The Prescription Forms

Practitioners in Texas use single or multiple (triplicate) copy forms, issued by the Department, to write prescriptions for Schedule II controlled substances. These forms are provided by DPS at cost. Pharmacists transmit a record of the prescription to the Department electronically or, in limited instances (and with prior Department approval), forward a copy of the prescription. See the section on waivers for more information.

Prescription forms may be obtained only from the Texas Prescription Program. Cards for reordering are mailed with each prescription set; however, in the event one is needed, order cards can be requested from the Texas Prescription Program. Also acceptable, in lieu of an order card, is a request on official letterhead that provides the practitioner's registration information and the quantity of forms requested. At this time, orders must include a check or money order; however, it is anticipated that online ordering may be possible at a future date. Orders and payment should be sent to:

Texas Department of Public Safety
Texas Prescription Program
PO Box 15999
Austin, Texas  78761-5999

Upon receipt of prescription forms, the practitioner is encouraged to verify the accuracy of the preprinted registration information and record the form's control number in a separate location. If there are problems with the prescriptions, or if any are ever lost or stolen, the Texas Prescription Program should be contacted immediately.

image of prescription form

The above Official Prescription form became available September 1, 2010. The only modification, from the previous single copy Official forms, is in the top portion. The arrangement of the preprinted practitioner information has been changed and two barcodes have been added; one for the DPS Controlled Substance Registration number and one for the Official Prescription form control number. The barcode type is Code 39 (also known as 3 of 9 barcode) and is readable by most standard barcode scanners. In addition to the barcodes, this prescription form contains several security features to assist the pharmacist in verifying the form’s authenticity:

Note: Every Official Prescription form, produced from January 1982 through the present, contains the practitioner’s DPS and DEA registration numbers, a unique control number and the DPS seal (as a watermark) on the face of the prescription.  The modifications to the Official Prescription forms do not invalidate previously issued prescription forms.  An Official Prescription form is considered valid if it contains the security features associated with that particular format/layout and the practitioner’s DPS Controlled Substance Registration number is current and valid.  To confirm the validity of a practitioner’s registration, go to: http://www.txdps.state.tx.us/csr/index.aspx.

prescription form image

The above prescription was available between March 1, 2002 and August 31, 2010. It contains a number of security features designed to assist the pharmacist in verifying its authenticity:

triplicate prescription

The triplicate prescription (see above) is the original form used by the program, which began on January 1, 1982. This form is still valid for prescribing and dispensing Schedule II controlled substances and has a control number located in the bottom right corner of the prescription.

When filling a triplicate prescription, the pharmacist should destroy the second copy. With electronic reporting, it is no longer necessary to send the original to the Department, so pharmacists may keep this copy for their own records.

Practitioner Responsibilities:
Complete the prescription according to federal and state requirements:

Pharmacist/Pharmacy Responsibilities:
On the transmitted or mailed prescription, indicate:

Department Responsibilities: