Rx Alert Report Form

The following are acceptable to report to RxAlert for distribution:

Pharmacy/Prescriber initiated reports
a. Stolen prescription pads
b. Prescriber’s request to have prescriptions verified (non‐patient specific)
Examples: all prescriptions for controlled substances or all phoned‐in prescriptions for controlled substances, etc.
c. Thefts, robberies
d. RxPatrol reports (www.rxpatrol.org)

Other reports deemed necessary by RxAlert and regulatory agencies (i.e., CDC Health Alerts & Advisories, NABP e‐alerts, etc.)

Suspected Medicaid fraud should be reported to Medicaid at 888.364.3224.

RxAlert no longer reports identification-specific incidents of forgery, doctor/pharmacy shopping or possible drug‐seeking behavior. Please report these directly to your DHEC Drug Control Inspector and sign up for the DHEC Prescription Monitoring Program (see info below).

DHEC Fact Sheet on Prescription Monitoring Program Available on DHEC Website
The South Carolina Prescription Monitoring Program (PMP), known as SCRIPTS (South
Carolina Reporting & Identification Prescription Tracking System) went into effect Feb. 1, 2008
for pharmacies and dispensing prescribers to comply with submitting schedules II‐IV
controlled substance dispensing activity. SCRIPTS is intended to improve the state’s ability to
identify and stop diversion of prescription drugs in an efficient and cost effective manner
that will not impede the appropriate medical utilization of licit controlled substances where
there is a valid prescriber‐patient or pharmacist‐patient relationship.

For more information on the PMP, contact PMP staff or visit the DHEC Web site.
Phone: 803.896.0688 Website: http://www.scdhec.gov/scripts

Reports of forgeries or other activities regarding controlled substances should be reported directly to your DHEC Drug Control Inspector. Thefts and robberies should be reported immediately to local authorities and regulatory agencies where required by law. Suspected Medicaid fraud should be reported to Medicaid at 888.364.3224.

Name*
First Last
Date of Incident*
Date of Report*
Email*
Phone Number
Reporting Pharmacist/Prescriber*
City*
County*
Reporting Pharmacy Name and Store # OR Prescriber Practice Name*
REPORT CATEGORY Select the option that best describes your report. If needed, more than one may be selected.*
- Stolen prescription pad(s)
- Prescriber requests prescriptions verification
- Theft/Robbery (for purpose of community awareness)
- Other
If "Other", please explain.
SITUATION DESCRIPTION Please completely describe the situation as it should be distributed through RxAlert. NO PATIENT SPECIFIC INFORMATION can be shared through RxAlert – please do not include it*
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Rx Alert Report Form

Rx Alert Report Form

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