Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

TB/LTBI Prescription and Medication Request Guidelines
Medication ordering process:
Carefully and legibly complete the TB/LTBI Prescription and Medication Request Form as soon as
a new TB/LTBI order is received from a provider. Your medical provider should complete the
“Provider Prescription” section. Incomplete forms will be returned for clarification.
Be sure to include the date the medication will be needed at your facility. Medication orders
are batched and shipped weekly by facility for efficiency.
Overnight shipping such as Goldstreak must be preauthorized by the EPI Team.
DOT therapy will be packaged in Dose Packs unless otherwise instructed.
Check the option (Bottles or Dose Packs) of your choice.
Dose Packs are NOT child proof and are required to be stored in a secure area.
All medications must be stored in a secure location out of the reach of children.
Request only the total number of DOSES needed to complete the therapy regimen. Please
reduce the amount requested by any doses that were given from stock or other sources.
When ordering DOT daily dosing, please indicate if you administering 5 or 7 doses a week as
this will impact the auto-refill schedule for the medication.
List the number of doses given from stock on the form. If no doses were given from stock please
indicate “0” on the TB/LTBI Medication Request Form.
TB Medications will be shipped to Public Health Centers and Licensed Medical Clinics.
Fax the TB/LTBI Medication Request form to the Alaska TB program at 907-563-7868 for
review.
Medication refill process:
Request refills on patients who have NOT been enrolled in the auto refill service two weeks
prior to your anticipated need to allow for processing and shipping time. The auto-refill
options negate the need for a facility to request refills.
Prior to dispensing, the Drug Room will fax a list of scheduled medication refills to your facility.
This is an opportunity for each facility to preview their upcoming medication order and
communicate any changes affecting the order PRIOR to its actual refilling and insures orders
are labeled and dispensed accurately and on a timely basis.
Review this fax carefully and note status changes such as discontinued medications, medication
holds, lost clients, wasted doses, etc. If you are in need of a refill medication that does not
appear on this fax, simply add it to this fax. Note, all new medication orders, dosage changes,
provider changes, scheduling changes and duration changes require a new medication request
form be submitted for processing through the normal channels.
Rev 11-28-2012 Page 1