Centre) 2

for the registration and transfer to the Agency of the prescription forms withdrawn from circulation by drawing up a act of transfer thereof.

11. In the Agency and a medical treatment institution the special prescription forms shall be registered in a registration journal for special prescription forms in order to ensure the accounting and control of circulation of prescription forms in the institution. The format of the registration journal for special prescription forms shall be determined by the relevant Agency director and the head of the medical treatment institution. [26 June 2007]

12. The Agency shall keep the special prescription forms and the originals of photo materials thereof in a safe equipped with an alarm system, which is located in a room ensured against entrance of unauthorised persons and equipped with an alarm system. The ordinary prescription forms and the originals of photo materials thereof, as well as defective and withdrawn from a circulation prescription forms shall be kept in a room, which is ensured against entrance of unauthorised persons, observing that the defective and withdrawn from a circulation prescription forms shall be kept separately until the destruction thereof in order to prevent confusion with valid prescription forms.

13. A responsible official shall ensure the issuance of prescription forms upon a request approved by the manager of a medical treatment institution (signature of the manager of the medical treatment institution and stamp of the medical treatment institution). The requisites of the medical treatment institution, date of request, request number, number and type of prescription forms shall be indicated in the request. Ordinary prescription forms shall be issued also upon a physician’s written request. Given name, surname, diploma number, address, phone number of the physician, the number of prescription forms, date of request shall be indicated in this request, as well as a signature certifying the information indicated. A request of special prescription forms shall be valid for seven days. The Agency shall store requests of special prescription forms for three years, requests of ordinary prescription forms – for one year.

14. A responsible official shall ensure that the number of prescription forms issued, the series and numbers of the issued prescriptions, the date of issuance of prescription forms, as well as the issuer (given name, surname) shall be indicated on the request of ordinary prescription forms. The issuer and the recipient shall certify the referred to information with a signature.

15. The Agency shall issue prescription forms to a person, who acts on behalf of the manager of a medical treatment institution with an authorisation approved by the manager of the medical treatment institution. An official entitled to receive special prescription forms, date of issuance of the authorisation and number thereof, as well as the term of validity of no more than seven days shall be indicated in the authorisation. The official shall submit the authorisation and present a personal identification document upon receipt of prescription forms, as well as submit a guarantee letter if payment is made by transfer. A physician shall present a personal identification document, diploma attesting his or her education or a physician certificate upon receipt of ordinary prescription forms for ordering medicinal products for personal use.

16. Prescription forms received form the Agency, as well as the prescription forms withdrawn form circulation until the transfer thereof to the Agency, and unused prescriptions until the destruction thereof shall be stored in a medical treatment institution in a safe equipped with an


alarm system, which is placed in a room ensured against entrance of unauthorised persons, observing that prescription forms withdrawn form circulation and unused prescriptions are stored separately in order to prevent confusion thereof with valid prescription forms. A medical treatment practitioner shall ensure the storage of the received prescription forms so that unauthorised persons may not access them.[26 June 2007]

17. Defective, damaged, withdrawn from circulation prescription forms and unused prescriptions shall be registered in a registration journal of invalid prescription forms and in a prescription registration journal in order to ensure the control of the accounting and circulation of prescription forms, including the making of an annotation regarding the destruction of a prescription form or prescription and the transfer of withdrawn from circulation prescription forms to the Agency (act number and date). The format of the registration journal of invalid prescription forms and the prescription registration journal shall be determined by the relevant Agency director and the head of the medical treatment institution. [26 June 2007]

18. The pages of the registration journals referred to in Paragraphs 11 and 17 of these Regulations (hereinafter – a registration journal) shall be numbered and bound together. Prior to making the first entry the manager of the relevant institution shall approve the registration journals with a signature and the stamp of the institution.

19. Entries in the registration journals shall be numbered and they shall be made without leaving blank spaces and deleting entries. Corrections shall be certified with words “Labotam ticēt” [Correction valid], a signature of the responsible official or the manager of the medical treatment institution and a stamp of the relevant institution.

20. A manager of a medical treatment institution and the Agency shall establish a commission (including employees of the relevant institution therein), which shall once a month inspect how the procedures for the storage of prescription forms are observed at the institution, as well as shall carry out an inventory of prescription forms. The commission shall draw up an inventory act regarding the results of the inspection. The institution shall keep an inventory act for three years.

21. If a shortage or a surplus of the special prescription forms is detected, a theft, robbery has occurred, or the losses have been caused due to a natural disaster, the relevant safe shall be sealed and the Health Inspectorate, as well as the State Police (if a theft or robbery has occurred) shall be notified immediately of the fact. [26 June 2007; 5 February 2008]

22. In the case referred to in Paragraph 21 of these Regulations the manager of the institution shall establish a commission. The commission shall consist of:

22.1. the manager of the institution or his or her authorised official;22.2. the responsible official (if the incident occurred in the Agency); and22.3. a representative of the State Sanitary Inspection and the Health Inspectorate.

[5 February 2008]

23. The commission referred to in Paragraph 22 of these Regulations shall draw up an act. The type of incident, the prescription form series, numbers, quantity, date of drawing up of


the act and commission members (given name, surname and position) shall be indicated in the act. The act shall be drawn up in two copies and all the members of a commission shall sign it. The first copy of the act shall remain in the medical treatment institution or the Agency (if the incident has occurred in the Agency), and the second copy shall be transferred to the Health inspectorate. If a shortage of prescription forms has been determined (also theft or robbery), the Health Inspectorate shall notify pharmacies regarding the series and numbers of the relevant prescription forms.[5 February 2008]

24. Defective prescription forms and prescription forms withdrawn from circulation at the Agency, defective prescription forms and unused prescription forms at a medical treatment institution shall be destroyed in the presence of a commission (consisting of at least two persons) established by the manager of the Agency or the medical treatment institution respectively. An act in two copies shall be drawn up regarding the destruction of prescription forms/prescriptions, indicating the type, series, numbers, quantity of the prescription forms/prescriptions destroyed, the place of destruction, date, destruction method, other conditions related to destruction, as well as the commission members (given name, surname and position). All members of the commission shall sign the act. The Agency or the medical treatment institution respectively shall keep the first copy of the act for three years. The second copy of the act shall be sent within a period of three days to the State Sanitary Inspection and the Health Inspectorate.[26 June 2007; 5 February 2008]

25. When writing out a special prescription for purchase of narcotic or equivalent psychotropic medicinal products, a medical treatment practitioner shall notify the patient that unused special prescriptions shall be turned in to the medical treatment institution in which they have been written out.

26. Special prescriptions on which narcotic or psychotropic medicinal products equivalent thereto have been ordered shall be stored at a pharmacy for five years, while other special prescriptions shall be stored for three years. Ordinary prescriptions shall be stored at a pharmacy for one year.

27. A patient shall store the multiple-use prescription referred to in Paragraph 35 of these Regulations until the entire amount of medicinal products ordered is received, or, with the consent of the patient, the pharmacy in which the patient shall further receive the medicinal products ordered on the prescription. If the pharmacy stores the prescription it shall without delay inform the patient regarding a change in the location of the pharmacy or other circumstances, which may influence the accessibility of the medicinal products ordered on the prescription for the patient. If the patient does not leave the multiple-use prescription in the pharmacy, the pharmacy shall ensure the registration of the prescription data and information regarding medicinal products issued in such a way that ensures the possibility of the Health Inspectorate to examine the justification for the issuing of the medicinal products. After the whole quantity of the ordered medicinal products has been issued, the pharmacy, at which the last purchase was made, shall keep the prescription.[26 June 2007; 2 June 2008]

28. The pharmacy shall, after the closing of the prescription, give the second copy of the special prescriptions printed up to 31 December 2008 to the patient. If the expenses for the acquisition of the medicaments ordered on special prescription are compensated partly or


fully by an insurance company, the pharmacy may transfer the second copy of the relevant prescription to the insurance company in accordance with the agreement entered into regarding the payment for medicaments.[2 June 2008]

III. Procedures for Writing out Prescriptions

29. A prescription shall be written out on the official forms (Annexes 1 and 2), taking into account the requirements referred to in Annex 3 of these Regulations for completing the prescription forms. A prescription shall be written out in a clearly legible handwriting or by using a computer, or other technical means which ensure clear and unmistakable data perception. A medical treatment practitioner is prohibited to receive and store prescription forms on which the name of medicinal products is indicated.

30. Prescription requisites and text shall be clearly legible and indelible. Mistakes and corrections are not allowed in writing out a prescription. [2 June 2008]

31. Medicinal products and medical devices for primary and secondary outpatient treatment shall be ordered on prescriptions. It is prohibited to order medicinal products and medical devices for provision of a physician practice.

32. A physician and physician’s assistant (paramedic), who works at a medical treatment institution, have the right to write out an ordinary prescription. A physician who does not work at a medical treatment institution is permitted to order medicinal products on the ordinary prescription for personal use only.

33. Only a physician, who works at a medical treatment institution, has the right to write out a special prescription. Only a physician, who has entered into contractual relations with the Agency, has the right to order medicinal products and medical devices the expenses of the supply of which are partially or fully covered for the patient from funds allocated for the compensation of the expenses of acquisition of medicinal products in conformity with regulatory enactments regarding the procedures for compensation of expenses for the acquisition of medicinal products and medical devices (hereinafter – compensation procedures).[2 June 2008]

34. Only a narcologist may order medicinal products that contain buprenorphine to a patient to whom the State limited liability company “Rīgas psihiatrijas un narkoloģijas centrs” [Rīga Psychiatric and Narcology Centre] has issued a programme card of buprenorphine substitution therapy. The narcologist shall also indicate in the referred to programme card information regarding the name, dose, amount of medicinal products ordered, the date of ordering and the prescription number. The prescription for the supply of the medicinal product, which contains buprenorphine shall be ordered for the patient not more often than once every two weeks.[26 June 2007]34.1 Medicinal products, which in accordance with regulatory enactments regarding the procedures for medicinal product classification are intended for out-patient medical treatment, but which may cause serious side-effects due to which for the use thereof is needed an instruction from the relevant medical treatment specialist and supervision for the whole of the


period of medical treatment, and for which is applied the marking “Pr.II” with an indication from the specialist physician, may be ordered only by the indicated specialist physician.[26 June 2007]

34.2 In ordering medicinal products the use of which may cause a heightened risk to health and the use of which needs to be specially supervised, the specific risk prevention programme developed by the holder (owner) of the medicinal product registration certificate and co-ordinated with the State Agency of Medicines. The holder (owner) of the medicinal product registration certificate shall ensure the accessibility of the programme to physicians who have the right to order the relevant medicinal products.[26 June 2007]

34.3 Medicinal products, which contain isotretinoin may be ordered for women of reproductive age not more than for a one month long medical treatment course, taking into account in accordance with the Pregnancy Planning Programme developed by the holder (owner) of the medicinal product registration certificate and co-ordinated with the State Agency of Medicines specified in Paragraph 34.2 of these Regulations. The holder (owner) of the medicinal product registration certificate shall ensure the accessibility of the Pregnancy Planning Programme to physicians who have the right to order medicinal products, which contain isotretinoin.[26 June 2007]

35. If, when ordering medicinal products on the ordinary prescription, a physician provides the possibility for the patient to purchase the medicinal products systematically, receiving the amount of the ordered medicinal products piecemeal no more than once a month, the physician shall indicate on the prescription “Ārstēšanas kursam” [For a medical treatment course]. The physician shall approve the referred to indication with a signature and a personal stamp, and this prescription shall be deemed as a multiple-use prescription.

36. Medicinal products and medical devices shall be ordered on a single ordinary prescription form for a treatment course of no more than three months, with the exception of the medicinal products referred to in Annex 4 of these Regulations, which a physician may order on a multiple-use prescription referred to in Paragraph 35 of these Regulations for a treatment course of up to one year.

37. It is permitted to order only one drug or medical device on the special prescription form, providing the quantity of secondary packaging (hereinafter – packaging) for a treatment course of not more than three months.

38. In writing out a prescription for purchase of narcotic and equivalent psychotropic medicinal products a physician shall not exceed the maximum amount of narcotic and equivalent psychotropic substances specified in Annex 5 of these Regulations, permitted to order on a single prescription.


39. In writing out a prescription for the supply of psychotropic medicinal products (except in the case referred to in Paragraph 38 of these Regulations) and of narcotic analgesic products, the physician shall order a medicinal product medical treatment course for one month. A psychiatrist, narcologist, neurologist and family doctor, within the scope of the procedures for compensation may order the referred to medicinal products for a medical treatment course of up to three months.[26 June 2007]

40. If a medical treatment practitioner orders narcotic or psychotropic medicinal products for a patient, or medicinal products which the State Agency of Medicines has recognised as narcotic analgesic agents, he or she shall make an entry in the outpatient's card and indicate the name, dose, amount of the relevant medicinal products and the date of ordering thereof. The manager of the medical treatment institution shall ensure the inspection of the therapeutic justification and correctness of ordering of the referred to medicinal products not less than once a month.

41. A health care practitioner shall order an alcohol or aqueous solution thereof on an ordinary prescription form. Not more than 150 g of alcohol of 96% or aqueous solution of alcohol, or pharmacy-prepared medicinal products containing no more than 150 g of alcohol of 96%, shall be ordered on a prescription.

42. The following narcosis agents are prohibited from ordering on prescriptions:42.1. GHB (sodium oxybutirate and lithium oxybutirate);42.2. fentanyl injection solution; and42.3. diethyl ether.

43. In writing out a prescription, only the prescription abbreviations in Latin referred to in Annex 6 of these Regulations are permitted..

44. A health care practitioner shall approve an ordinary prescription form with a signature and a personal stamp. If a special prescription shall be written out, a stamp of the medical treatment institution is required additionally (practice physicians may use a personal stamp, which includes the requisites of a physician’s practice).

45. If a health care practitioner, in cases specified in the Pharmacy Law, writes out a prescription for the purchase of medicinal products not included on the list of medicinal products registered in the Republic of Latvia, he or she shall notify the patient regarding the procedure for the purchase of these medicinal products.

46. A health care practitioner, who writes out a prescription on the basis of a request of a patient, shall issue a true copy or a copy of the prescription. A pharmacy is prohibited from dispensing medicinal products or medical devices on the basis of a true copy or copy of a prescription.[2 June 2008]

47. A medical treatment practitioner is prohibited from issuing incomplete or partially completed prescription forms to a patient, except in the cases referred to in Annex 3 of these Regulations, when a certain prescription requisites may not be indicated.


48. The term of validity of the special prescription shall be 30 days. The term of validity of an ordinary prescription shall be three months, except:

48.1. the prescription on which is ordered the medicinal products referred to in Paragraph 34.3 of these Regulations and for which the term of validity is seven days; and

48.2. the multiple-use prescription referred to in Paragraph 36 of these Regulations the term of validity of which (not exceeding one year) shall be determined by a physician.[26 June 2007]

IV. Duties of Pharmacies and State Authorities Regarding the Circulation of Prescriptions and Prescription Forms

49. If medicinal products and medical devices have been ordered on the special prescription forms, a pharmacy, in accordance with the agreement regarding prescription data processing by computerised means, shall provide the following information to the Agency:

49.1. the prescription series and number;49.2. E form type (if a prescription has been written out to a citizen of another

European Union Member State, Norway, Iceland, Liechtenstein or Switzerland in accordance with the international agreement providing for mutual settlements for the health services rendered);

49.3. the date the prescription was written out;49.4. given name, surname and personal identity number of the patient (for the person

presenting E form – an identification number);49.5. name of the medical treatment institution;49.6. given name, surname, personal identity number and speciality of a physician;49.7. code of diagnosis;49.8. compensation percentage to be applied in accordance with the compensation

procedure specified;49.9. name of insurance company (if an insurance company compensates the patient

for the purchase of medicinal products);49.10. name of medicinal products ordered; 49.11. code and quantity (number of packages) of the medicinal products dispensed.

Within the scope of the procedures for compensation for the distributed medicinal products shall be indicated price for one packaging, the amount intended for payment (taking into account the number of packages) and the allocation thereof between patient and another payer; and

49.12. date of dispensing of medicinal products.[26 June 2007]

50. The Agency shall:50.1. accumulate and process the data of the prescriptions referred to in Paragraph 49

of these Regulations;50.2. upon the request of the State Agency of Medicines, the Medicines Pricing and

Reimbursement State Agency, the Health Inspectorate and law enforcement institutions provide information regarding the consumption of those medicinal products and medical devices, which have been ordered on the special prescription forms; and

50.3. upon the request of the Ministry of Health, the Health Inspectorate and law enforcement institutions provide information regarding the writing out of the special prescriptions.[5 February 2008]


51. The Health Inspectorate shall control the observation of the procedures for circulation of prescription forms in the Agency and medical treatment institutions, as well as the observation of the procedures for circulation of prescription forms in pharmacies.[5 February 2008]52. [5 February 2008]

V. Closing Provisions

53. Special prescription forms and prescription forms on which medicinal products for differentiated payment are ordered, which have been printed before the day these Regulations come into force may be used up to 15 June 2005.

54. Ordinary prescription forms printed before the day these Regulations come into force may be used up to 30 June 2005.

55. Cabinet Regulation No. 250 of 14 July 1998, Regulations for Manufacture and Storage of Prescription Forms and Writing Out Prescription Forms (Latvijas Vēstnesis, 1998, No. 212/213; 2001, No. 7; 2003, No. 167) is repealed.

55.1 The utilisation of electronic prescriptions developed by the State Agency of Medicines is permitted, ensuring the parallel functioning of typographically printed prescriptions up to the implementation of the full electronic prescription system. The content of electronic prescriptions shall conform to the requirements of these Regulations, and it shall be established in accordance with the regulatory enactments regarding electronic documents.[26 June 2007]

55.2 The ordering of medicinal products and medical devices on prescription forms, which are printed up to 30 September 2007 shall be permitted up to 1 May 2008.[26 June 2007]

55.3 Paragraph 28 of these Regulations shall be repealed from 1 July 2009.[2 June 2008]

55.4 The ordering of medicinal products without indicating the ordered medicinal product code, and medical devices on special prescription forms, which have been printed up to 31 December 2008 shall be permitted up to 30 June 2009.[2 June 2008]

56. Paragraphs 49 and 50 of these Regulations shall come into force on 1 July 2005.

Prime Minister A. Kalvītis

Minister for Health G. Bērziņš


Transitional Provisions Regarding Amendments

to Cabinet Regulation No. 175 of 8 March 2005, Regulations for Manufacture and Storage of Prescription Forms, as well as Writing out and Storage Prescriptions

Transitional Provision(regarding amending regulation No. 392 of 2 June 2008)

Sub-paragraphs 1.1, 1.3, 1.5 and 1.9 of these Regulations shall come into force on 1 January 2009.


Annex 1 Cabinet Regulation No. 175

8 March 2005

Sample of the Ordinary Prescription Form

[26 June 2007]




8 March 2005

Sample of the Special Prescription Form

[26 June 2007; 2 June 2008]




8 March 2005

Requirements for Filling the Prescription Forms

I. General Requirements

1. [26 June 2007]

2. The introductory part of the prescription (Inscriptio) shall indicate:2.1. the date of writing out of the prescription;2.2. the given name, surname, personal identity number (for a person presenting E

form – identification number) and address of the patient. When writing out an ordinary prescription for personal use a physician in place of the given name and surname of the patient shall write “pro me” (for me) or “ad usum proprium” (for personal utilisation), in the place for the address shall indicate his or her actual place of residence address and telephone number;

2.3. the name, code, address and telephone number of the medical treatment institution; and

2.4. the given name, surname, speciality and personal identification number of the medical treatment practitioner who writes out the prescription.[26 June 2007]

3. In the address part (Invocatio) shall write “Rp.:” (Recipe – take).

4. In the prescription part (Praescriptios. Designatio materiarum) after "Rp.:" the form of the medicinal products, the name with a capital letter in Latin in genitive case shall be written, indicating the dose of the form of medicinal products and number of doses.

5. For medicinal products with compound composition to be made upon individual prescriptions:

5.1. the name of each medicinal product substance shall be written in a separate line, listing the narcotic, psychotropic and other substances subject to strict registration first, then the remaining substances of great virtue and other active substances;

5.2. if the name of the medicinal product substance is long, it is permissible to continue with it also on the next line;

5.3. the first word of the names of medical treatment herbs shall be written with a capital letter even if they are not at the beginning of the line, but the designation of the part of the herb in this case shall be written with a small letter;

5.4. if any correcting substances have been added to the medicinal products due to the organoleptic property thereof, they shall be listed after active substances; and

5.5. ancillary substances, which ensure the necessary consistency, form and amount of the medicinal products, shall be listed last on the prescription.

6. The amount in mass, capacity or operation units shall be written on the right side of the prescription opposite to the name of the relevant medicinal product ingredient:


6.1. for medicinal product substances of hard or soft consistency – in grams or in fractions of a gram, writing them as unnamed figures;

6.2. for liquids – in millilitres, adding the abbreviation “ml” after the figure;6.3. the amount of alcohol shall be written out in grams, indicating the concentration

of the alcoholic solution;6.4. the number of drops shall be designated with Roman numerals, writing it after the

abbreviation “gtt.”;6.5. the number of operation units shall be indicated for the active substances of the

drug agent, after which the abbreviation “DV” shall be written.

7. If two or more medicinal product ingredients shall be taken in equal amounts, this may be indicated only after the last of these ingredients by writing “āā” before the amount.

8. Indicating the last medicinal product ingredient to be added in order to obtain the required total mass or capacity of the medicinal products, the abbreviation “ad” shall be used before the numerical amount designation.

9. Instructions to the dispensing pharmacy (Subscriptio) regarding the making up of the medicinal products, the form and amount of medicinal products, indicating the mass or capacity, or operation units, and the type of package, shall be written in Latin, using generally accepted prescription abbreviations in accordance with Annex 6 of these Regulations.

10. Instructions to the patient (Signatura) regarding medicinal product usage shall be written in Latvian after the abbreviation “D.S.”, indicating the doses, when, how often and how the medicinal products shall be used.[26 June 2007]

11. If medicinal products ordered on a prescription shall be made up and dispensed urgently, the medical treatment practitioner shall write the note “Cito!” If medicinal products shall be dispensed immediately, the note “Statim!” shall be written. It is recommended to indicate the note in another colour.

12. If it is prohibited to substitute the medicinal products, the health care practitioner shall strike off crosswise the area "Zāles atļauts aizvietot" [It is permitted to substitute the medicinal products].

13. The medical treatment practitioner shall strike off crosswise all areas of the prescription form, which, in the specific case, are not intended to be filled.

II. Requirements for Filling Ordinary Prescription Forms

14. If a medical treatment practitioner intends for an option to select one of the analogue medicinal products when writing out an ordinary prescription, he or she shall indicate several medicinal products, separating them with the abbreviation “s.” (sive – or), and one of the medicinal products ordered shall be dispensed at a pharmacy.


15. A diagnosis code in accordance with the International Classification of Diseases (10th

Revision) (hereinafter – ICD classification) shall be indicated, if the medicinal products are written out on a multiple-use prescription.[26 June 2007]

16. A medical treatment practitioner shall indicate the term of validity of the prescription in accordance with the diagnosis and medicinal products to be ordered.

17. A pharmacist or assistant pharmacist, who dispenses the medicinal products, shall indicate the code (registration number in the Latvian Medicinal Product Register) or name, the quantity (number of packages), price (of one package) of the medicinal products dispensed, the amount intended for payment (taking into account the number of packages) and the prescription closing date, confirming this information with a signature and a personal stamp.[26 June 2007; 2 June 2008]

18. Dispensing the medicinal products on the basis of a multiple-use prescription, the pharmacist or assistant pharmacist shall make a mark on the reverse side of the prescription regarding the quantity dispensed and the date of dispensation, attesting the mark with a signature and a personal stamp, and shall ensure the possibility to identify the pharmacy where the medicinal products were dispensed.

III. Requirements for Filling Special Prescription Forms

19. A physician shall indicate the type of E form, if a prescription has been written out to a citizen of another Member State of the European Union, Norway, Iceland, Liechtenstein or Switzerland in accordance with the international agreement, which provides for mutual settlements for the health care services provided.

20. A pharmacist or pharmacist’s assistant who issues the medicinal products, taking into account the contract entered into with the insurance company and the conditions of the insurance policy, shall indicate the name of insurance company and the amount of the compensation, if the insurance company compensates the patient for supply of the medicinal products.[26 June 2007]

21. A physician shall indicate the amount of the State compensation, if the medicinal products or medical devices are written out on a prescription in accordance with the compensation procedures specified.

22. On all special prescriptions the physician shall indicate the diagnosis code in conformity with the ICD classification. In ordering glycemia test strips for pregnant women the code “Z33” shall be indicated in addition to the primary diagnosis.[26 June 2007]

22.1 [2 June 2008][26 June 2007; 2 June 2008]

23. A pharmacist or assistant pharmacist, who dispenses the medicinal products, shall indicate the code (the identification number of the medicinal product in the list of compensated


medicinal products for medicinal products distributed within the scope of the procedures for compensation or the registration number of the medicinal product in the Latvian Medicinal Product Register – in other cases) or name (the name shall be indicated if the medicinal product is not included in the Latvian Medicinal Product Register), quantity (number of packages), price (of one package) of the medicinal products dispensed, the amount intended for payment (taking into account the number of packages), the allocation thereof between patient and other payer, as well as the date of medicinal product dispensation, confirming this information with a signature, personal stamp and a stamp of the dispensing pharmacy. If the quantity to be dispensed is not in full packages, the quantity of packages shall be indicated in decimals with a precision of up to four figures after the decimal point.[26 June 2007]




8 March 2005

Medicinal products Permitted to Order on an Ordinary Prescription Form for Treatment Course of More than Three Months

No. Anatomical therapeutic chemical group of medicinal products

Exceptions (medicinal products permitted to order

on a single prescription for a treatment course of not more

than three months)

1. Gastrointestial Tract and Metabolism

1.1. Agents for treatment of functional gastrointestinal disorders

A03BA01 Atropine

A03BA03 Hyoscyamine

A03FA02 Cisapride

1.2. Agents for treatment of liver diseases and bile production or bile flow disorders

1.3. Agents for diabetes treatment (A10)

2. Blood and Haemopoietic Organs

2.1. Antithrombotic agents (B01AC07 Dipyridamole)

3. Cardiovascular System

3.1. Vasodilators to be utilised for treatment of heart diseases (C01D)

3.2. Antihypertensive agents (C02) C02BA01 Trimetaphan

C02CC02 Guanethidine

C02CC04 Debrisoquine

C02DA01 Diazoxide

3.3. Diuretic agents (C03)

3.4. Beta blockers (C07)

3.5. Calcium channel blockers (C08) C08EA02 Bepridil

C08EX01 Lidoflazine

3.6. Renine-angiotensine system influencing agents (C09)

3.7. Serum lipid level reducing agents (C10) C10AX02 Probucol

C10AX04 Benfluorex

C10AX09 Ezetimibe





than three months)

4. Urogenital System and Sexual Hormones

4.1. Hormonal contraceptive agents for systematic use (G03A)

4.2. Oestrogens (G03CA, natural and semi-synthetic)

4.3. Combinations of oestrogens (G03CC04 Estrone, G03CC06 Estriol)

4.4. Progestagens (G03D) G03DA01 Gestonorone

G03DB02 Megestrol

G03DB04 Nomegestrol

4.5. Combinations of progestagens and oestrogens (G03F) G03FB03 Chlormadinone and Estrogen

4.6. Urological agents including spasmolythic agents (G04B) G04BE01 Alprostadil

5. Systemic Hormone-Containing Agents Except Sexual Hormones and Insulins

5.1. Agents containing thyroid gland hormone

5.2. Antithyroid agents (H03B)

5.3. Antiparathyroid hormones (H05B)

6. Muscle and Skeleton System

6.1. Anti-inflammatory and antirheumatic agents, non-steroidal (M01AA, M01AB, M01AC, M01AE, M01AG, M01AX)

M01AA02 Mofebutazone

M01AX17 Nimesulide

6.2. Central acting muscle relaxants (M03B)

6.3. Antigout agents (M04A) M04AB03 Benzbromarone

7. Nervous System

7.1. Antimigraine agents, alkaloids (N02CA)

7.2. Antiepileptic agents (N03) N03AG04 Vigabatrin

N03AX10 Felbamate

7.3. Antiparkinson agents (N04) N04BA Dopa and dopa derivatives

8. Respiratory System

8.1. Agents for treatment of obstructive airways diseases, adrenergic agents, inhalable agents (R03A)

R03AA01 Epinephrine

R03AK01 Epinephrine in combinations

8.2. Other agents for treatment of obstructive airways diseases, Translation © 2008 Tulkošanas un terminoloģijas centrs (Translation and Terminology Centre) 19




than three months)

inhalable agents (R03BB, R03BC, R03BX)

8.3. Other agents for treatment of obstructive airways diseases, systemic agents (R03DA, R03DB, R03DX)

R03DA04 Theophylline R03DA74, in R03DB04 Theophylline combinations

9. Sense Organs

9.1. Antiglaucoma and myotic agents (S01E) S01EA05 Brimonidine

S01EB03 Ecothiopate

S01EB04 Demecarium

S01EB08 Aceclidine




8 March 2005

Maximum Amount of Narcotic and Equivalent Psychotropic Substances Permitted to Order on a Single Prescription

No. International name of the substance

Maximum amount of substance permitted to order on a prescription

(in grams)

Notes

1. Buprenorphine hydrochloride 0.224

2. Cyclobarbital 1,0

3. Dihydrocodeine tartrate 6.72

4. Ethylmorphine 1.0

5. Fentanyl 0.084 no more than 10 adhesive plasters

5.1 Hydromorphone hydrochloride

6.4

6. Codeine 0.3

7. Methylphenidate hydrochloride

0.6

8. Morphine hydrochloride 0.4 in injection solutions

9. Morphine hydrochloride 6.0 in pellets

10. Morphine sulphate 12.0

11. Oxycodone 4.48

12. Petidine 0.5

13. Pentazocine 0.3

14. Trimeperidine 0.4[26 June 2007]




8 March 2005

Generally Accepted Prescription Abbreviations

No. Full designation in Latin Abbreviation Designation in Latvian

1. acidum acid., ac. skābe [acid]

2. adde pievieno, piejauc [add, admix]

3. ad manum medici ad man. med. ārsta rokās [in the hands of a physician]

4. ad usum externum ad us. ext. ārīgai lietošanai [for external use]

5. ad usum internum ad us. int. iekšķīgai lietošanai [for internal use]

6. ad usum proprium ad us. propr. personīgai lietošanai [for personal use]

7. ad vitrum ad vitr. stikla traukā [in a glass container]

8. aequalis aeq. vienāds [equal]

9. ampulla amp., ampull. ampula [ampoule]

10. ana āā līdzīgās daļās, pa [in equal parts, by]

11. anhydricus anhydr. bezūdens [waterless]

12. aqua aq. ūdens [water]

13. aqua destillata aq. dest. destilētais ūdens [distilled water]

14. butyrum butyr. sviests [butter]

15. compositum comp. salikts [compound]

16. capsula amylacea caps. amyl. cietes kapsula [starch capsule]

17. capsula gelatinosa caps. gel. želatīna kapsula [gelatine capsule]

18. charta chart. papīrs [paper]

19. charta cerata chart. cer. vaskots papīrs [wax paper]

20. charta paraffinata chart. paraff. parafīna papīrs [paraffin paper]

21. concentratus conc. koncentrēts [concentrated]

22. cortex cort. miza [peel]

23. crystallisatus cryst. kristālisks [crystalline]

24. cum c. ar [with]



25. Da; Detur; Dentur D. dod; lai tiek dots; lai tiek doti [give; to be given]

26. Da in scatula D. in scat. dod kārbiņā [to be given in a box]

27. Da in vitro D. in vitr. dod stikla traukā [to be given in a glass container]

28. Da in vitro nigro D. in vitro nigro dod tumšā traukā [to be given in a dark container]

29. Da, Signa; Dentur, Signetur D.S. dod, apzīmē; lai tiek dots, lai tiek apzīmēts [give, designate; to be given, to be designated]

30. Da tales doses;

Dentur tales doses

D.t.d. dod tādas devas; lai tiek dotas tādas devas; izsniegt šādas devas [give such doses; to be given such doses; to dispense the following doses]

31. decoctum dec. novārījums [decoction]

32. depuratus dep. attīrīts [purified]

33. destillatus destill. destilēts [distilled]

34. dilutus dil. atšķaidīts [diluted]

35. divide in partes aequales div. in p. aeq. sadali vienādās devās; sadali līdzīgās devās [divide in equal parts; divide in similar parts]

36. dosis d., dos. deva [dose]

37. emplastrum empl. plāksteris [adhesive plaster]

38. emulsum, emulsio emuls. emulsija [emulsion]

39. extractum extr. ekstrakts, izvilkums [extract; essence]

40. extractum fluidum extr. fl. šķidrais ekstrakts [liquid extract]

41. extractum siccum extr. sicc. sausais ekstrakts [dry extract]

42. extractum spissum extr. spiss. biezais ekstrakts [thick extract]

43. fiat (fiant) f.lai pagatavotu, lai top, lai veidotos [in order to prepare, let it become, in order to form]

44. flores fl. ziedi [flowers]

45. folium fol. lapa [leaf]

46. fructus fr. auglis [fruit]



47. gelatina gel. želatīna [gelatine]

48. globulus glob. lodīte [pellet]

49. gutta, guttae gtt. piliens, pilieni [droplet, droplets]

50. guttas gtts pilienus [droplets]

51. herba hb. laksti, zāle [tops, grass]

52. in ampullis in amp., ampull. ampulās [in ampoules]

53. infusum inf. uzlējums [infusion]

54. in capsulis in caps. kapsulās [in capsules]

55. in oblatis in obl. oblatēs [in cachet shell]

56. in tabulettis in tab., in tabul. tabletēs [in pellets]

57. linimentum lin., linim. šķidrā ziede, liniments [liquid ointment, liniment]

58. liquor, liquidus liq. šķidrums, šķidrs [liquid element, fluidal]

59. massa m. masa [mass]

60. massa pilularum m. pil. zirnīšu masa [mass of pillules]

61. Misce; Misceatur M. sajauc; lai tiek sajaukts, samaisīts [mix; let it be mixed, blended]

62. Misce.Da.Signa;

Misceatur, Detur, Signetur

M.D.S. sajauc, dod, apzīmē; lai tiek sajaukts, dots, apzīmēts [mix, give, designate; let it be mixed, given, designated]

63. Misce fiat M.f. sajauc, lai top [mix; let it become]

64. mixtura mixt. mikstūra [mixture]

65. mucilago muc. gļotas [mucus]

66. numero N. skaitā [in number]

67. oleum ol. eļļa [oil]

68. pars, partes p. daļa, daļas [part, parts]

69. partes aequales p. aeq. vienādas daļas, vienādās (līdzīgās) devās [equal parts, equal (similar) parts]

70. paste past. pasta [paste]

71. pilula, pilulae pil. zirnītis, zirnīši [pillule, pillules]

72. praecipitatus ppt., praec. izgulsnēts – nogulsnes



[precipitated – sediment]

73. pro injectionibus pro inj. iešļircināšanai [for injection]

74. pro usu externo pro us. ext. ārīgai lietošanai [for external use]

75. pro usu interno pro us. int. iekšķīgai lietošanai [for internal use]

76. pulvis, pulveres pulv. pulveris [powder]

77. purus pur. tīrs [pure]

78. quantum satis q.s. cik vajag; vajadzīgajā daudzumā [in the amount required]

79. radix rad. sakne [root]

80. Recipe Rp. ņem [take]

81. repete, repetatur repet. atkārtot; lai tiek atkārtots [repeat; to be repeated]

82. rhizoma rhiz. saknenis, zemes stumbrs [rhizome; rootstock]

83. satis s. diezgan, pietiekami [enough; sufficient]

84. semen sem. sēklas [seeds]

85. seu, sive s. jeb [or]

86. siccus sicc. sauss [dry]

87. Signa, Signetur S. apzīmē; lai tiek apzīmēts [designate; to be designated]

88. simplex simpl. vienkāršs [simple]

89. sirupus sir. sīrups [syrup]

90. solutio sol. šķīdums [solution]

91. species spec. zāļu tēja [herbal tea]

92. spiritus spir. spirts [alcohol]

93. sublimatus subl. sublimēts [sublimated]

94. subtilis subt. smalks [subtle]

95. subtilissimus subtiliss. vissmalkākais [the subtlest]

96. suppositorium supp. svecītes [suppositories]

97. suppositorium rectale supp. rect. svecīte, rektālais supozitorijs [suppository, rectal suppository]

98. suppositorium vaginale supp. vag. vaginālais supozitorijs [vaginal



suppository]

99. tabuletta; tabulettae tab., tabul. tablete, tabletes [pill; pills]

100. tales t. tādas [such]

101. tinctura t-ra, tinct., tct. tinktūra [tincture]

102. unguentum ung. ziede [ointment]

103. verte V. apgriez [reverse]

104. vitrum vitr. stikla trauks, trauks [glass container; container]



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