Prescriptions

Prescriptions sit on the Documents tab of the clinical record, under Prescriptions and in All: each row shows the first drug (and how many more), the prescriber, its status and date, and the next step as a button — Issue & print and Edit on a draft, Open on a printed script — with Discard and Void under More.

What you see before prescribing

The prescription form — new or edited — and the issue confirmation both open on the patient's medical history, read fresh when the dialog opens:

• Alerts in force, each with its kind. An alert raised from a form that no clinician has reviewed yet is marked Unreviewed — an unreviewed allergy shows here before it reaches the allergy list.
• The free-text Medical alert from the patient's details, when it is not already listed as an alert.
• Allergies that are active, with their severity and reaction.
• Current medications, with dose, frequency and route.

A list with nothing in it says None recorded. While the history loads, grey placeholders take its place. If it cannot be loaded, the dialog says Couldn't load allergies with Retry, and the prescription cannot be saved or issued until it loads.

Interaction check

Each time you save a draft, Smileline checks each prescribed medicine against the patient's current medications (those marked active in the medical history) and against the other medicines on the same prescription, using a licensed drug database. The dialog stays open on the Interaction check until you click Done. Smileline never writes its own pharmacology: what it shows is the database's answer, with the database's own severity, summary, management advice and, where given, the mechanism and references, so you can review the basis yourself.

The check reads one of:

• No interactions: "No interactions found between these medicines and the patient's current medicines." This appears only when every medicine was recognised, every pair was checked and the data is current.
• Interactions found: each interaction, most severe first.
• Incomplete: something couldn't be fully checked, listed with the reason — a medicine the database didn't recognise, pairs that weren't checked, or drug data that is out of date — beside any interactions found. Incomplete never means there are no interactions.
• Not checked: the drug database couldn't be reached. Click Check again to try once more; an outage never blocks a prescription — you can give a reason and issue it.

A check interrupted before it finished says so: everything the database had sent is kept, and Check again runs a fresh one. A prescription can't be issued on a check that didn't finish.

The database sees only the medicine names, forms, strengths, routes and codes, never the patient's name, date of birth or any other identifier. Free-text alerts and allergies aren't checked for interactions.

Interaction checking runs only where Smileline has qualified a licensed drug database for the site's country, and practices can't switch it on themselves. No country is qualified yet, so for now the check reads "Smileline doesn't check interactions here yet: check the BNF or your formulary" (outside the UK, your national drug reference) and records that interactions weren't checked.

Draft

Click New above the list and choose New prescription. Pick the site (its jurisdiction decides which kinds are offered: an NHS FP10D or a private script in the UK, the state form in the US, a private script elsewhere), the kind, then add each item: drug, strength, form, dose, quantity, directions and whether it is a controlled substance. At a US site each item also has Refills (US); a site anywhere else doesn't show it, and Smileline refuses refills there. Save the draft; until it is issued, Discard under the row's More deletes it.

To change a draft before it is issued, click Edit on its row. The same form opens with the draft filled in and the patient's name and date of birth at the top. The site stays the draft's own; change the kind, the items or the note and click Save draft — the items you see replace the old ones as a whole; a change to the note alone leaves the items as they are. A draft that was issued, voided or discarded in the meantime cannot be saved: the form closes and the list shows where it stands. If a colleague saved the draft since you opened it, your save is refused rather than overwriting theirs.

A drug chosen from the practice's coded list keeps its code. If you change a coded drug's name, Smileline asks whether the code still applies: Keep code or Unlink code. The draft can't be saved until you choose.

Picking from Medications

Start typing in Drug: the medicines on your practice's Medications list that match are listed beneath the field. Pick one with the mouse, or with the arrow keys and Enter, and it fills the item — drug, strength, form and any dose, quantity, directions, refills and controlled-substance mark the practice set for it. A field the medicine has no default for is left empty for you to fill in. Every field stays yours to change before you save.

A drug that isn't on the list is typed in full, as before. Archived medicines aren't offered, and an issued prescription keeps its own copy of what was printed.

Issue and print

Click Issue & print on the draft's row. A confirmation opens naming the patient and their date of birth, with the patient's alerts, allergies and current medications at the top, the Interaction check beneath them and the prescription's items last.

Give a reason in Your reason for each interaction and for each thing not fully checked; Use this reason for all copies the first reason you typed to every one. Issue & print stays off until each has a reason. If the draft or the patient's medications changed since the check, or the drug data went out of date, the issue is refused and the check runs again: reasons for anything it still lists are kept. The check, its reasons and the database version are kept with the issued prescription for good, and Interaction check under the row's More shows them. Prescriptions issued before interaction checks existed have none.

When you've checked everything, click Issue & print. You confirm your password (the prescription is a professional act that needs a fresh sign-in), the script is rendered to a PDF filed on the patient's documents, and the prescription becomes Issued with its items frozen. Open on its row shows the printed script, which is also listed under Files.

The issued prescription always matches its PDF: if the draft is edited — by you in another tab or by a colleague — while the script is rendering, the issue is refused and nothing is frozen. Check the draft and choose Issue & print again. Only the prescriber who wrote the draft can issue it, and that is checked before anything is printed. A script is filed on the patient's documents only once it is issued: an issue that fails leaves no printed script behind, and trying again issues it once. An unused PDF left by a failed attempt is cleaned up after seven days; issued prescriptions and filed documents are preserved. If a very old attempt needs a new PDF, choose Issue & print again.

Cleanup failures appear under Unused prescription PDFs in Clinical storage, where an authorised member can review and replay them. Legal holds pause cleanup.

Void

An issued prescription that must not be dispensed is voided with Void under the row's More: give the reason, then confirm your password again. The void is sealed on the record with who voided it and when; nothing is deleted.