Thank you for choosing Rcopia, the award-winning e-prescribing system from DrFirst! This packet contains all the registration forms needed to get

Transcription

1 Thank you for choosing Rcopia, the award-winning e-prescribing system from DrFirst! This packet contains all the registration forms needed to get your practice up-and-running with Rcopia.

2 Registration Packet This packet contains all of the registration forms needed to get your practice up and running with Rcopia and Rcopia-MU. Please fill out and fax (or scan+ ) these forms, as well as a copy of each Provider s DEA license to your Sales Representative. Below you will find definitions for the different roles within Rcopia and Rcopia-MU. Take a moment to familiarize yourself with these roles and their respective functions. You will be asked to assign these roles to staff members within your office. For offices with more than one Provider, simply photocopy the Provider Registration Form found on the next page so that each Provider has his or her own copy. Role Typical User Primary Functions Physician Physician Nurse Practitioner Physicians Assistant Electronically create, sign & send prescriptions Approve renewals Delete patients from the practice s account Add, delete, or edit patients medication and allergy lists Capable of performing Provider Agent, Clinical Staff, and Non-Clinical Staff functions as well Provider Agent Nurse Electronically send prescription on behalf of provider; copy is sent to provider for signature Create prescriptions for provider to sign Approve renewals, copy is sent to provider for signature Add pharmacies to the practice list Capable of performing Clinical Staff and Non-Clinical Staff functions as well Clinical Staff Nurse Medical Assistant Create prescriptions for provider to sign Add or edit patients medication and allergy lists Capable of performing Non-Clinical Staff functions as well Non-Clinical Front Desk Staff Add patients to the practice account Edit patient demographic information Designate patients default pharmacy View prescription report

3 Rcopia Provider Registration By signing below the provider acknowledges that he/she: is a licensed practitioner with the legal authority to write prescriptions in the state(s) in which he/she practices medicine. I also hereby affirm that except as set forth in this paragraph, I will personally prescribe and order the medications using the user identifier ("user ID") and password provided to me by DrFirst. To the extent that someone other than myself uses the Rcopia system to order medications that I prescribe for patients who are under my care (for purposes of this agreement such person is referred to as the "Provider Agent") such person will be acting pursuant to my express written instructions and I agree that I am solely responsible for insuring that adequate documentation exists verifying that I am the prescribing physician and that such documentation will be provided to the Pharmacy dispensing such medication, and/or DrFirst, if requested. Name of Practice: Name of Provider: (PLEASE PRINT or TYPE) Provider Signature Please provide your signature in the box below so that we can include it on your prescriptions when a signature is required. Please be sure to fill the entire box with your signature, but do not allow it to touch the sides. Please fax this form to (352) Please DO NOT attach cover sheet. Also include the following documents once completed: Copies of your DEA registration and state medical license Provider Agent authorization form If you have any questions about the form or how to register your staff, please call (800) to speak with a DrFirst Implementation Specialist.

4 Provider Agent Agreement I, hereby affirm that except as set forth in this paragraph, I will personally prescribe and (Physician Name) order the medications using the user identifier ( user ID ) and password provided to me by DrFirst. To the extent that someone other than myself uses the Rcopia/Rcopia-MU system to order medications that I prescribe for patients who are under my care (for purposes of this agreement such person is referred to as the Provider Agent ) such person will be acting pursuant to my express written instructions and I agree that I am solely responsible for insuring that adequate documentation exists verifying that I am the prescribing physician and that such documentation will be provided to the Pharmacy dispensing such medication, and/or DrFirst, if requested. Date Practice Name Physician Signature External ID/Single Sign On ID (if applicable) Staff Registration Staff Member Name Provider Agent Clinical Staff Non-clinical Staff

5 Rcopia Provider Credentials Please complete field under each heading. You may either PRINT or type directly into the text fields. Do not send registration paperwork unless these fields are completed. Thank you for you r cooperation.