Grocery Pharmacy Prescription Intake Log

Daily log for recording in-store pharmacy prescription intake volume, insurance rejection rates, processing issues, and pharmacist sign-off.

Log Details

• Store Number
• Log Date
• Shift
• Pharmacy Technician Name
• Technician Employee ID

Prescription Intake Summary

• Total Prescriptions Received
  Total count of all new prescriptions received this shift.
• Intake Channels Used This Shift
  Select all channels through which prescriptions were received.
• New Prescriptions
  Count of first-fill prescriptions.
• Refill Prescriptions
  Count of refill prescriptions.
• Controlled Substance Prescriptions (Schedule II–V)
  Count of DEA Schedule II–V prescriptions received. Verify hard-copy requirements per DEA 21 CFR Part 1306.
• Transfers In
  Count of prescriptions transferred in from another pharmacy.

Insurance and Adjudication

• Total Insurance Claims Submitted
• Total Claims Rejected
  Count of claims that received a rejection code from the payer.
• Rejection Rate Note
  Rejection rate = (Claims Rejected ÷ Claims Submitted) × 100. A rate above 10% should be flagged for pharmacist review and documented below.
• Primary Rejection Reason Codes Observed
  Select all NCPDP rejection reason codes encountered this shift.
• Other Rejection Reason Detail
  Describe any rejection codes not listed above.
• Insurance Overrides Processed
  Count of claims requiring manual override or pharmacist intervention.
• Cash-Pay Prescriptions
  Count of prescriptions processed without insurance (cash, discount card, etc.).

Processing Exceptions and Holds

• Prescriptions Placed on Hold
  Count of prescriptions not dispensed and awaiting resolution.
• Reason(s) for Holds
  Select all applicable hold reasons.
• Prescriptions Returned Unfilled
  Count of prescriptions returned to patient without dispensing.
• Data Entry Corrections Made
  Count of prescription entry corrections requiring technician or pharmacist override.
• Exception Notes
  Describe any notable exceptions, patient complaints, or unusual situations encountered during intake.

Pharmacist Review and Sign-Off

• Pharmacist-in-Charge Review Completed
• Pharmacist Correction Notes
  Document any corrections or discrepancies identified during review.
• Pharmacist-in-Charge Name
• Pharmacist License Number
  State-issued pharmacist license number for audit trail purposes.
• Pharmacist Signature
  Electronic signature certifying the accuracy of this log.
• Sign-Off Date and Time