Medication Prescription form
The Medication Prescription form includes the details of the prescription ordered for a patient.
|
Field |
Description |
|---|---|
|
Medication Prescription | |
|
Number |
Auto-generated number for the prescription. |
|
Patient |
Name of the patient to whom the medication will be given. |
|
Medication product |
Medication product being prescribed for the patient. |
|
Practitioner |
Name of the practitioner who ordered the prescription for the patient. |
|
Prior prescription |
Prescription ordered earlier for the patient. |
|
Reference Medication event |
Encounter that identifies the occurrence of contact between patient and healthcare provider. |
|
Organization |
Healthcare provider that is responsible for the prescription. |
|
Dosage specification |
Dosage specification for the patient. Note: This field is set as mandatory only when a program is associated with the case. In this case, the medication prescription is entered according to the dosage specification published for the program. |
|
Status |
Status of the ordered prescription. The following statuses are available by default:
For more information about the available statuses, see medication prescription statuses defined in the FHIR specifications. |
|
Status reason |
Explanation of the selected status. |
|
Priority |
Urgency of the prescription that is used to make informed decision if needing to be prioritized. |
|
Date authored |
Date and time when the prescription was written. |
|
Validity start date |
Earliest time of the validity period of the prescription. |
|
Validity end date |
Latest time of the validity period of the prescription. |
|
External ID |
Identifier of the record in an electronic medical record (EMR) system. |
|
Case |
Enrollment case associated with the prescription. |
|
Diagnosis details | |
|
When a program is associated with the case, each field in this section is automatically set to its corresponding value included in the program. | |
|
Primary diagnosis |
Main condition in a patient submitted by the practitioner as the reason for the healthcare service requested. |
|
Tertiary diagnosis |
Highly specialized medical care recommended for the patient by the practitioner. |
|
Secondary diagnosis |
Coexisting condition that might exist in a patient submitted by the practitioner. |
|
Dosage characteristics | |
|
This section appears only when a dosage specification is associated with the medication prescription. The section displays dosage characteristics configured by your administrator for the selected dosage specification. | |
|
Dosage details | |
|
This section is automatically populated when a dosage specification is selected for the medication prescription. The fields within this section are read-only and populated corresponding to their dosage characteristics. When no dosage specification is selected, the section displays the value as entered by a healthcare representative. | |
|
Dosage |
Recommendation of the medication dosage. |
|
Quantity |
Quantity of the specified medication in one fill. |
|
Number of authorized refills |
Number of authorized refills for the medication. |
|
Instructions for patient |
Instructions for the dosage of the medication product. |
--- title: Medication Prescription form description: The Medication Prescription form includes the details of the prescription ordered for a patient. locale: en-US canonical_url: https://www.servicenow.com/docs/r/australia/healthcare-life-sciences/healthcare-and-life-sciences-service-management-core/hcls-med-prescription-form.html release: australia product: Healthcare and Life Sciences Service Management Core classification: healthcare-and-life-sciences-service-management-core topic_type: reference last_updated: "2026-09-10" reading_time_minutes: 2 breadcrumb: [Reference, Healthcare and Life Sciences Service Management Core, Healthcare and Life Sciences Service Management, Healthcare and Life Sciences] --- # Medication Prescription form The Medication Prescription form includes the details of the prescription ordered for a patient. <table id="table_ut3_b5r_crb"><thead><tr><th> Field </th><th> Description </th></tr><tr class="sub-head"><th colspan="2"> Medication Prescription </th></tr></thead><tbody><tr><td> Number </td><td> Auto-generated number for the prescription. </td></tr><tr><td> Patient </td><td> Name of the patient to whom the medication will be given. </td></tr><tr><td> Medication product </td><td> Medication product being prescribed for the patient. </td></tr><tr><td> Practitioner </td><td> Name of the practitioner who ordered the prescription for the patient. </td></tr><tr><td> Prior prescription </td><td> Prescription ordered earlier for the patient. </td></tr><tr><td> Reference Medication event </td><td> Encounter that identifies the occurrence of contact between patient and healthcare provider. </td></tr><tr><td> Organization </td><td> Healthcare provider that is responsible for the prescription. </td></tr><tr><td> Dosage specification </td><td> Dosage specification for the patient. **Note:** This field is set as mandatory only when a program is associated with the case. In this case, the medication prescription is entered according to the dosage specification published for the program. </td></tr><tr><td> Status </td><td> Status of the ordered prescription. The following statuses are available by default: - Active - Draft - Cancelled - Completed - Entered in error - Expired - On-Hold - Stopped - Unknown For more information about the available statuses, see [medication prescription statuses](https://www.hl7.org/fhir/http://www.hl7.org/fhir/2015may/medication-prescription-status.html) defined in the FHIR specifications. </td></tr><tr><td> Status reason </td><td> Explanation of the selected status. </td></tr><tr><td> Priority </td><td> Urgency of the prescription that is used to make informed decision if needing to be prioritized. </td></tr><tr><td> Date authored </td><td> Date and time when the prescription was written. </td></tr><tr><td> Validity start date </td><td> Earliest time of the validity period of the prescription. </td></tr><tr><td> Validity end date </td><td> Latest time of the validity period of the prescription. </td></tr><tr><td> External ID </td><td> Identifier of the record in an electronic medical record \(EMR\) system. </td></tr><tr><td> Case </td><td> Enrollment case associated with the prescription. </td></tr><tr><td class="sub-head" colspan="2"> Diagnosis details </td></tr><tr><td colspan="2"> When a program is associated with the case, each field in this section is automatically set to its corresponding value included in the program. </td></tr><tr><td> Primary diagnosis </td><td> Main condition in a patient submitted by the practitioner as the reason for the healthcare service requested. </td></tr><tr><td> Tertiary diagnosis </td><td> Highly specialized medical care recommended for the patient by the practitioner. </td></tr><tr><td> Secondary diagnosis </td><td> Coexisting condition that might exist in a patient submitted by the practitioner. </td></tr><tr><td class="sub-head" colspan="2"> Dosage characteristics </td></tr><tr><td colspan="2"> This section appears only when a dosage specification is associated with the medication prescription. The section displays dosage characteristics configured by your administrator for the selected dosage specification. </td></tr><tr><td class="sub-head" colspan="2"> Dosage details </td></tr><tr><td colspan="2"> This section is automatically populated when a dosage specification is selected for the medication prescription. The fields within this section are read-only and populated corresponding to their dosage characteristics. When no dosage specification is selected, the section displays the value as entered by a healthcare representative. </td></tr><tr><td> Dosage </td><td> Recommendation of the medication dosage. </td></tr><tr><td> Quantity </td><td> Quantity of the specified medication in one fill. </td></tr><tr><td> Number of authorized refills </td><td> Number of authorized refills for the medication. </td></tr><tr><td> Instructions for patient </td><td> Instructions for the dosage of the medication product. </td></tr></tbody> </table>**Parent Topic:**[Healthcare and Life Sciences Service Management Core reference](https://raw.githubusercontent.com/ServiceNow/ServiceNowDocs/australia/markdown/australia/healthcare-life-sciences/healthcare-and-life-sciences-service-management-core/hcls-serv-mgmt-core-reference.md)
| title | Medication Prescription form |
| description | The Medication Prescription form includes the details of the prescription ordered for a patient. |
| locale | en-US |
| canonical_url | https://www.servicenow.com/docs/r/australia/healthcare-life-sciences/healthcare-and-life-sciences-service-management-core/hcls-med-prescription-form.html |
| release | australia |
| product | Healthcare and Life Sciences Service Management Core |
| classification | healthcare-and-life-sciences-service-management-core |
| topic_type | reference |
| last_updated | 2026-09-10 |
| reading_time_minutes | 2 |
| breadcrumb | ReferenceHealthcare and Life Sciences Service Management CoreHealthcare and Life Sciences Service ManagementHealthcare and Life Sciences |