Prescription Audit Checklist
Use this checklist to systematically review and assess prescriptions for accuracy, completeness, and safety.
Patient Full Name
*
First Name
Last Name
Patient Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Prescription Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Prescriber's Name
*
First Name
Last Name
Medication(s) Prescribed (List all)
*
Prescription Audit Items
*
Rows
Yes
No
N/A
Patient identifiers present and legible
1
2
3
Prescriber identifiers present and legible
4
5
6
Medication name(s) clearly written
7
8
9
Dose, route, and frequency specified
10
11
12
Allergies checked and documented
13
14
15
Potential drug interactions assessed
16
17
18
Contraindications considered
19
20
21
Instructions to patient are clear
22
23
24
Prescription is dated and signed
25
26
27
No abbreviations or unclear terms used
28
29
30
Are there any errors or omissions detected in this prescription?
*
No errors or omissions found
Minor errors/omissions (not safety-critical)
Major errors/omissions (potential safety risk)
Other (please specify)
Overall prescription quality rating
*
1
2
3
4
5
Additional Comments or Recommendations
Auditor's Name
*
First Name
Last Name
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Audit Checklist
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