Provider Manual · Part X

Refills & medications

Medication work between visits: pharmacy renewal and patient refill requests, prescribing without an open encounter, the chart's medication timeline, transmission statuses and errors, and pharmacies.

7 sections~14 min read6 screenshots

Part X

Refills & medications

Medication work between visits: pharmacy renewal and patient refill requests, prescribing without an open encounter, the chart's medication timeline, transmission statuses and errors, and pharmacies.

10.1Rx inbox requests

Work pharmacy renewal & change requests

Medication work that happens between visits arrives in the Rx view of the Inbox: pharmacy renewal requests, change requests, pharmacy-initiated new prescriptions, patient refill requests, cancellation denials, and transmission errors. The view is available to physicians and admins (staff accounts never see it), and the list refreshes itself every 30 seconds, so answered and newly arrived requests appear without a reload.

Open the Rx view. Click Inbox in the main tab bar, then the Rx view (pill icon) in the inbox sidebar. List rows are titled by request type plus the medication’s NDC product code — open the message to see the drug name.
Read the request. The header card shows the drug, the patient, and a colored request-type chip, with a key-value grid for Prescriber, Pharmacy, Written Date, Quantity, Refills, and Substitution. Below it sit Request Info (for example “Pharmacy requests renewal (2 refills).”), Medication Details (change requests show a side-by-side comparison instead), and a Timeline. The right panel adds Status, an AI Summary of the request, Pharmacy Details, and Routing / Identifiers.
Approve — as written or with changes. Approve answers the pharmacy as requested. To adjust the prescription first, open More → Edit Medication; the Edit Prescription: dialog ends in Approve with Changes. Changing only the refill count sends the approval with the new count; any other edit sends your version back as a replacement prescription. For change requests, More also offers Validate, which returns a validated response to the pharmacy — the status card then reads Change request validated.
Or reject with a reason. Reject reveals a Select denial reason dropdown with the standard denial codes (“Patient unknown to the prescriber”, “Patient has requested refill too soon”, “Refill not appropriate”, “Medication is discontinued”, “Other”) and an Additional details (optional) box. Confirm Denial sends it; the status card then shows Renewal request denied with “Denial sent to the pharmacy. We’ll refresh if they respond.”

Request chip	What it is	Your actions
`Renewal Request`	The pharmacy asks you to renew a prescription that is out of refills.	`Approve`, `Approve with Changes`, or `Reject`
`Change Request`	The pharmacy proposes a change, shown as a comparison against your original order.	`Approve`, `Validate`, `Approve with Changes`, or `Reject`
`New Prescription`	A pharmacy-initiated request for a new prescription.	`Approve` or `Reject`
`Patient Refill Request`	A refill request submitted from the patient portal.	`Create Rx` or `Deny` — see Patient refill requests
`Cancel Request Denied`	The pharmacy declined your electronic cancellation.	Informational — see Status & errors
`Error`	A prescription failed transmission or verification.	Informational — re-issue; see Status & errors

Rx inbox view with a pending New Prescription request selected: Status Pending, a Prescriber / Pharmacy / Written Date grid, Medication Details and Timeline cards, a Quick Actions panel on the right, and Approve, Reject and More buttons — An actionable Rx request: the detail cards on the left, status and routing on the right, and the `Approve` / `Reject` / `More` action bar.

One answer per request. Once a request has been approved, validated, or denied, the action buttons lock and the Status card records the outcome — for example Renewal request approved with “Approval transmitted to the pharmacy.”, or for a change request, “Change response sent to the pharmacy. Any pharmacy follow-up will appear here.”

Controlled substances: actionable requests carry a Controlled substance banner — “Approving requires passkey (EPCS) verification. Denials do not require passkey.” Approving opens the same passkey verification used for in-encounter EPCS signing. Schedule II renewals are blocked outright (“Schedule II renewals cannot be approved. Deny the request and issue a new prescription.”), and Schedule II change requests must carry a days supply between 1 and 30 before approval is attempted.

10.2Patient refill requests

Approve or deny patient refill requests

Patients ask for refills from the patient portal medications screen using Request refill. Their requests land in the same Rx inbox as pharmacy traffic, marked with an amber Patient Refill Request chip, and the message itself explains the model: “Patient requested a refill from the portal. Creating an Rx makes an internal draft for clinician review.” What patients are allowed to request is governed by your practice’s Refill Preferences.

Review what the patient reported. A dedicated Patient Request card shows Remaining Supply (in days, or “Not provided”), Pharmacy Confirmed, Patient Attestation, and Review Status, plus any free-text note the patient added.
Create the draft prescription. For patient requests the action bar swaps labels: the primary button is Create Rx and the deny button is Deny. Create Rx converts the request into an internal draft — it copies the drug, sig, quantity, days supply, and refills, and sets the patient’s pharmacy from the request. The status card confirms with Draft prescription created and “Review, sign, and send the draft prescription from the prescription workflow.”
Or deny with a reason. Deny uses the same denial-reason flow as pharmacy requests; the recorded outcome reads Patient refill request denied.

Create Rx sends nothing to the pharmacy. It produces a draft for clinician review — the prescription still has to be reviewed, signed, and sent from the prescription workflow before the patient gets their medication. Don’t treat a created draft as a completed refill.

Blocked and re-checked requests: a request can arrive already blocked by policy — Schedule II requests always are — with the reason shown in a warning box and Create Rx disabled (“This patient refill request is blocked by prescription policy.”); you can still deny it. Even an unblocked request is re-validated when you click Create Rx (pharmacy confirmation, attestation, medication eligibility, controlled-substance rules), so conversion can refuse with an explanatory error. Patient-reported medications still flagged Needs review on the chart can’t generate refill requests at all — see the Medications tab.

10.3Prescribe without a visit

Prescribe from the chart with Create Orders

The Create Orders modal lets a physician prescribe — and order labs or imaging in the same send — straight from a patient’s chart, with no encounter open. It embeds the same order-entry workspace you use at encounter completion, so the search window, prescription builder, and safety checks all behave identically. There is no on-screen button for it: it opens from the keyboard or by voice, and the shortcut is physician-only.

Open it from the keyboard. With a patient chart open, press F7 or Ctrl+O — the modal opens titled Create Orders with the patient’s name. You can also ask the voice assistant (“prescribe lisinopril 10 mg for this patient”) to open it pre-populated, titled Prescription from Command Hero; and inside a patient’s Inbox message, the New Order toolbar button expands the same workspace as an inline Orders panel.
Pick the pharmacy. The Pharmacy row preselects the patient’s primary pharmacy and also surfaces recommended nearby ones; the gear beside it opens the patient’s pharmacy manager (see Patient pharmacies). A pharmacy is required whenever a medication is in the cart — otherwise sending stops with “Please select a pharmacy for medication orders”.
Add and edit orders. Type into Search orders (medications, labs, imaging, screeners, forms)… to open the Search Orders window. Each added medication row has a pencil to edit (the full structured builder — see Write a structured prescription), a star to Save as favorite, a trash to Remove medication, and the usual medication safety check icons.
Send. The footer offers Cancel and a live-counting send button (for example Send 1 Order); while it works, the button reads Creating encounter and sending orders…. Confirmation — and any per-order failure text — arrives as a plain browser dialog.
Clear the diagnosis gate. E-prescribing requires a diagnosis on every medication. If one is missing, clicking send opens the diagnosis-association dialog with the banner “1 medication needs a diagnosis before it can be sent to the pharmacy.” Pick from the patient’s problem list, common diagnoses, or an ICD-10 search, then Save & send orders links the diagnosis and transmits in one step (the same association concept as in-encounter linking).

Create Orders modal with a Pharmacy row reading Select pharmacy, a unified search box for medications, labs, imaging, screeners and forms, an empty cart reading No orders added, and a Send 0 Orders button — The standalone Create Orders modal — pharmacy on top, one search box for everything, and a live-counting send button.

Pharmacy dropdown open inside Create Orders with a Search pharmacies box and a Closest to Physician list of pharmacies with distances — The pharmacy picker searches the directory and lists options *closest to physician* with distances.

A visit record is created for you. Because no encounter is open, sending auto-creates a medication-only draft encounter using your practice’s medication/prescription visit type (or the first available type), and the prescriptions transmit against it automatically. On the Encounters tab its chief complaint reads Medication Order via Command Hero — even when you launched with the keyboard shortcut. Labs and imaging in the same send route through your usual lab and radiology integrations.

10.4Medications tab

Review the chart’s Medications tab

The chart’s Medications tab is the read-only picture of everything the patient takes and has taken: a visual Medication Timeline up top, then Active Medications and Medication History tables. Use it to orient before a refill decision or a renewal approval.

Scan the timeline. The Medication Timeline draws each medication course as a horizontal bar across time. The Active Only toggle limits it to current therapy; switch it off to see full history (the empty state reminds you: “No active medications to display.”).
Read the tables. Both cards share the columns Medication, Clinical Details, Prescribing Physician, and Dates. Rows show name and strength, the sig (No sig provided when missing), a status pill, the prescriber — imported records keep their attribution, e.g. “Imported from Epic” with the date — and dates such as Start: and Last fill:.
Check the chips. A red Discontinued pill carries a hover tooltip, Reason for discontinuation:, with the recorded reason (also repeated inline as Reason:). An amber Needs review chip marks a patient-reported medication not yet matched to the drug database — its tooltip reads “Review and match before refill requests are allowed.”, and until it’s matched the patient cannot request refills of it from the portal.

Chart Medications tab showing the Medication Timeline with Cardiovascular, Psychiatry and Other swimlanes spanning several years, and the Active Medications table below — The Medication Timeline groups courses into swimlanes across years; the tables below carry the sig, prescriber, and dates.

This tab is review-only. There are no add, edit, or discontinue controls here. Discontinue medications through med management at encounter close, or cancel a sent prescription from order entry (see Status & errors) — the tab reflects those changes. For staff accounts, the tab is gated by the matching chart permission (see Staff accounts).

10.5Status & errors

Track prescription status & resolve transmission errors

After you send a prescription it moves from queued, to transmitted, to sent once the pharmacy electronically confirms receipt. There is no global “all prescriptions” dashboard — status lives in two places: each Rx message’s Timeline card in the Inbox, and the medication row inside order entry.

Stage	What it means
Pending	Queued and waiting to transmit.
Transmitted	Handed to the e-prescribing network; the Timeline records `Prescription transmitted`.
Sent	The pharmacy verified receipt — the prescription is at the pharmacy.
Error	Transmission failed or the pharmacy rejected the verification; an `Error` item appears in the Rx inbox with the reason.
Cancellation pending	You cancelled; waiting for the pharmacy to confirm.
Canceled	The pharmacy confirmed the cancellation.

Audit from the Timeline. Open any Rx message: the Timeline card lists Prescription created, Prescription transmitted, the request event, and Last filled with timestamps. Pharmacy fill notifications update the record automatically — dispensed, partially dispensed, or not dispensed — feeding Last filled and the fill count. For support calls, Routing / Identifiers has the Message ID and Pharmacy Ref #.
Resolve errors by re-issuing. Failures surface as Rx inbox items titled Error - plus the NDC, with a Prescription Error banner carrying the network’s error text (or a generic Transmission Issue). The status card explains: “This prescription has an error status and cannot be approved or denied.” There is no retry button — issue a new prescription (standalone or in-encounter) or call the pharmacy.
Cancel a sent prescription. In the order-entry workspace, a sent medication row shows Rx ID: with its identifier and a red Cancel button. Cancelling sends an electronic cancellation (CancelRx) to the pharmacy; the prescription sits in cancellation-pending until the pharmacy verifies, then flips to canceled.
Read a cancellation denial. If the pharmacy declines, a Cancel Request Denied item appears in the Rx inbox with a CancelRx Response card: Response Type, Received, Denial Reason, Reason Code, Prior Dispensing, and Approved/Denied Note, alongside the Original Cancel Request details. A warning appears if transport clipped any fields.

Rx inbox view with a transmission error message titled Error - Escitalopram Oxalate 10 TABLET selected — A transmission error in the Rx inbox — informational only; the fix is a fresh prescription or a call to the pharmacy.

10.6Patient pharmacies

Manage a patient’s pharmacies

Each patient carries a list of Preferred Pharmacies with one marked Primary — the primary is what the Pharmacy selector preselects every time you prescribe, in-encounter or via Create Orders. You manage the list from the chart’s patient-info panel, or from the gear next to the pharmacy selector inside order entry, so you can fix it mid-prescription without leaving the modal.

Find the panel. The chart’s patient-info panel has a collapsible Preferred Pharmacies section listing each saved pharmacy card — name, Primary badge, address, phone. The empty state reads No preferred pharmacies set; compact layouts condense it to Pharmacies (N) with the primary’s name.
Open the manager. The gear button (tooltip Manage pharmacies) opens the Manage and Select Pharmacies dialog, with the Current Pharmacies list and its count badge on top.
Click a card to set the primary. There is no separate radio or button — clicking a pharmacy card makes it the primary (green border plus the Primary badge). Hover a card to reveal the trash (Remove pharmacy); removing the primary automatically promotes the first remaining pharmacy.
Add from the directory. Add New Pharmacy opens the Pharmacy Search panel — search by Pharmacy name and location against the national pharmacy directory and add results as preferred or primary. Duplicates are de-duplicated by name, address, and phone.
Save. Nothing persists until Save Changes — Cancel or closing the dialog discards your edits. If saving fails, the dialog stays open with an alert so you can retry.

Pharmacy selector showing a searchable list sorted Closest to Physician with several Seattle pharmacies — The prescribing pharmacy selector preselects the patient’s primary and lists nearby options — keep the patient’s list current and prescriptions go to the right place by default.

10.7Refill preferences

Set practice-wide refill rules

The admin-only Refill Preferences screen controls what patients may request from the portal and how controlled-substance refills are reviewed — its header says exactly that: “Control how patients request refills and how controlled substances are reviewed.” The rules you set here decide which patient refill requests arrive actionable, arrive blocked, or never get submitted at all.

Open it from the Admin menu. In the top toolbar, open Admin (shield icon) and choose Prescriptions. The menu only appears for admin accounts; the modal is headed Admin · Prescriptions / Refill Preferences.
Start from a preset. Start from a preset offers four policies to apply and then fine-tune: Standard Primary Care, Conservative Controlled Substance, Maintenance Med Friendly, and Portal Disabled.
Tune each group, then save. Work through the setting groups below and save — the screen confirms with “Refill preferences saved.”

Patient access

Allow patients to request refills is the master switch — off hides the portal refill flow entirely. Also here: Confirm pharmacy before sending, Require attestation, and Allow requests when refills remain (off routes patients who still have charted refills to their pharmacy first).

Timing & limits

Earliest request sets how many days before the expected runout a request may be made; Duplicate cooldown sets the minimum wait before re-requesting the same medication.

Recent visit rule

Require a recent visit with a Visit window, plus an If outside the window behavior — flag the request for review, or block it outright.

Controlled substances

Schedule III/IV policy, Unknown schedule handling, Visit window override, Recent UDS window, EPCS-enabled approvers only (see EPCS enrollment), Require PDMP check, and Require signed controlled-substance agreement.

Routing & alerts

Route incoming requests to chooses where requests land (the Rx inbox), with Notify the assigned provider and Notify the staff pool toggles for alerts.

Patient messages

Three optional copy templates the portal shows patients — When a request is blocked, When a visit is required, and Request received. Placeholders show the default wording, so leave them blank to use it.

Schedule II is never refillable by request. The federal Schedule II block is built into Hero EMR and re-applied on every save — no preset or setting turns it off. Patients who try see the request arrive blocked, as described in Patient refill requests.

Need help? Email support@heroemr.com.