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Run: Grocery Pharmacy Prescription Intake Log

Daily pharmacy intake log for tracking prescription volume, insurance rejections, processing exceptions, and pharmacist sign-off in one place.

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Log Details

Store Number (required)

Log Date (required)

Shift (required)

Pharmacy Technician Name (required)

Technician Employee ID (required)

Prescription Intake Summary

Total Prescriptions Received (required)

Total count of all new prescriptions received this shift.

Intake Channels Used This Shift (required)

Select all channels through which prescriptions were received.

New Prescriptions (required)

Count of first-fill prescriptions.

Refill Prescriptions (required)

Count of refill prescriptions.

Controlled Substance Prescriptions (Schedule II–V) (required)

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 (required)

Total Claims Rejected (required)

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 (required)

Count of prescriptions not dispensed and awaiting resolution.

Reason(s) for Holds

Select all applicable hold reasons.

Prescriptions Returned Unfilled (required)

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 (required)

Pharmacist Correction Notes

Document any corrections or discrepancies identified during review.

Pharmacist-in-Charge Name (required)

Pharmacist License Number (required)

State-issued pharmacist license number for audit trail purposes.

Pharmacist Signature (required)

Electronic signature certifying the accuracy of this log.

Sign-Off Date and Time (required)

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