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(4) international classification of disease code;

(5) quantity of the item or service being prescribed;

(6) directions or instructions for proper use of the item or service, including the frequency of use when applicable;

(7) duration or estimated length of need for the item;

(8) enrolled prescribing provider’s signature and order signature date;

(9) number of refills, if applicable; and

(10) date of the face-to-face examination as required under (s) of this section if prescribing durable medical equipment, medical supplies, or related items and services. (u) A prescription order for durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, and related items and services that require a certificate of medical necessity form may be part of the certificate of medical necessity, if the certificate of medical necessity includes all of the components of a prescription order as described in (t) of this section. (v) The clinical assessment of need portion of a certificate of medical necessity that contains a prescription order for durable medical equipment, prefabricated off-the-shelf orthotics, medical supplies, or related items and services may not be prepared by a supplier of durable medical equipment, prefabricated off-the-shelf orthotics, medical supplies, or related items and services to the prescriber. (w) The department will not pay for durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services if they were prescribed more than one year before a claim for payment is submitted. For the purposes of payment, a prescription order written and signed by the prescriber after a product has been dispensed will not be accepted. (x) A prescriber shall sign a prescription or affix to a prescription an authenticated digital signature from an electronic health record system. The department will not accept a signature stamp or a copy of a signature as part of a valid prescription order even if affixed to the prescription order by the prescriber. The department will accept a prescription order or certificate of medical necessity received by facsimile with the prescriber’s original or authenticated digital signature. (Eff. 2/1/2010, Register 193; am 7/7/2010, Register 195; am 6/2/2019, Register 230) Statutory Authority: Authority: AS 47.05.010 AS 47.07.030