Dr. Donovan is happy to review all requests from currently active patients seen within the past 18 months for a prescription refill prior to their next appointment with him. However, he needs to know that his patients are doing well on the medication prior to refilling it and that their health status has not changed in any significant way since the last appointment. The following questionnaire (see below) provides Dr. Donovan with an immediate update on your health and allows him to evaluate whether or not it is appropriate to refill the prescription without an appointment. Please complete the following form in full. The information goes directly to Dr. Donovan and he will review it carefully. If he is able to, he will renew your prescription by phoning or faxing in your prescription to the pharmacy you indicate on the form. Kindly note that completion of this form does not guarantee that Dr. Donovan will be able to refill your prescription. There are many circumstance where a follow up appointment is mandatory to determine if it is appropriate and safe to continue the medication.
REQUIREMENTS FOR REFILLING A MEDICATION
Please note that ALL patients receiving prescription refills MUST:
1. Update our office with ANY changes in health throughout the next 12 months if they occur
2. Update our office if you have received ANY new blood test results. If you take any off the following medications you must send us new blood test results within 6 months of your refill: hydroxychloroquine, mycophenolate mofetil (CELLCEPT), cyclosporine, methotrexate, azathioprine.
3. Have an appointment with Dr. Donovan again WITHIN 12 MONTHS of the date of your prescription renewal. Renewals are not given to any patient who has not been seen by Dr. Donovan within the past 24 months. There are no exceptions.
Should you wish to email any results or photos please send to firstname.lastname@example.org and they will be added to your file.