WADENA MEDICAL CENTER PRESCRIPTION RENEWALS:

If you are out of refills on a prescription issued by a Wadena Medical Center healthcare provider, simply fill out the following form. We will confirm the details with the physician and phone the refill into the specified pharmacy. Be sure to fill out the form completely.

Please allow two working days for this request to be processed. If there is a problem/question with your refill, a nurse will call you. Otherwise, please call your pharmacy to verify your prescription is ready to be picked up.

Patient Information

First Name:  *

Last Name:  *

Patient Date of Birth:  *

(Example 5/30/1971)

Daytime Phone Number:  *

Email Address:  *

Physician/Provider:  *

Drug Name:  *

Drug's Strength/Dosage:  *

Directions:  *

Pharmacy Name:  *

Pharmacy City:  *

Pharmacy Phone Number:  *

Additional comments regarding your prescription:

Please enter the characters you see in this picture:

Characters

This helps prevent automated form submissions. If you are not sure what the characters are, make your best guess. You will have another try in the next screen.
Can't see the image?  Click here for an audible version in english.

Find even more useful information at:
National Library of Medicine Website
Brought to you in conjunction with TCH and the Bio-Medical Library, University of Minnesota

© Tri-County Hospital, Wadena Medical Center, Fair Oaks Lodge 2008. All rights reserved. Designed by Tri-County Hospital.