Medical practitioners and nurse practitioners in NSW can issue an image-based prescription for most medicines; sending by email or fax to a pharmacy.

This temporary measure will better support patients, prescribers and pharmacists during the COVID-19 response, and allow better integration of the prescription and supply of medicines with the Commonwealth Government’s COVID-19 response telehealth reforms.

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How does it work?

A medical practitioner or nurse practitioner can issue an image-based prescription for emailing or faxing to a pharmacy. Image-based prescriptions do not need to be followed up with a hard copy of the prescription, and can be issued with repeats.

Image-based prescriptions can only be issued and dispensed for Schedule 4 medicines, except those in Appendix D (S4D medicines). S4D medicines and Schedule 8 (S8) medicines are not included in the temporary arrangements due to risks associated with fraudulent prescription and supply.

The steps for image-based prescribing are:

  1. Prescriber issues a regular prescription, including a handwritten signature
  2. Prescriber prepares an image of the prescription
  3. Prescriber sends the image-based prescription to the patient’s pharmacy of choice by email or fax
  4. Pharmacist dispenses the prescription and arranges supply to the patient
  5. Prescriber keeps the physical prescription for two years

All repeats must be supplied and held in the same pharmacy as the original supply.

There are no changes to issuing and dispensing prescriptions for S4D and S8 medicines. A prescriber may still direct a pharmacist to dispense S8 and S4D medicines by telephone, email or fax, and the paper-based prescription must be sent to the pharmacist within 24 hours.

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Medicines excluded from image-based prescribing

Image-based prescriptions cannot be used for Schedule 8 medicines and Schedule 4 Appendix D medicines.

Schedule 8 medicines and drug classes

  • opioids
  • selected benzodiazepines (alprazolam, flunitrazepam)
  • psychostimulants (dexamfetamine, lisdexamfetamine, methylphenidate)
  • cannabis-based medicines

Schedule 4 Appendix D medicines and drug classes

  • anabolic steroids
  • barbiturates
  • benzodiazepines (except alprazolam, flunitrazepam)
  • erythropoietins
  • growth hormones
  • quetiapine
  • peptides
  • pregabalin
  • selective androgen receptor modulators
  • tramadol
  • zolpidem
  • zopiclone

On 17 April 2020, additional substances identified as liable to abuse, misuse and trafficking were included in Appendix D as prescribed restricted substances.

The addition of these substances will better align the NSW legislative framework with the National Poisons Standard.

The following medicines are now included in Appendix D as prescribed restricted substances:

  • pregabalin
  • quetiapine
  • tramadol
  • zolpidem
  • zopiclone

As with any Schedule 4 Appendix D medicine, prescriptions for these medicines can only be dispensed for up to six months from the date of issue.

A list of all Schedule 4 Appendix D medicines is available.

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Frequently asked questions

Do I need to issue the prescription in a different way?

No. There is no change to the way you issue a prescription, the instructions required, or any other details required on the prescription. You must sign the prescription by hand (digital signatures are not permitted).

How do I make an image-based prescription?

Issue a prescription as normal, including signing the prescription by hand. Once the prescription is complete, the prescriber can fax it to a pharmacist, scan it and email it to a pharmacist, or take a photograph of it and email it to a pharmacist. The signed physical prescription must remain with the prescriber for storage for two years.

Can I use a digital signature on the prescription?

No, digital signatures are not permitted. The prescription must be printed and signed by hand. An image can then be made.

Can I issue a prescription with repeats?

Yes, image-based prescriptions can include instructions for a repeat supply. To comply with PBS requirements, all repeats must be supplied and held in the same pharmacy as the original supply.

Can the image-based prescription be sent via text message, or sent to the patient?

No. The image-based prescription must be sent directly from the prescriber to the pharmacy, either by email or fax.

Where do I find the email address for a community pharmacy?

Use your search engine or tools such as It is advisable to confirm details with the pharmacy before sending an email or fax, check if they hold stock of any unusual medicines or medicines known to be in short supply.

Should I make a record of the pharmacist the prescription has been sent to?

A prescriber may record the name of the pharmacist they have sent an image-based prescription to, but this is not required by law.

Which medicines can I issue an image-based prescription for?

Image-based prescriptions can be used for Schedule 4 medicines excluding those in Appendix D. Schedule 4 Appendix D medicines and Schedule 8 medicines are not included in the temporary arrangements.

How do I store the prescriptions?

Printed copies of image-based prescriptions must be kept for two years from the date of issue. You can keep them securely at your place of practice.

How long will image-based prescribing be permitted?

This temporary change is in place until 30 September 2022. Electronic prescribing using prescription exchange services is expected to be widely available by this time.

I have questions. Who do I contact?

For more information contact the Duty Pharmaceutical Officer at the NSW Ministry of Health at​​​​​

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Current as at: Wednesday 29 September 2021
Contact page owner: Pharmaceutical Services