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Processing. Compounding. Filling. Shipping. Reporting. The whole pharmacy. On one record.

Neil types each prescription on one page and checks it against your rules. Your pharmacist verifies it, and the fill, the box and the invoice follow.

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Prescription 7-204-118 at Skerry Compounding, on one page: it arrives from Dr. R. Lindqvist at Selkie Clinic at 09:14 for M. Alvarez, testosterone 10 mg/g cream, a Schedule III medicine, 90 g for 90 days. Neil types it, prices it at Selkie Clinic's $0.50 a gram and checks it: the date of birth matches, the quantity is within Skerry's limit and the ingredient has a USP monograph, but the state it ships to allows 30 days. J. Mbeki, in customer care, calls the clinic at 09:31; at 09:40 Dr. Lindqvist sends a new prescription for 30 g with 2 refills, $15.00 on Selkie Clinic's weekly invoice; and at 09:44 the pharmacist P. Novak verifies the page against Dr. Lindqvist's 09:40 prescription and signs. Neil has typed 1,187 prescriptions that day and held 14 for customer care
Prescriptions › Selkie Clinic › Rx 7-204-118
Verified 09:44
  1. Received
  2. Typed
  3. Checked
  4. Verified
  5. Filled
  6. Shipped
PrescriptionThu 5 Nov, 09:44

Checks4 to run3 of 4 passed4 of 4 passed

Original

eRx, 09:40
ALVAREZ, M DOB 03/14/1971Testosterone 10 mg/g creamSig: Apply 1 g daily to the skinQty: 30 g Days: 30 Refills: 2Lindqvist, R, MD Selkie Clinic
Audit trail
typed by Neil today
1,187
held for customer care
14
Nothing is filled until a pharmacist verifies it against the originalEvery field compared with the 09:40 eRx. Filling is nextAs written. Schedule III, so tonight it is reported to the state it ships toAs written, and matched to M. Alvarez's record at SkerryAs signed. Dr. Lindqvist's DEA registration covers Schedule IIIDr. Lindqvist's directions, word for wordAs written: 90 g, at 1 g a dayChanged by Dr. Lindqvist at 09:40. The 90 g as written is keptAs written: no refillsAdded by Dr. Lindqvist at 09:40, with the 30 gSelkie Clinic's rule for HRT creams: Changeset #212, signed by T. Brennan30 g at Selkie Clinic's $0.50 a gram, from Changeset #212Selkie Clinic's account: its prescriptions go on one invoice a weekThe address on the prescription, the same as on file14 Mar 1971 on the prescription and on M. Alvarez's recordSkerry's limit for this cream is 120 g a fill, set by D. CastellanosSo 503A allows it as a bulk ingredient, from a registered supplierSkerry's rule for that state, 30 days of a Schedule III, set by D. CastellanosDr. Lindqvist's electronic prescription, kept as it arrivedEvery field from the 09:14 eRx, the price from Selkie Clinic's rule90 days asked, the state allows 30, so J. Mbeki in customer care is toldJ. Mbeki's call to Dr. Lindqvist's office, noted on the prescription30 g with 2 refills, sent by Dr. Lindqvist; the first is keptP. Novak compared every field with Dr. Lindqvist's 09:40 eRx and signed
Verification

Awaiting the checks

Awaiting the pharmacist

P. Novak, pharmacistThu 5 Nov, 09:44 CSTPassword and authenticator code

One record. Nothing typed twice.

A pharmacy system, a lab module, paper and a shipping tool each hold part of a prescription, with scripts typing between them.

Compared onA pharmacy system and its add-onsSeal
A prescriptionTyped by your staff, page after pageTyped by Neil, verified by your pharmacist
A compoundWeights worked out by handWeights corrected from the certificate
FillingOne prescription at a time100 prescriptions from one scan
A boxLabeled by hand, rates not comparedLabeled at the best rate
A recallA spreadsheet and a day of calls306 patients found in a morning
A practice's pricesA rule per product, typed by handOne sentence, tested on last month

The compound, step by step.

The active ingredient's weight is corrected for its certificate's assay and loss on drying, and read from the balance. QC signs on the lot.

The compounding record of lot PG-1104, 6,000 progesterone SR 200 mg capsules to formula F-0412 v6, on Wed 4 Nov: L. Haddad signs the line clearance; the progesterone is corrected from 1,200.0 g to 1,213.3 g for the assay and loss on drying on Fjord's certificate for lot FJ-88213, and the lactose comes down by the same 13.3 g; balance B-11 reads 1,213.28 g, 774.03 g and 592.69 g; the blend runs 15 minutes at 25 rpm; 10 capsules weigh a mean of 431 mg; N. Ferreira passes the QC check; and P. Novak releases 6,000 capsules to dispensing with a beyond-use date of 3 May 2027
Compounding › Lot PG-1104
Released 11:52
  1. Clearance
  2. Weigh
  3. Blend
  4. Fill
  5. QC
  6. Release
Step 8 of 8Wed 4 Nov, 11:52

Release

Clear the bench, scoops and balance of the last lot, ES-⁠1103, estradiol cream.Progesterone micronized USP, Fjord lot FJ-⁠88213, on balance B-⁠11.Hypromellose, on balance B-⁠11.Lactose monohydrate, to bring the blend to 2,580.0 g, on balance B-⁠11.Blend the three for 15 minutes at 25 rpm.Fill size 1 capsules, 430 mg each. Weigh 10 of them.White to off-⁠white powder, in a clear capsule.Release to dispensing, with its beyond-⁠use date.

6,000capsulesBeyond-use date 3 May 2027
6,000 capsules, gramsTargetWeighed
Progesterone1,200.0 g1,213.3 g1,213.28 g
Hypromellose774.0 g774.0 g774.03 g
Lactose monohydrate606.0 g592.7 g592.69 g
Total, 430 mg a capsule2,580.0 g2,580.0 g2,580.00 g

Compounding record

F-0412 v6
The certificate, the weights and the check stay on the lotSigned by L. Haddad: bench, scoops and B-⁠11 clear of lot ES-⁠1103, estradiol creamFrom Fjord's certificate for lot FJ-⁠88213, kept since it was received: assay 99.4%, loss on drying 0.5%Read from balance B-⁠11 at 08:14:37; accepted 1,212.1 to 1,214.5 gRead from balance B-⁠11 at 08:22:16; accepted 773.2 to 774.8 gRead from B-⁠11 at 08:27:52; 13.3 g under the formula's 606.0 g, so each capsule still holds 430 mgBlended from 08:31 to 08:46 at 25 rpm; signed by L. HaddadSize 1 capsules, filled by 11:31; 10 weighed on balance B-⁠12, each within 5% of 430 mgWhite to off-⁠white powder, clear capsule: checked by N. Ferreira and kept with lot PG-⁠1104Released to dispensing by P. Novak, pharmacist; dated 180 days out, the USP <795> limit for a nonaqueous preparation

One scan fills a hundred.

Scan a lot and every prescription that needs only that lot prints; Neil proposes the rest. At final verification the box's label prints, at the best rate.

The fill of Thu 5 Nov from lot PG-1104, progesterone SR 200 mg: A. Rahimi scans the lot and 100 prescription labels print, then fills the 100 by attestation with one signature; Neil finds 10 more patients who take the lot with other medicines in the same box, and A. Rahimi fills them, leaving 2,700 capsules; P. Novak verifies M. Alvarez's box, three prescriptions from lots PG-1104, TS-1103 and ES-1103, and its label prints at once, FedEx overnight at $25.60 against UPS at $41.20; a box to Alaska comes to $62.40 overnight, over the $30 limit, so T. Brennan is told and can offer two-day at $28.90
Fulfillment › Lot PG-1104
T. Brennan told 10:52
  1. Scan
  2. Labels
  3. Fill
  4. Linked
  5. Verify
  6. Ship
Progesterone SR 200 mg, 30 capsulesThu 5 Nov, 10:52

Box to Alaska

$62.40Overnight, over the $30 limit

Fill and ship

Thu 5 Nov
Over the limit, the account's owner decidesReleased to dispensing by P. Novak on Wed 4 Nov at 11:52, with its compounding recordOne scan of the lot's label at the fill benchOne for each verified prescription that needs only this lot: 30 capsules eachOne signature by A. Rahimi for the 100 bottles, each 30 capsules from PG-⁠1104Found by Neil: 10 more verified patients take PG-⁠1104 with other medicines in the same boxA. Rahimi chose to fill them; 2,700 capsules of PG-⁠1104 remainVerified by P. Novak against each prescription: three lots in one boxFedEx $25.60 and UPS $41.20 compared by Neil; under the $30 limit, it printed at onceOver the $30 overnight limit T. Brennan set for Selkie Clinic; theirs to offer two-⁠day at $28.90

Billed and reported every night.

Cards are charged, practices invoiced and each state is sent its controlled substance file, all from the day's prescriptions.

Skerry Compounding's close on Thursday 5 November: of the day's 3,412 prescriptions, 2,964 go on 37 practices' invoices, Selkie Clinic's weekly invoice among them, and 448 are charged by card, 445 approved for $19,264.00 and 3 declined and passed to customer care. The card charges include the patient's share of 14 prescriptions billed to a manufacturer's program in the NCPDP format, whose claims were adjudicated as each was processed and are reconciled with the day's shipments at 22:10. At 23:00 the 38 controlled substance prescriptions go in one ASAP file to each of 9 states by SFTP, and all 9 are accepted by 23:04. The close runs on the schedule the pharmacist-in-charge, D. Castellanos, signed
Close › Thu 5 Nov
Closed 23:04
Skerry CompoundingThu 5 Nov, 23:04

Prescriptions accounted for

3,412of 3,412Invoiced, paid by card or with customer care
Controlled substance reports38 prescriptions

Close

Every night at 22:00
Closed at 23:04, on the schedule D. Castellanos signedEach verified by a pharmacist, then scanned by its carrier; the last pickup at 18:30Each card-⁠paid prescription shipped today, charged through Skerry's own processor account at its rates2 for insufficient funds, 1 expired. With J. Mbeki in customer care, to call each patient on FridayThe day's batch, closed with Skerry's own processor; each charge is on its prescriptionEach at its practice's own price, on that practice's weekly or monthly invoiceSelkie Clinic's week, 212 prescriptions, each priced by its rules: HRT creams at $0.50 a gram. Due Fri 13 NovAdjudicated by the program as each was processed, which set the patient's share; each matched to its shipmentOne file for each state, 38 controlled substance prescriptions in all; M. Alvarez's testosterone is oneEach state's reply is kept with its file. The last came from Texas at 23:04Arizona: 4 prescriptions in one ASAP file, sent by SFTP at 23:00. Accepted at 23:01Colorado: 3 prescriptions in one ASAP file, sent by SFTP at 23:00. Accepted at 23:02Florida: 7 prescriptions in one ASAP file, sent by SFTP at 23:00. Accepted at 23:01Georgia: 4 prescriptions in one ASAP file, sent by SFTP at 23:00. Accepted at 23:03New Jersey: 3 prescriptions in one ASAP file, sent by SFTP at 23:00. Accepted at 23:02Nevada: 2 prescriptions in one ASAP file, sent by SFTP at 23:00. Accepted at 23:01Texas: 9 prescriptions in one ASAP file, sent by SFTP at 23:00. Accepted at 23:04Utah: 2 prescriptions in one ASAP file, sent by SFTP at 23:00. Accepted at 23:02Washington: 4 prescriptions in one ASAP file, sent by SFTP at 23:00. Accepted at 23:03

A recall in a morning.

From a supplier's lot to every patient it reached. Your pharmacist approves the notices, and each patient's answer is kept.

A recall at Skerry Compounding on Monday 9 November: at 08:12 Fjord Fine Chemicals recalls progesterone lot FJ-88213 by email. Neil reads it and traces it on the record to two compounded lots, PG-1028 and PG-1104, 306 patients and their 41 prescribers, and the stock on the shelf: 2,597.68 g of the powder, the 5 kg received less what the two lots took, and 2,700 capsules of PG-1104. It drafts the notices and proposes the quarantine. At 08:31 the pharmacist-in-charge, D. Castellanos, approves: the powder and the capsules are quarantined and the notices go. By 17:00, 221 patients have chosen a replacement, 62 a refund, and 23 have not answered and are listed for customer care to call
Lots › FJ-88213
283 of 306 answered
Fjord Fine ChemicalsMon 9 Nov, 17:00

Lot FJ-88213 reached

306patientsDispensed from 2 lots since Wed 28 OctReading Fjord's noticeTracing its lots' prescriptionsAnd their 41 prescribers, through 2 lotsTold at 08:31, with their 41 prescribers221 replacement62 refund23 to call

HistoryRecall

Lot FJ-88213
Nothing leaves until the pharmacist-⁠in-⁠charge approves5 kg received 20 Oct, less 1,189.04 g to PG-⁠1028 and 1,213.28 g to PG-⁠11041,189.04 g on B-⁠11 for assay 99.4%, loss on drying 0.5%; checked by N. FerreiraEvery label printed from PG-⁠1028 names its prescription: 196 patients1,213.28 g on B-⁠11 for assay 99.4%, loss on drying 0.5%; checked by N. FerreiraFrom Thursday's fill: 100 at the 10:02 scan, 10 linked, M. Alvarez among themPG-⁠1104's 6,000 capsules less the 110 prescriptions of 30 filled Thu 5 NovFjord Fine Chemicals' notice by email, read by Neil as it arrivedFrom each lot's record: FJ-⁠88213 was weighed into bothEvery prescription filled from either lot, and the prescriber on each2,597.68 g of FJ-⁠88213 and 2,700 capsules of PG-⁠1104; none of PG-⁠1028 is leftA notice for each patient and prescriber, from the recall and each prescriptionSigned by D. Castellanos, pharmacist-⁠in-⁠charge, meaning: quarantine and sendBy email to 306 patients, each with a page to choose on, and their 41 prescribersEach patient's choice, made on Skerry's own page, kept with their prescriptionListed for customer care to call, each with their prescription

Yours to change.

Say the rule. Neil drafts the change, tests it on last month's prescriptions, and it is in force when you sign.

Changeset #212 to Selkie Clinic's prices at Skerry Compounding. T. Brennan, who looks after the account, types: All HRT creams for Selkie Clinic are $0.50 a gram. Neil drafts one rule in place of 14 typed one at a time, covering the 14 creams in the group, every strength and base, and leaves out the 2 progesterone SR capsules, which are not creams and stay $0.50 a capsule. Replayed on October's 1,204 Selkie Clinic prescriptions, 96 change price and none falls below cost, and all 6 tests pass. T. Brennan signs on Monday 2 November at 14:12 and the rule is in force
Changesets › Selkie Clinic prices › Changeset #212
in force
HRT creams
14 rules → 1
  • Price
  • CreamsCovers
  • CapsulesLeaves out

Drafted by Neil from your formulary.

14 rules as they stand, a gram's price6 tests to run on October6 of 6 passed on October

Until T. Brennan signs, Selkie Clinic's 14 rules stay as they areIn force from 14:12 for every new Selkie Clinic prescriptionTyped by T. Brennan, who looks after Selkie Clinic's accountBefore, a rule for each product and strength, typed one at a time; one with no rule stopped its prescriptionA cream in Selkie Clinic's HRT group: 10 and 20 mg/g, in the regular and the vaginal baseA cream in the HRT group: 0.1 and 0.5 mg/g, in the regular and the vaginal baseCreams in the HRT group too: estriol 1 mg/g in both bases, progesterone 50 and 100 mg/g, bi-est and DHEAIn the HRT group but not creams: the 100 and 200 mg capsules keep their own ruleEvery Selkie Clinic prescription from October, priced again under the ruleEach of the 96 listed with its old price and its new one, to readEach cream's price against its cost, from its last compounded lotEvery strength in both bases, priced by the one ruleBefore, a strength with no rule stopped its prescriptionProgesterone SR 100 and 200 mg keep their own ruleOnly Selkie Clinic's prices changeA prescription already on an invoice is not priced againRetired, not deleted: the audit trail shows what each one was
Approval

Awaiting the tests

Awaiting signature

T. Brennan, account manager

T. Brennan, account managerMon 2 Nov, 14:12 CSTPassword and authenticator code

Questions from a pharmacy.

Do you charge for each prescription or API call?

No. One subscription for the pharmacy, whatever its volume, and the API is yours to call.

Can it take payment?

Yes. Cards are charged through your own processor's account, at your rates, and practices are invoiced weekly or monthly. A manufacturer's program is billed in the NCPDP format as each prescription is processed. A declined card goes to your customer care team with its prescription.

Does it report controlled substances to each state?

Yes. Each state's prescription monitoring program gets its file in the ASAP format, by SFTP, every day, and the state's reply is kept with it.

We have built our own front end. Can Seal run behind it?

Yes. Every record has an API: a released lot reaches your system with its lot number and quantity, and your orders reach Seal. Start with the lab and quality, and move the rest when you choose.

Who builds it, and who owns it?

A Seal deployment strategist builds it with your team, at your pharmacy, and stays until the result is measured and you have signed it. After that you change it yourselves: say the rule, and Neil drafts the change for you to sign. Your records are yours, and export in full.

Can we dispense outside one of our own rules?

Yes, as your decision. The override and its reason are signed by your pharmacist-in-charge and kept with the prescription. A rule that carries a state's law has no override: the prescriber changes the prescription.

Is it only for 503A?

No. The same record runs a 503B outsourcing facility under cGMP: batch records, environmental monitoring and release.

Which parts of Seal is this?

All five, on one record. The GxP execution system runs compounding, verification and quality. ERP runs prices, stock, shipping, invoices and payment. Portal gives practices and patients their own page. Edge reads your balances and instruments into the record. Neil types, checks, traces and drafts, and your people verify and sign.

See your pharmacy in Seal.

Your own prescriptions typed, checked and priced 48 hours after we agree the scope, for your pharmacists to verify.

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