Wednesday, March 10, 2010
 
 
You are here: PATIENTS * PRESCRIPTION REFILLS
 

   

***This is just a sample Rx. Refill Request.***
 
In a LIVE example as in www.johnjryandmd.com the doctor and patients log in to a private server and by entering the their unique password protected tunnel, patients and colleagues leave messages and doctors log in under their administrative security to check their private messages having been notified by email that a Rx. Request has been made.

    
   

It is the practice of Michael Sonick, D.M.D. to maintain a strict record of all prescriptions provided for his patients.  Excellent and proper medical care requires that the doctor review the patient's medical chart prior to amending or refilling any prescriptions.  Since this is an on-line service, you will be asked to provide input on the following questions:
Patient Name:
Patient DOB:
Parent or Guardian Name:
Street Address:
City  
State
Area Code & Telephone:
Area Code & Cellphone:
Alternate Phone:
Considering the level of pain and discomfort, please state your assessment of the problem:
Please state the type and quantities of any other medication on hand:
Please state the name of the medication, dosage and date last prescription was filled:
Please state the name of the pharmacy used for the last prescription:
Please state the telephone number of the pharmacy used for the last prescription:
Please state any drug allergies that you may have:
Any questions you may have regarding the medication or dosage:
Submit Cancel

Once this request is received by Dr. Sonick, your pharmacy will be called withing six (six) hours.  As Dr. Sonick may be away from the computer, you are asked to follow up your request with a phone call. 

In order to maintain patients' records and in an effort to prevent any abuses by members of the public posing as patients of Dr. Sonick, NARCOTIC MEDICATIONS will NOT be refilled outside of the actual office and therefore will not be accepted within this online service. 

Note: This prescription refills service will not be enabled while site is under construction.
 
   
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