Refills Re-Authorization to Physicians Template:


# Physician Content Use
1 Dr. Good Morning Dr. Patient is requesting refills. Would you like to to authorize more refills for this perscription for another 6-months? Cheers. Thank You.
2 NP. Good Morning NP. Patient is requesting refills. Would you like to to authorize more refills for this perscription for another 6-months? Cheers. Thank You.
3 MISC Good Morning. Patient is requesting refills. Would you like to to authorize more refills for this perscription for another 6-months? Cheers. Thank You.

Early Dispense or Change Request/Authorization Template:

(Vacation, Early Dispense, Backordered, Lost Supply, etc)


# Case Content Use
1 Vacation

***** !!! Urgent !!! ***** ***** !!! Urgent !!! ***** ***** !!! Urgent !!! *****
Good Morning Dr.
Patient is going on vacation in X days.
They will be dispensing Y days early.
Would you like to authorize this early dispense?
Cheers, Thank You.

***** !!! Urgent !!! ***** ***** !!! Urgent !!! ***** ***** !!! Urgent !!! *****

2 Lost Supply

***** !!! Urgent !!! ***** ***** !!! Urgent !!! ***** ***** !!! Urgent !!! *****
Good Morning Dr.
Patient has lost/damaged their medication dispense.
They are requesting a replacement and will be dispensing X days early.
Would you like to authorize this early dispense and replacement supply?
Cheers. Thank You.
***** !!! Urgent !!! ***** ***** !!! Urgent !!! ***** ***** !!! Urgent !!! *****

3 General Early Dispense

***** !!! Urgent !!! ***** ***** !!! Urgent !!! ***** ***** !!! Urgent !!! *****
Good Morning Dr.
Patient is requesting an early dispense of their medications.
They are requesting a dispensing X days early.
Would you like to authorize this early dispense?
Cheers. Thank You.
***** !!! Urgent !!! ***** ***** !!! Urgent !!! ***** ***** !!! Urgent !!! *****

4 Backordered

***** MEDICATION BACKORDERED *****
Good Morning Dr.
This Medication is Backordered.
Would you like to prescribe an alternative for the time being?
Cheers. Thank You.
***** MEDICATION BACKORDERED *****

Print Transfer Request Form:


Transfer Form