Record keeping – Ohio Admin. Code 4729-5-27

“Record keeping”

All records relating to the practice of pharmacy, including prescription information entered into the record-keeping system, prospective drug utilization review, patient counseling and prescription information must be uniformly maintained for three years.  All pharmacy records must be uniformly maintained for three years, be readily available, and be produced upon request for inspection by a state board or agent.  All computerized record-keeping systems must be able to provide immediate retrieval of patient profile information for all prescriptions filled within the previous twelve months, and for retrieval within three working days of all prescriptions dispensed within the previous three years.  Patient profile information will include the full name and address of the patient, the name, strength, dosage form and quantity of the drug prescribed and the refill history of the prescription.  Any pharmacy that maintains records at a different location must send written notifications to the state boards.

A computerized record-keeping system must be able to produce both an electronic record and a hardcopy printout and must include specific information.  Hart copy documentation must also include specific information and records of each day.  Every pharmacist must keep a tamper evidence record including date of dispensing, prescription number, patient name, the name and strength and quantity of the drug, identification of the pharmacist, and identification of controlled substances.  A log must be kept of all changes to a prescription record.

Records on all immunizations must be maintained for three years and include the following information:

• Full name and address of the patient;
• Patient’s date of birth or age;
• Patient’s gender; and
• Positive identification of the patient, parent, or legal guardian of the patient who gives informed consent to administer an immunization.