UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Prescription Renewal Requests
UWMF Psychiatry Clinic
Effective Date: July, 2010 Approval: See Authorization
Supersedes Protocol: July, 2005 Contact: See Author
PURPOSE: To provide guidelines regarding prescription renewal requests at the UWMF Psychiatry Clinic.
DEFINITION: A prescription renewal can be made for any medication currently being prescribed by the patient’s physician,
or physician on-call for a UWMF patient.
Physician is defined as: The patient’s physician, or the physician on-call.
POLICY: Physicians and staff will use the following guidelines when a patient requests a prescription renewal, or when a
pharmacy is faxing a prescription renewal request to the clinic.
A prescription renewal can be made in person (during an appointment) or via the phone, but should be made by the actual
person to whom the medication(s) are prescribed, (unless prior provisions have been made between the clinic and patient**).
Patients are informed to give 48 business hours notice for renewal requests. Pharmacies may also request renewals via
telephone, or fax.
**Written authorization from the patient stating that others (names listed) are approved to request renewals of prescriptions or
to pick up written prescriptions from our office.
SUPPLIES: Physician’s order, Patient’s record.
PROCEDURE WHEN THE PHYSICIAN IS IN THE OFFICE
1) Reception staff will document:
Patient’s name and date of birth
Date and time of call
Physician’s name, and pharmacy name and phone number
Name of medication(s), dose(s), quantity and directions in taking the medication.
2) Reception staff will pull the patient’s medical record, attach prescription request to the medical record, and place the
medical record in the physician’s mailbox.
3) Physician will review patient’s medical record to verify prescription.
4) If authorizing the request, physician will document the renewal prescription request on the patient’s “Medication Record”
in the patient’s medical record.
5) Physician will indicate on the phone message that the request has been authorized and phone the prescription into the
pharmacy (or fill out the prescription renewal fax form, or hand write a prescription hard copy for patient to pick up.) If
prescription renewal has been denied, physician will document that it has been denied, and will place patient’s record in
6) If renewal request is denied by the physician, the reception staff will notify the patient (in person and/or via the phone)
and the pharmacy; and the reason of denial (e.g., needs an appointment, early refill, etc.).
NOTE: If patient’s prescription renewal request is for a Schedule II medication, reception staff will inform
patient that we are NOT able to phone/fax in this prescription to the pharmacy. Wisconsin State law requires that
the pharmacy fill this type of prescription with only a hard copy.
* Reception staff will offer to mail the hard copy to the patient,
the patient’s pharmacy, or ask if the patient would like to come to the
clinic to pick up and sign for the hard copy.
PROCEDURE WHEN THE PHYSICIAN IS OUT OF THE OFFICE
1) Prescription renewal will be reviewed and authorized or denied by covering physician who is in clinic, or prescription
renewal will wait until patient’s physician returns to the office.
2) Covering physician will refer to the PROCEDURE WHEN THE PHYSICIAN IS IN THE OFFICE listed above.
PROCEDURE FOR INDIGENT PATIENT MEDICATION PROGRAM:
1) Patient will be referred to the Patient Resources Department Medication Assistance Program at 821-4278 or the main
Patient Resources line at 821-4819.
PROCEDURE WHEN PHARMACY FAXES A REQUEST TO THE CLINIC
Reception staff receives fax request from pharmacy.
Reception pulls patient’s medical record, attaching fax, and puts the medical record into the physician‘s mailbox.
Physician reviews prescription renewal request, checks box if physician denies request, or if he/she authorizes,
how many refills, and physician signs and dates the request.
If denied, the physician writes on the fax the reason for the denial.
After completing the request, the physician puts the patient record, with prescription renewal request, into
Reception staff faxes the completed prescription renewal request to the pharmacy, documents with initials, the
date, and the time faxed.
WRITTEN BY: Scheree Krueger, Director Clinic Operations
Donna Croxford, Clinic Operations Manager
REVIEWED BY: Ronnie Peterson, R.N., M.S., Manager Clinical Support
UWMF Psychiatry Clinic
Medical Director Date