Encounter completion — orders & prescribing

Order medications, labs, imaging & more

The Orders section is one search box for everything you order at the visit — prescriptions, lab panels, imaging, referrals, screeners, and forms. Pick a destination pharmacy first so prescriptions know where to go.

1. Choose the pharmacy. Open Select pharmacy… and the dropdown is grouped, not one flat distance-sorted list: Primary Pharmacy first, then Patient Pharmacies, then up to five Closest to Physician, then up to five Closest to Patient. A group with nothing in it is left out entirely, so don’t expect all four on every patient — the first two need pharmacies already saved on the chart, and Closest to Patient needs a usable home address to measure from. On a patient with neither, the dropdown opens on Closest to Physician alone. Type two or more characters and a Search Results group from the wider pharmacy directory appears above those groups. Add or edit pharmacies with Manage pharmacies.
2. Search and add. Type into Search orders and press Search & Add to open the Search Orders window. Filter by tab: all, order sets, medication, lab, imaging, referral, screeners, forms, or favorites. The order sets tab only appears when order sets are enabled for your organization — see Order sets. Each result shows its name, brand names, and type; controlled medications are flagged with their schedule (for example Schedule: CIV).
3. Watch the renal cue. Latest Cr under the order list surfaces the most recent creatinine so you can dose-adjust without leaving the screen.

Write a structured prescription

Selecting a medication opens Edit Medication, where you build the sig from structured fields. Hero EMR assembles the directions and a one-click Auto-fill proposes a starting regimen with dosing guidance.

1. Build the sig. Set Action, Route, Dose (amount + unit), Frequency, Duration, Dispense (amount + unit), and Refills. A live summary of the directions is assembled from those fields and updates as you go.
2. Fill in the as-needed details. Choosing As needed (PRN) (or ticking the as-needed box) reveals a free-text reason — “As needed for… (e.g. pain, nausea, anxiety)” — and a Max doses per day field. Both fold into the directions the pharmacy receives.
3. Check the advisory readouts.
   • If the dispense quantity looks implausible for the days’ supply, the dialog shows the implied amount per day so you catch an absurd quantity (1800 tablets, 20 capsules a day) before sending. The same dispense/day summary appears on the order row in the list. It’s advisory and never blocks you.
   • For patients under 18 with a recorded weight and a catalog-matched product, a weight-based mg/kg readout appears under the dose fields. It is advisory only — it never edits the order.
4. Let Auto-fill propose a regimen. Auto-fill populates the structured fields and surfaces a Medication Hero dosing note — e.g. “For anxiety, clonazepam initial adult dose is 0.25–0.5 mg PO daily, may increase to 1 mg daily as needed.” Adjust anything before saving.
5. Delay the fill if you need to. Do not fill until (optional) sends the prescription now but asks the pharmacy to hold the fill until the date you pick. Leave it blank to fill now.
6. Say how it relates to what the patient already takes. When the patient already has the same drug on their list, the dialog shows Already on the medication list with one choice per matching entry:
   • Replaces and the entry, for example “Replaces Lisinopril 10 mg tablet”. The old entry moves to Past on the day the new prescription starts. Until then it stays current.
   • Take alongside and the entry. Both stay current, and Hero stops flagging them as a possible duplicate.
   • Continues and the entry, offered when you are prescribing the very same product. The prescription simply renews that entry. If the patient really takes two separate prescriptions of it, pick Take alongside … (separate prescription).
   • Not specified. Leave the decision for later.
   Hero pre-selects Replaces only when the new prescription has the same release (for example IR for IR) and the same route as the one matching entry. A different release, such as ER added to IR, is pre-set to Take alongside. When Hero can’t tell, nothing is pre-selected. The choice is optional and never blocks saving or signing. It takes effect once the prescription is sent.
7. Set substitution and pharmacy notes. Toggle Substitution Allowed and add a Note to Pharmacy if needed, then Save Changes to drop the order onto the list.
8. Check the chip on the order card. Back in Orders, the prescription’s card repeats the choice as a chip: Replaces … in amber, Take alongside … in blue, or Continues … in grey. If you haven’t chosen, it reads Already on the list: and the entry. Click the chip to change the choice any time before the prescription is sent.

Read the medication safety checks

Every medication order carries a row of five Medication Hero checks. Four of them — interactions, allergies, indication/dosage, and black box — run automatically and show green when clear; click any icon for the detail. A red or amber result means review before you sign. The fifth, PDMP, is a status readout only: it stays grey until a check has actually been run, and clicking it just opens its tooltip.

Link each order to a diagnosis

Orders should be tied to the diagnosis that justifies them. The Associations grid — diagnoses down the side, orders across the top — lets you check the box where they intersect. Linking supports medical necessity and is required before a prescription can be sent.

1. Open the Associations grid. It appears under the order list once you have at least one diagnosis and one order.
2. Check the intersections. Tick the box where a diagnosis row meets an order column (for example F41.1 × Clonazepam). The footer tracker shows Linked (0/1) in amber until every order is linked, then flips to a green Linked.

Sign controlled prescriptions (EPCS)

Non-controlled prescriptions send when you press their own Sign & Send, or when you finalize the visit if you haven’t. Controlled substances (Schedule II–V) require EPCS — DEA-regulated two-factor signing — before they can be transmitted. The order’s button always reads Sign & Send; for a controlled drug that is otherwise ready to go, its tooltip adds “(2FA required)”. The button stays disabled until a pharmacy is selected and a diagnosis is linked.

1. Select a pharmacy and link the diagnosis. Both are prerequisites; the button’s tooltip tells you what’s still missing (“Cannot send: Select a pharmacy, Associate a diagnosis with this medication”).
2. Click Sign & Send. The Controlled Rx Mobile Approval dialog opens. It restates the full prescription — patient and DOB, medication with its schedule, directions, refills, and the prescriber’s name, service address, and DEA number — alongside the legal signing attestation.
3. Confirm the DEA prescribing location. Hero defaults the DEA and service address to the registration whose state exactly matches the patient’s recorded address. Use the DEA-location dropdown for a manual change when needed. If the patient has no state or no registration matches, the dialog flags the issue and requires you to select a location before signing can continue. A manual selection for a different state remains visible as a warning so you can confirm it deliberately.
4. Check the PDMP. The dialog shows a PDMP not checked indicator with a Run PDMP button. This is the only place the state database is actually queried. Where a PDMP check is required for this drug’s schedule and your state, Start mobile approval stays disabled until Run PDMP comes back with a usable report — a stale or expired result blocks it too, and the reason is shown beneath the indicator.
5. Complete two-factor approval. Choose Start mobile approval to push the request to your registered phone, or Enroll passkey if you haven’t set up a second factor. Completing 2FA signs the prescription and authorizes transmission to the pharmacy.

Route a controlled prescription to a supervising physician

Some states require a physician to sign all, or some, of the controlled-substance prescriptions that nurse practitioners and physician assistants write. In Hero EMR the NP or PA prepares the prescription and routes it to a supervising physician (MD or DO) in the practice instead of approving it on their own phone. The physician reviews it in the Inbox Rx view with everything needed to decide, and then signs it, edits it first, or returns it with a reason. The prescription goes out under the physician’s name, DEA registration, and PDMP check — the physician is the prescriber of record, and the NP or PA is recorded as the one who prepared it.

For the NP or PA: route the prescription

1. Prepare the order as usual. Build the prescription, choose the pharmacy, and link a diagnosis, exactly as for any controlled prescription (Signing controlled prescriptions). Then click the order’s Sign & Send.
2. Choose Route to supervising physician. It sits beside Start mobile approval at the bottom of the Controlled Rx Mobile Approval dialog. The dialog becomes Route for supervising signature — “A supervising physician reviews this prescription and signs it under their own DEA registration.” You don’t approve on your phone, pick a DEA location, or run the PDMP for a routed prescription; the physician does those when signing. Back returns you to signing it yourself.
3. Pick the physician. The Supervising physician list shows your default first (marked Default), then your favorites, then everyone else, and your default is preselected. Click a physician’s star to add or remove a favorite, and Make default on the selected physician to preselect them next time. A physician who can’t sign controlled prescriptions yet is greyed out with Not set up for EPCS; No DEA registration in WA (or the patient’s state) warns that they have no DEA registration there. With more than eight physicians, a Find a physician search box appears.
4. Add a note and send. The optional Note to Dr. … box (up to 1,000 characters) travels with the request — “Anything the physician should know before signing.” Click Send to Dr. … for signature; a pharmacy has to be selected first. If a severe drug interaction is flagged, the warning’s confirm button reads Route anyway.
5. Follow it on the order row. The row shows where the prescription stands: Awaiting Dr. …’s signature, Dr. … is signing, Signed & sent by Dr. …, or Sending failed. While it waits, Edit and Remove are locked (“Waiting for Dr. … Withdraw it to make changes.”). You can finish and close the visit while a request is waiting.

For the supervising physician: review, then sign, edit, or return

A routed request brings everything you need to decide onto one screen:

1. Open the request. Click Inbox, then the Rx view. A request reads Signature requested · drug, with the schedule chip (for example C-II) and “from” the NP or PA who prepared it. Opening it shows who asked you to sign and when, an Awaiting signature status, their note, and the panels above.
2. Edit it if something needs to change. Edit opens Edit Prescription; Use these changes keeps your version. Nothing is sent from there — the request is marked Edited by you, your changes are saved to the prescription when you sign, and both of you can see what changed. Discard edits goes back to what was routed. A compound can’t be edited here; return it instead.
3. Sign and send. Sign & send opens Sign controlled prescription, the same EPCS signing you use for your own prescriptions: run or refresh the PDMP, confirm the DEA prescribing location (matched to the patient’s state automatically), check the summary — you are the Prescriber and the NP or PA appears as Prepared by — and choose Start mobile approval to approve on your phone. “Signed and sent” confirms it is queued for the pharmacy.
4. Or return it with a reason. Return to name asks why: Needs a visit, Dose or quantity change needed, Not clinically indicated, PDMP concern, or Other (which needs a note). Nothing is sent to the pharmacy.

When a prescription comes back

A returned prescription lands in the NP’s or PA’s own Rx view as Returned by Dr. …, and the order row reads “Returned by Dr. …: reason — note”. From the returned item they can Edit & re-route it (the dialog asks “What changed since it was returned”), Open visit while the visit is still open, Discard prescription, or Dismiss the item. If the physician signed but the send didn’t reach the pharmacy, the row shows Sending failed: the physician can return it to the preparer, or the preparer can withdraw it to fix and resend. Finished requests stay in the Rx view for seven days.

Practice settings (admins)

Set the practice policy under Admin → Prescriptions → Supervisory signing, then Save changes.