Article 5: Clinical Verification Process

Overview

Clinical verification is a critical step where the pharmacist reviews and approves the prescription before it can be filled. This article covers the verification checks, documentation requirements, and the approval process.

Accessing Clinical Verification

Once an order is scheduled, it moves to the Clinical Verification queue.

Navigation:

1. Go to the Clinical section

2. View orders awaiting verification

3. Select an order to begin the verification process

Verification Checks

The pharmacist must complete several verification checks before approving the prescription:

1. Day Supply Verification

Purpose: Confirm the day supply is appropriate for the patient

Steps:

1. Review the day supply shown

2. Compare with patient's dosing schedule

3. Click to confirm verification

2. Cost Verification

Purpose: Ensure the cost/gross profit makes sense

Steps:

1. Review the prescription cost

2. Verify gross profit is within expected range

3. Investigate any anomalies

4. Click to confirm verification

3. Insurance Verification

Purpose: Confirm insurance adjudication is complete and accurate

Steps:

1. Review insurance information

2. Verify coverage details

3. Confirm adjudication is complete

4. Click to confirm verification

4. Clinical Indication

Purpose: Pharmacist confirms clinical appropriateness

Steps:

1. Review the medication and indication

2. Check for drug interactions

3. Verify dosage appropriateness

4. Confirm clinical approval

Automatic Documentation

Signature and Timestamp

As each verification is completed:

• The system automatically captures a digital signature

• A timestamp is recorded

• The verifying pharmacist is documented

Note: In the live system, the actual prescription image is also displayed for reference.

Verification Screen Layout

SectionInformation DisplayedPatient InfoName, DOB, allergiesPrescriptionMedication, strength, quantityDay SupplyNumber of days coveredCostPatient cost, insurance paymentInsurancePayer information, adjudication statusNotesAny relevant order notesVerification CheckboxesEach check to be completed

Completing Verification

Complete Verification Button

Once all checks are confirmed:

1. Review that all verification items show as complete

2. Click Complete Verification

3. The order moves to the Filling Queue

Verification Status

StatusMeaningPendingAwaiting pharmacist reviewIn ProgressPharmacist actively reviewingVerifiedAll checks complete, ready for fillingOn HoldIssue identified, requires resolution

Assigning Orders

User Assignment

Orders can be assigned to specific team members:

1. Select the order

2. Click the Assign option

3. Choose the user from the dropdown

4. The assigned user sees the order in their queue

Tip: Use assignment to distribute workload or route specific medications to specialized pharmacists.

Adding Notes

Clinical Notes

During verification, pharmacists can add clinical notes:

1. Enter notes in the designated field

2. Notes are saved with a timestamp

3. Notes are visible in the patient's clinical history

Common Note Types:

• Drug interaction considerations

• Dosage adjustments

• Patient counseling points

• Follow-up requirements

Troubleshooting from Clinical

Sending to Troubleshooting

If an issue is identified during verification:

1. Click the troubleshooting option

2. Select the appropriate queue:

   • Billing Troubleshooting - Insurance/billing issues

   • Scheduling Troubleshooting - Delivery/timing issues

   • Clinical Hold - Clinical concerns

3. Add notes explaining the issue

4. The order is removed from clinical queue

Important: See Article 10: Troubleshooting & Rescheduling Orders for detailed troubleshooting procedures.

Best Practices

Verification Quality

• Review all information carefully before confirming each check

• Don't rush through verifications

• Document any concerns in notes

• Escalate unusual situations appropriately

Documentation

• Be thorough with clinical notes

• Include relevant patient interactions

• Document any deviations from standard process

Quick Reference

VerificationWhat to CheckDay SupplyMatches dosing, appropriate durationCostReasonable gross profit, accurate pricingInsuranceAdjudication complete, coverage confirmedClinicalDrug appropriate, no interactions, correct dose

Next Steps

Once clinical verification is complete, the order moves to Article 6: Prescription Filling & Label Printing where the physical prescription is prepared.