Chapter 3 of 421.25% of exam

Order Entry and Processing

Order entry turns a prescriber's instructions into an accurate label, a correct quantity, and a billable claim. This chapter covers intake, sig translation, the calculations technicians perform daily, and the packaging and labeling that finish the job.

Prescription Intake and Data Entry

Processing begins by confirming that the order is complete, legitimate, and matched to the right patient profile. Missing elements must be resolved before the prescription moves forward. Accurate entry at this stage prevents downstream errors in dispensing and billing.

Required elements of a prescription
A valid order shows the patient's name and address, the date issued, the drug name, strength, and quantity, complete directions for use, refill authorization, and the prescriber's name, address, and signature.
Patient profile setup
Record demographics, allergies, current medications, disease states, and insurance details so the system can screen for interactions and duplicate therapy.
Electronic prescriptions
E-prescriptions arrive already structured, but the technician still confirms drug, strength, quantity, and directions against the transmitted record instead of assuming the data is correct.
Refills and authorization
Refills are dispensed only within the number and time frame authorized, and requests beyond that must go to the prescriber for new authorization.
Third-party claim fields
Claims require the correct BIN, PCN, group number, member ID, and person code, and rejections often trace to a mismatch in one of these fields or in days supply.
Prior authorization and rejections
When a plan rejects a claim for prior authorization, quantity limits, or non-formulary status, the technician documents the message and routes the clinical decision to the pharmacist or prescriber.

Sig Codes and Directions

Prescribers compress directions into abbreviations drawn largely from Latin, and the technician expands them into plain patient language. The translation must state how much, how, how often, and for what purpose when indicated. Certain abbreviations are banned because they invite misreading.

Frequency abbreviations
QD is once daily, BID is twice daily, TID is three times daily, QID is four times daily, QAM is every morning, QHS is at bedtime, and q4h means every four hours.
Quantity and form abbreviations
Common terms include tab for tablet, cap for capsule, gtt for drop, tsp for teaspoonful (5 mL), tbsp for tablespoonful (15 mL), and ss for one half.
Condition and timing terms
PRN means as needed, AC is before meals, PC is after meals, HS is at bedtime, and UD or UT DICT means use as directed.
Translating a sig
The sig i tab PO BID PRN pain becomes Take one tablet by mouth twice daily as needed for pain, written in plain language at an accessible reading level.
Dangerous abbreviations
Reject or clarify orders using U, IU, QD, QOD, cc, or a trailing zero, because each has been repeatedly misread as a different value.
ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations
Auxiliary label selection
The sig and the dosage form drive auxiliary labels such as shake well, take with food, may cause drowsiness, avoid sunlight, and do not crush or chew.

Days Supply and Dosage Calculations

Days supply drives both the label and the insurance claim, and an incorrect value causes rejections or early refill problems. Most dosing math reduces to ratio and proportion or to a weight-based formula. Always convert units before dividing.

Days supply formula
Divide the total quantity dispensed by the total amount used per day, so 60 tablets taken twice daily equals a 30-day supply.
Liquid days supply
Convert the sig to milliliters per day and divide the bottle volume by that number, remembering that one teaspoonful equals 5 mL and one tablespoonful equals 15 mL.
Insulin days supply
Standard insulin is 100 units per mL, so a 10 mL vial contains 1000 units and a patient using 40 units per day has a 25-day supply.
Weight-based dosing
Convert pounds to kilograms by dividing by 2.2, then multiply the kilogram weight by the milligrams per kilogram to reach the dose.
Ratio and proportion
Set the known concentration equal to the unknown quantity in the same units and cross multiply, which handles most strength and volume conversions.
Metric conversions
One kilogram equals 1000 grams, one gram equals 1000 milligrams, one milligram equals 1000 micrograms, one liter equals 1000 milliliters, and one fluid ounce is about 30 mL.

Compounding Math and IV Rates

Compounding requires expressing strength consistently and combining or diluting stock to reach the ordered concentration. Infusion orders add a time dimension that converts volume into a rate. Each formula below appears regularly on the exam.

Percent strength
Percent weight in volume is grams per 100 mL, percent weight in weight is grams per 100 grams, and percent volume in volume is milliliters per 100 mL.
Ratio strength
A ratio strength such as 1:1000 means one gram of drug in 1000 mL of solution, which equals one milligram per milliliter.
Dilution formula
Use the first concentration times the first volume equals the second concentration times the second volume to find how much stock solution and diluent are needed.
Alligation
When mixing a higher and a lower strength to reach a desired middle strength, subtract diagonally to find the number of parts of each component, then convert parts to actual quantities.
IV flow rate in mL per hour
Divide the total infusion volume by the infusion time in hours, so 1000 mL over 8 hours runs at 125 mL per hour.
Drop rate
Multiply the milliliters per minute by the administration set drop factor in drops per milliliter to obtain drops per minute.

Business Math, Packaging, and Labeling

Pharmacies must price, bill, and stock products correctly while dispensing them in compliant containers. Business math questions center on cost, markup, and inventory turnover. Labeling and packaging rules protect the patient after the prescription leaves the counter.

Average wholesale price and markup
Markup is the selling price minus the acquisition cost, and the markup percentage is that difference divided by the cost, while reimbursement formulas often start from average wholesale price minus a discount plus a dispensing fee.
Gross profit and discounts
Gross profit is revenue minus cost of goods sold, and a discount reduces the price by the stated percentage of the original amount.
Inventory control
Turnover equals annual cost of goods sold divided by average inventory value, and par levels with reorder points keep fast movers in stock without overbuying.
Prescription label elements
The dispensed label must show the pharmacy name and address, prescription number, date, patient name, prescriber name, drug name and strength, quantity, directions, refills remaining, and beyond-use or expiration date.
Child-resistant packaging
Most oral prescription drugs must be dispensed in child-resistant containers unless the prescriber or the patient requests otherwise in the manner allowed by law.
Poison Prevention Packaging Act of 1970
Repackaging beyond-use dates
A repackaged solid oral dose in a unit-dose container is given a beyond-use date no later than one year from repackaging or the manufacturer expiration date, whichever comes first, unless stability data support otherwise.
USP <795>
Test your knowledge
Practice questions on Order Entry and Processing
Practice now →
← Previous
Patient Safety and Quality Assurance
Next →
Federal Requirements

Last updated: July 2026

Report