Formulary drugs may be restricted to use, either by medical service (eg., a drug restricted to use by NICU attending physicians), prescribing criteria (eg., a drug restricted to use by specific indication), or patient care area (eg., a drug restricted to use only in NICU). If the physician orders a restricted formulary drug, the following guidelines shall apply:

1. Restriction by a medical service: The attending, fellow or resident will include the name of the service after their signature (eg., Dr. J. Jones / attending [Cardiology]). 
2. Restriction by prescribing criteria: The attending, fellow or resident will include the indication for use after their signature (eg., Dr. J. Jones [for VIPomas]);. 
3. Restriction by patient care area: The attending, fellow or resident will include the patient care area after their signature (eg., Dr. J. Jones [in MICU]). 

When an order requesting a restricted drug without the above information is received by pharmacy, the prescribing physician will be contacted to give or obtain authorization. If a physician requests a restricted formulary drug that is not authorized by their service, indication or patient care area, then they need to comply with one or more of the following: obtain a consult from an authorized service, call a Pharmacy and Therapeutics Committee member for special authorization of the new indication, or move the patient to the needed area for proper treatment.

If a 23 hour-admit patient is admitted on a restricted drug, they may be maintained on that drug without the need for proper authorization. However, if the patient is required to stay longer, then proper authorization must be obtained. In order to receive restricted medication on a 23-hour admit, the physician will write after the order and signature " (23 hour admit)." 

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