|
- Let us take this "Office Headache" away from you!
- No more endless calls from your patients leaving garbled messages of what RX they need filled.
- No more countless hours of precious staff time to call the patients back to gather detailed information of what the patent needs.
- No more waiting on line with the pharmacy to call in RX refills!
- HIPAA compliant documentation of EVERY call for your records!
|
|
|
|
|
Rx Refill Form
Doctor's Name:
Pt Name:
Patients Ph#:
Pharm Ph#:
Pharm Fax#:(MANDATORY)
Spell Medication:
How often takes Meds?:
Milligrams (dosage)?:
Pt Address: (If Controlled Substance)
To Be Completed By Office:
Print Dr. Name: x_________________
Signature: x______________________
DEA#:___________________________
NPI#_____________________________
ABC CARDIOLOGY
123 Main Street
Anywhere, USA
Ph#: 888-333-4444 Fax#: 999-777-6666
|
|
|
|
|
|
|
| |
