U.S. patent number 3,625,547 [Application Number 04/826,066] was granted by the patent office on 1971-12-07 for composite prescription form.
Invention is credited to William A. Burke.
United States Patent |
3,625,547 |
Burke |
December 7, 1971 |
COMPOSITE PRESCRIPTION FORM
Abstract
A composite prescription form comprising five individual form
parts which are detachably secured together at their upper ends in
a superposed relationship with respect to each other. The
prescription form contains a plurality of preprinted information
and the pharmacist types the form upon receiving a new
prescription. The form is then separated with one portion of the
first or top part being used as a prescription label and the other
portion of the first part being filed for daily computation and
record. The second part of the form is a sack label with the third
part of the form being the prescription itself. The fourth part of
the form is identical to the third part and provides a copy of the
original prescription. The fifth part of the form is a three-line
part which is separable from the form so that it may be secured to
a permanent patient prescription ledger card. A modification of the
form is also disclosed and is designed for use as a refill
prescription form. The modification utilizes three parts which are
substantially identical to parts 1, 2 and 5 of the first described
forms, respectively.
Inventors: |
Burke; William A. (Grand
Island, NB) |
Family
ID: |
25245607 |
Appl.
No.: |
04/826,066 |
Filed: |
May 9, 1969 |
Current U.S.
Class: |
462/56; 283/81;
462/902; 283/900 |
Current CPC
Class: |
B42D
15/00 (20130101); B42D 5/02 (20130101); Y10S
462/902 (20130101); Y10S 283/90 (20130101) |
Current International
Class: |
B42D
5/02 (20060101); B42D 5/00 (20060101); B42D
15/00 (20060101); B11 () |
Field of
Search: |
;282/23,8R,9R,22R,22A
;283/18,21,19 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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|
|
|
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1,176,986 |
|
Aug 1964 |
|
DT |
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1,265,260 |
|
May 1961 |
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FR |
|
1,176,986 |
|
Aug 1964 |
|
DT |
|
Primary Examiner: Michell; Robert W.
Assistant Examiner: Dyer; R. P.
Claims
I claim:
1. A composite prescription form, comprising,
at least a prescription label, a package label and a ledger card
label detachably secured together in a superimposed
relationship,
and a transfer means for transferring impressions from one label to
other of the labels positioned therebeneath,
said prescription label having a perforated tear line provided
thereon for facilitating the separation of said prescription label
into first and second portions, said second portion being a record
stub having a spindle perforation formed therein,
said transfer means having a nontransfer area provided thereon so
that the prescription ingredients will not be indicated on said
package label but will be indicated on said second portion and on
said ledger card label,
a prescription sheet member removably positioned between two of the
aforementioned labels,
and an auxiliary prescription sheet member removably positioned
beneath said prescription sheet member,
said prescription label and said package label being substantially
identical in size, said prescription sheet members having a
substantially greater length than said prescription label and said
package label.
2. A composite prescription form, comprising,
at least a prescription label, a package label, a ledger card label
and a prescription sheet member detachably secured together in a
superimposed relationship,
a transfer means for transferring impressions between the
aforementioned labels and sheet member,
said prescription label and said package label being substantially
identical in size,
said prescription sheet member having a substantially greater
length than said labels so that certain prescription information
may be imprinted on said prescription sheet member without
imprinting said certain prescription information on said
labels.
3. The form of claim 2 wherein said ledger card label has a
substantially shorter length than said prescription label and said
package label so that certain prescription information imprinted on
said prescription label and said package label will not be
imprinted on said ledger card label.
4. A composite prescription form, comprising,
at least a prescription label, a package label, and a ledger card
label detachably secured together in a superimposed
relationship,
and a transfer means for transferring impressions from one label to
other of the labels positioned therebeneath,
said prescription label having a perforated tear line provided
thereon for facilitating the separation of said prescription label
into first and second portions, said second portion being a record
stub having a spindle perforation formed therein,
said transfer means having a nontransfer area provided thereon so
that the prescription ingredients will not be indicated on said
package label but will be indicated on said second portion and on
said ledger card label.
5. The form of claim 4 wherein a prescription sheet member is
removably positioned between two of the aforementioned labels.
6. The form of claim 5 wherein an auxiliary prescription sheet
member is removably positioned beneath said prescription sheet
member.
Description
Current prescription filling practice is such that it takes
approximately 7 minutes for the pharmacist to type the prescription
and copy thereof, prescription label, sack label, patient record
and store record. Obviously, any reduction of this 7 minute period
would be highly economically desirable.
Therefore, it is a principal object of this invention to provide a
composite prescription form.
A further object of this invention is to provide a composite
prescription form which includes five individual parts which are
detachably secured together in a superposed relationship.
A further object of this invention is to provide a composite
prescription form for use with new prescriptions.
A further object of this invention is to provide a composite
prescription form for use with refill prescriptions.
A further object of this invention is to provide a composite
prescription form which substantially reduces the time needed for
typing various forms connected therewith.
A further object of this invention is to provide a composite
prescription form including a three-line part which is designed for
use with a permanent patient prescription ledger card.
A further object of this invention is to provide a composite
prescription form wherein information is transferred from one part
of the form to another to eliminate the necessity of individually
typing the same.
A further object of this invention is to provide a composite
prescription form which is convenient to use.
A further object of this invention is to provide a composite
prescription form which provides a convenient and accurate
record.
A further object of this invention is to provide a composite
prescription form which is economical of manufacture, and refined
in appearance.
These and other objects will be apparent to those skilled in the
art.
This invention consists in the construction, arrangements, and
combination of the various parts of the device, whereby the objects
contemplated are attained as hereinafter more fully set forth,
specifically pointed out in the claims, and illustrated in the
accompanying drawings in which:
FIG. 1 is a top view of the form;
FIG. 2 is an exploded top view of the form illustrating the
individual portions of the form;
FIG. 3 is a sectional view as seen along lines 3--3 of FIG. 1;
FIG. 4 is a top view of a modification of the form;
FIG. 5 is an exploded top view of the form of FIG. 4;
FIG. 6 is a sectional view as seen along line 6--6 of FIG. 4;
and
FIG. 7 is a fragmentary view of a ledger card adapted to have the
fifth part of the first form or the third part of the second form
detachably secured thereto for a permanent patient record.
The composite prescription form of FIGS. 1-3 is generally
designated by the reference numeral 10 and includes parts 12, 14,
16, 18 and 20 and may be constructed of paper generally described
as of the pressure sensitive type so that information will be
transferred between the various parts of the form but it is
preferred that the forms be constructed of conventional paper which
would require that carbons 22, 24, 26 and 28 be employed.
The parts and carbons are assembled in a superposed relationship
and are secured at their upper ends by any convenient means such as
adhesive or the like and such relationship is best illustrated in
FIG. 3.
Part 12 is provided with a perforated tear line 30 which separates
the top area 32 from the bottom area 34 thereof. Bottom area 34 has
a perforated tear line 36 provided therein which separates or
divides it into portions 38 and 40. Bottom area 34 has a preprinted
top line 42 which is divided into areas entitled, DATE, RX NUMBERS,
PATIENT, AMT, INGREDIENT, indicated by the reference numerals 44,
46, 48, 50 and 52 respectively. Bottom area 34 is provided with a
second line 54 positioned below line 42 which is divided into areas
56, 58, 60, 62 and 64 positioned below areas 44, 46, 48, 50 and 52
respectively. Area 58 is preprinted with a prescription number
which happens to be 124658 in this case for purposes of
illustration. Bottom area 34 is also provided with a third line 66
which is divided into areas entitled, DR., REFILLABLE and ADDRESS,
which are indicated by the reference numerals 68, 70 and 72
respectively.
Bottom area 34 is also provided with an area 74 wherein the
doctor's directions would be typed by the pharmacist and an area 76
for the pharmacy label identifying the drugstore with pertinent
information. Area 74 would be larger than that indicated in the
drawings while the pharmacy label would be slightly smaller than
that indicated in the drawings. It is desired that area 74 be large
enough for at least four lines of typing. Portion 40 of bottom area
34 is provided with a subarea 78 entitled DRUG CODE No. (which is
the drug identicode IBM number) and a subarea 80 wherein the
following preprinted statement is found, "Thank you. Save this for
taxes and insurance." The letter N is also found in subarea 80 as
well as line 82 which is followed by the letters R. P. Immediately
above line 82 is the phrase "Rx filled by." Portion 40 is provided
with a spindle perforation 84 formed therein. Portion 34 serves as
the prescription label while portion 40 serves as a daily record
for the drugstore. Portion 40 permits the pharmacist to place the
same on a spindle so that the daily business for one day can be
recorded by adding up the dollar and cents amount of new
prescriptions and counting them for numerical tally. It is
preferred that part 12 be gum backed or have some other suitable
adhesive applied to the back thereof to facilitate the attachment
of portion 38 to the prescription.
Carbon 22 is positioned between parts 12 and 14 and is designed to
transfer information therethrough. Part 14 serves as a sack label
for the actual prescription once it has been placed in the
customer's sack. It contains all the pertinent information of part
12 with the exception that the ingredients area 64' is blocked out.
Area 64' corresponds to and is positioned beneath area 64 of part
12. It is customary practice to not inform the customer of the
ingredients in the prescription and that is the reason that area
64' is blocked out.
Carbon 24 is positioned beneath part 14 and above part 16 as
illustrated in the drawings. Part 16 is the prescription itself and
contains all the information of part 12 besides having an area 86
for the actual refill directions of the doctor, the doctor's name
and address and his registry number. Part 16 is also provided with
an area 88 wherein the actual prescription is typed or written in
full detail.
Carbon 26 is positioned beneath part 16 and above part 18 as
illustrated in FIG. 3. Part 18 is identical to part 16 so that it
is available in the instance wherein the pharmacy requires a copy
of the original prescription such as: A copy for filing in cases of
narcotics, abuse drugs, or possible for a telephone copy
prescription to mail back to the doctor. Parts 16 and 18 are
provided with perforations 73, 75 and 77, 79 respectively to
facilitate their positioning in the prescription file.
Carbon 28 is positioned beneath part 18 and above part 20 as
illustrated in FIG. 3. Part 20 is provided with lines 42', 54', and
66' which correspond with lines 42, 54 and 66 of part 12
respectively. Part 20 is comprised of Davac paper or other suitable
paper of the label type having an adhesive or the like on the back
side thereof so that it may be removed from the form 10 and
conveniently secured to a patient prescription ledger card
generally referred to by the reference numeral 90 in FIG. 7. The
patient prescription ledger card 90 is set up with the patient's
name and address, his doctors, the children and wife's name and the
allergies of anyone in the family that the pharmacist should be
concerned with. Part 20 is stuck onto the ledger card 90 in
vertical order as the patient has the prescription filled. The
ledger card is maintained in the pharmacist's files for purposes
of:
1. Being able to find the prescription number if the patient loses
the prescription;
2. For reference by the patient's doctor;
3. For insurance purposes for the patient;
4. For income tax purposes for the patient;
5. For control for drug abuse drugs; and
6. For control of allergies to medication for the patient.
Card 90 may be photocopied at the end of the calendar year and a
copy given to the patient for his income tax and insurance
purposes. It may also be photocopied any time during the year
necessary to fill these demands.
Carbons 22, 24, 26 and 28 are preferably provided with perforated
tear lines 92, 94, 96 and 98 respectively for convenience in
removing the same from the form 10. Parts 12, 14, 16, 18 and 20 are
provided with perforated tear lines 30, 93, 95, 97 and 99
respectively for convenience in removing the same from the form
10.
FIGS. 4-6 illustrate a modification of the form and is referred to
by the reference numeral 100. Form 100 is a three part form
comprised of parts 102, 104 and 106 and carbons 108 and 110. Form
100 is a refill prescription form and is substantially identical to
form 10 to the extent that parts 102, 104 and 106 correspond to
parts 12, 14 and 20 of form 10 respectively. The only difference on
this form is the omission of parts corresponding to parts 16 and 18
and in the omission of a preprinted prescription number. The
remaining difference is that form 100 does not have the letter "N"
which denotes new prescriptions such as in part 12 of form 10.
Upon receiving a new prescription, the pharmacist would place a
form 10 in a typewriter and type the following information:
Date in area 54;
Patient's name in area 60;
Cost of the prescription in area 62;
A one line abbreviation of the ingredients of the prescription in
area 64;
Doctor's name in area 68;
Indicate whether the prescription is refillable in area 70; and
Address of patient in area 72.
The pharmacist would then type the prescription instructions in
area 74 and would indicate the proper national drug code IBM number
in area 78. The pharmacist filling the prescription would then type
or write his initials in area 82 and would type or write the actual
prescription in full detail in area 88. The refill directions would
be indicated in area 86 and the doctor's name, address and registry
number would be also filled in.
When the form 10 has been completed in the manner indicated above,
portion 34 would be torn from the form 10 and portions 38 and 40
separated by means of the perforated tear line 36. Portion 38 would
be secured or attached to the prescription itself since portion 38
has the prescription instructions and pharmacy label thereon.
Portion 40 would be placed on a spindle or the like to provide a
convenient means for the pharmacy to check the daily business.
Carbon 22 may also be removed from the form 10 at this time if it
is convenient to do so. Part 14 would then be torn from the form 10
along the perforated tear line 93 and would be used as a sack label
once the prescription has been placed in the customer's sack. The
sack label contains all of the pertinent information thereon since
the typing of the same on part 12 would be reproduced thereon due
to the carbon 22 being positioned therebetween. Carbon 24 may then
be removed from the form 10 if it is convenient or desirable to do
so. Part 16 would be torn from the form 10 along the perforated
tear line 95 and is the prescription itself. Part 16 contains all
of the previous information besides having the actual refill
directions of the doctor, the doctor's name, address and registry
number and also having a space to write or type the actual
prescription in full detail. Part 16 would then be placed in the
proper pharmacy file. Part 18 would also be removed from the form
10 and would be properly filed if it is necessary to maintain a
duplicate copy for filing in cases of narcotics or drug abuse
drugs. The pharmacist may also wish to mail part 18 to the doctor
if the prescription was conveyed to the pharmacy by way of
telephone. Part 20 is then torn from the form 10 along the
perforated tear line 99 and is placed on the prescription ledger
card as indicated previously. Thus it can be seen that a composite
prescription form has been provided wherein the pharmacist need
only type the information once and result in providing a
prescription label, daily record, sack label, actual prescription,
duplicate copy of the prescription and a part which is secured to
the patient's prescription ledger card. It has been found that the
use of the form 10 results in a savings of approximately 3 minutes
per prescription which results in approximately 25 cents labor
costs being saved per prescription. Form 10 also provides a
convenient and accurate system of maintaining the proper pharmacy
records with a minimum of time.
Form 100 is used in an identical manner to form 10 and is designed
for use when the prescription is a refill prescription. Part 102
serves as the prescription label and business record stub as does
part 12 of the form 10. Part 104 serves as the sack label as does
part 14 of form 10. Part 106 serves the same purpose as the part 20
of form 10. The only difference in the preparation of form 100 with
respect to form 10 is that the prescription number must be written
on part 102 and the fact that parts comparable to parts 16 and 18
have been omitted since the prescription is a refill
prescription.
In summary, form 10 permits the accomplishment of several basic
procedures in a single operation. The form serves as a label; a
record for the store of the dollar amount and the numerical amount
of new prescriptions; it provides a label for a delivery sack or
pickup sack; it provides the original prescription; it provides a
copy of the original prescriptions; and it provides the record form
in the form of a stick-on piece attached to a permanent ledger card
to maintain a patient's record system. All of the above steps are
accomplished in one operation thereby saving many valuable minutes
of the pharmacist's time. Form 100 provides all of the above
features with the exception of the original prescription and copy
thereof. While the foregoing has described that the parts 12, 14,
16, 18 and 20 are individually torn from the form 10, it is also
convenient to simultaneously tear the parts 12, 14, 16 18 and 20
from the form 10.
Thus it can be seen that the forms accomplish at least all of their
stated objectives.
Some changes may be made in the construction and arrangement of my
Composite Prescription Form without departing from the real spirit
and purpose of my invention, and it is my intention to cover by my
claims, any modified forms of structure or use of mechanical
equivalents which may be reasonably included within their
scope.
* * * * *