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Medication Refill Note Request - Medication name, dose, directions, quantity/days’ supply requested, and pharmacy. - Request source (portal, pharmacy eRx, phone) and date. - Early refill or lost medication explanation if applicable. Clinical Review - Indication and last prescribing clinician/date. - Adherence concerns, side effects, and recent relevant visits. - Monitoring due/overdue: labs, vitals, PDMP/state database check if indicated, controlled-substance agreement status. - Allergies and interacting medications reviewed. Decision - Approved as requested / modified / denied / deferred pending visit or labs—with brief rationale. - New prescription details: dose, SIG, quantity, refills, and start/stop dates if changed. Counseling & Safety - Key counseling points (use, side effects, storage) if discussed. - For controlled substances: risk discussion elements as performed; naloxone if offered. Follow-Up - Visit or lab requirements before next refill. - Patient notification method (portal, pharmacy, phone).
What makes the structure useful, and which visits it fits best.
Why this template works
Structural advantages for real documentation
Best for
Visit types and clinicians who use this format
Illustrative excerpt of how a visit can land in this structure. Not a real patient record—review and edit every note before signing.
Request Portal refill: atorvastatin 40 mg nightly #90, 3 refills; pharmacy: Main St Pharmacy. Due today. Clinical Review Indication: hyperlipidemia; last filled 90 days ago; adherent per refill history. LDL 96 three months ago; LFTs normal. No myalgias reported in last message. NKDA. No interacting new meds. Decision Approved atorvastatin 40 mg PO QHS #90 with 3 refills. No dose change. Counseling / Follow-Up Continue nightly dosing; message for unexplained muscle pain/weakness. Lipid panel and visit due in ~3 months with chronic-care appointment. Patient notified via portal that Rx sent electronically.
What the product actually does with your template.
Paste this content into My Templates, or start from a specialty-generated template and edit the sections.
Capture the encounter with ambient recording or dictation. Wavo structures the note using your template.
Edit with Smart Transform if needed, then export or copy into your EHR. You stay responsible for the final note.
Start free, paste the template, and see how Wavo documents in your structure.