| Step No. | Step | Performer | Step type | Description | Documents | Key information |
|---|---|---|---|---|---|---|
| 1. | Retrieve renewal request message(s) | Office staff | Retrieving | Take or retrieve fax or phone message from a pharmacy or patient to request medication renewal; if phone, transcribed message to a note; calls pharmacy to clarify request as needed | Request fax or phone message | Telephone message transcribed to notes |
| 2. | Retrieve patient information | Office staff | Retrieving | Pull record and/or look up in practice management system; confirm that patient is seen in the clinic | Patient record | Patient identification confirmation on fax sheet or transribed phone message and clipped to the record to pass to authorized office staff for renewal approval |
| 3. | Deposit message with record for staff authorized for renewal approval | Office staff | Handoffs | Patient record, request | Patient ID, date of request | |
| 4. | Authorized staff retrieve message with record | Authorized office staff | Retrieving | Patient record, request | Medical records, details of request | |
| 5. | Check whether request meet protocol for authorization vs. needing physician review | Authorized office staff | Decision | Staff person checks protocol criteria for approving request without physician review and routes request to physician or to be approved per protocol | Patient record and protocol for staff renewal | Details of request, match to protocol |
| Protocol-approval pathway (a) | ||||||
| 6a. | Document protocol renewal | Authorized office staff | Processing | Document renewal on patient record | Patient record | Details of request |
| 7a. | Inform physician | Authorized office staff | Communication | Inform physician verbally or in writing | Note paper | Details of request |
| 8a. | Give patient record and prescription to office staff | Authorized office staff | Handoffs | Patient record, prescription copies | Details of request | |
| Physician-review pathway (b) | ||||||
| 6b. | Deposit message with record for prescriber approval | Authorized office staff | Handoffs | Patient record, request | Details of request | |
| 7b. | Prescriber retrieve message with record | Prescribing physician or nurse practitioner | Retrieving | Patient record, request | Patient ID | |
| 8b. | Prescriber approve or decline request or change medication | Prescribing physician or nurse practitioner | Decision | Decide if prescriber has approved request by looking up information such as last visit, lab results, current medication list, insurance coverage; complete prescription | Patient record, request | Approval or denial |
| 9b. | Give prescription and record to office staff | Prescribing physician or nurse practitioner | Handoffs | Patient record, prescription copies | Patient ID | |
| All renewals (pathways a and b rejoined) | ||||||
| 10. | File patient record | Office staff | Filing | Patient record, prescription copies | Patient ID | |
| 11. | Transmit to pharmacy | Office staff | Processing | Transmit to pharmacy via fax or phone | Prescription | Pharmacy information including name, address, phone number |