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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 696 (January 28, 2023).

49 Pa. Code § 18.6a. Prescribing, dispensing and administering drugs.

§ 18.6a. Prescribing, dispensing and administering drugs.

 (a)  No Schedule I controlled substances. A nurse-midwife may not prescribe or dispense Schedule I controlled substances as defined by section 4 of The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. §  780-104).

 (b)  Prescribing, dispensing and administering drugs. A nurse-midwife who has prescriptive authority may prescribe, administer and dispense drugs as follows:

   (1)  A nurse-midwife may prescribe, dispense or administer Schedule II through V controlled substances and legend drugs in accordance with the following restrictions:

     (i)   A nurse-midwife may not prescribe, dispense, order or administer a controlled substance except for a woman’s acute pain.

     (ii)   In the case of a Schedule II controlled substance, the dose must be limited to 72 hours and may not be extended except with the approval of the collaborating physician.

     (iii)   In the case of a Schedule III or IV controlled substance, the prescription must be limited to 30 days and shall only be refilled with the approval of the collaborating physician.

     (iv)   A nurse-midwife may prescribe, dispense, order or administer psychotropic drugs only after consulting with the collaborating physician.

     (v)   A nurse-midwife may only prescribe or dispense a drug for a patient in accordance with the collaborative agreement.

     (vi)   A nurse-midwife may not delegate prescriptive authority to another health care provider.

   (2)  A nurse-midwife authorized to prescribe or dispense, or both, controlled substances, shall register with the United States Drug Enforcement Administration.

 (c)  Prescription blanks. The requirements for prescription blanks are as follows:

   (1)  Prescription blanks must bear the license number of the nurse-midwife and the name and contact information, including phone number, of the nurse-midwife in a printed format at the heading of the blank, as well as the initials ‘‘C.N.M.’’ or similar designation.

   (2)  The signature of the nurse-midwife must be followed by the initials ‘‘C.N.M.’’ or similar designation to identify the signer as a nurse-midwife.

   (3)  A nurse-midwife may use a prescription blank generated by a hospital or other licensed healthcare facility, provided the information in paragraph (1) appears on the blank.

   (4)  Prescription blanks may not be presigned by the nurse-midwife or collaborating physician.

 (d)  Inappropriate prescribing. Any party who identifies an inappropriate prescription shall immediately advise the nurse-midwife or the collaborating physician. The nurse-midwife or collaborating physician shall advise the patient to modify or discontinue use of the drug as medically appropriate. In the case of a written prescription, the nurse-midwife or the collaborating physician shall notify the pharmacy of the changes to the prescription. The order to modify or discontinue the use of the drug or prescription must be noted in the patient’s medical record. The nurse-midwife shall seek consultation as medically indicated.

 (e)  Recordkeeping requirements. Recordkeeping requirements are as follows:

   (1)  When prescribing a drug, the nurse-midwife shall record in the patient’s medical record the name, amount, directions for use and doses of the drug prescribed, the number of refills, the date of the prescription and the nurse-midwife’s name. When utilizing electronic prescribing, the nurse-midwife shall comply with the requirements of the State Board of Pharmacy in §  27.201 (relating to electronically transmitted prescriptions).

   (2)  When dispensing a drug, the nurse-midwife shall record in the patient’s medical record the name, amount, directions for use and doses of the medication dispensed, the date dispensed, and the nurse-midwife’s name.

 (f)  Compliance with regulations relating to prescribing, administering, dispensing, packaging and labeling of drugs. A nurse-midwife shall comply with § §  16.92—16.94 (relating to prescribing, administering and dispensing controlled substances; packaging; and labeling of dispensed drugs) and Department of Health regulations in 28 Pa. Code § §  25.51—25.58 (relating to prescriptions) and regulations regarding packaging and labeling dispensed drugs. See §  16.94 and 28 Pa. Code § §  25.91—25.95 (relating to labeling of drugs, devices and cosmetics).


   The provisions of these sections 12 and 35 of the Medical Practice Act of 1985 (63 P. S. § §  422.12 and 422.35), unless otherwise noted.


   The provisions of this §  18.6a adopted April 3, 2009, effective April 4, 2009, 39 Pa.B. 1625.

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