Welcome To DrFirst!

Welcome To DrFirst!
Rcopia E-Prescribing Registration Packet
Thank you for choosing Rcopia, the award-winning e-prescribing system from DrFirst! This
packet contains all of the registration forms needed to get your practice up and running with
Rcopia. Please fill out and fax these forms, as well as a copy of the DEA and WA DOH license
for each practitioner to Jack Choi at 206-686-4889.
Below you will find definitions for the different roles within Rcopia. Take a moment to
familiarize yourself with these roles and their respective functions. You will be asked to
assign these roles to staff members within your office. If you have more than one
Provider, simply photocopy the Provider Registration and Provider Agent Forms found
on the next page so that each Provider has his or her own forms to sign.
Role
Typical User
Primary Functions
Electronically create, sign & send prescriptions
Physician
Provider
Nurse
Practitioner
Physician
Assistant
Approve renewals
Delete patients from the practice＇s account
Add, delete, or edit patients＇ medication and allergy lists
Capable of performing Provider Agent, Clinical Staff, and Non-Clinical
Staff functions as well
Electronically send prescription on behalf of provider; copy is sent
to provider for signature
Create prescriptions for provider to sign
Provider Agent
Nurse
Approve renewals, copy is sent to provider for signature
Add pharmacies to the Rcopia practice list
Capable of performing Clinical Staff and Non-Clinical Staff functions
as well
Nurse
Clinical Staff
Medical
Assistant
Create prescriptions for provider to sign
Add or edit patients＇ medication and allergy lists
Capable of performing Non-Clinical Staff functions as well
Add patients to the practice account
Non-Clinical
Staff
Edit patient demographic information
Front desk staff
Designate patients＇ default pharmacy
View prescription report
0128
09
Questions? Please contact Jack Choi at jchoi@highlinemedical.org
Provider Registration Form
Rcopia E-Prescribing Registration Packet
Date
Sales Rep
Please provide the contact information for the individual
responsible for administering e-prescribing in your office.
Practice Name
Contact Name
Physician Name
Title
Phone
Title
MD
DO
PA
CNP
Address
Email
Address 2
DEA number
City
State
Zip
Medical License Number
Office Phone
NPI Number
Office Fax
Specialty
Exp
Exp
State
Physician Email
Provider Signature
Please provide your signature in the box below so that we can include it on your prescription when a signature is
required. Be sure to fill the entire box with your signature, but without touching the edges.
During the deployment process, you will be assigned a unique password that will be required for you to
authorize the submission of a prescription to the pharmacy. Authorizing a prescription with your password will
attach the signature below to the electronic prescription. To protect yourself, please do not share your password
with others or write down where other may possibly find it.
Dispense As Written Statement
Some states require the phrase “Dispense As Written＂ written in the prescriber＇s handwriting to be included on
prescriptions that cannot be filled generically. Please sign “Dispense As Written＂ in the bow below.
012809
Questions? Please contact Jack Choi at jchoi@highlinemedical.org
Provider Agent Agreement
Who qualifies as a Provider Agent?Anyone in your office that currently calls in
prescriptions on behalf of the provider.
Rcopia E-Prescribing Registration Packet
I _____________________________ , hereby affirm that except as set forth in this paragraph, I will personally
prescribe and order the medications using the user identifier (“user ID＂) and password provided to me by
DrFirst. To the extent that someone other than myself uses the Rcopia system to order medications that I
prescribe for patients who are under my care (for purposes of this agreement such person is referred to as the
“Provider Agent＂) such person will be acting pursuant to my express written instructions and I agree that I am
solely responsible for insuring that adequate documentation exists verifying that I am the prescribing physician
and that such documentation will be provided to the Pharmacy dispensing such medication, and/or DrFirst, if
requested.
Physician Signature
Practice Name
Physician Name
Address
Date
Address 2
Email
City
State
Zip
Please list all Provider Agents
Name
012809
Signature
Questions? Please contact Jack Choi at jchoi@highlinemedical.org
Date
Staff Registration
Rcopia E-Prescribing Registration Packet
Practice Name
Address
Address 2
012809
Phone
Questions? Please contact Jack Choi at jchoi@highlinemedical.org
Non
Clinical
Staff
Email
Zip
Clinical
Staff
Staff Member Name
State
Provider
Agent
City