Refills & medications

Work pharmacy renewal & change requests

Pharmacy traffic that happens between visits arrives in the Rx view of the Inbox: pharmacy renewal requests, change requests, pharmacy-initiated new prescriptions, cancellation denials, and transmission errors — plus, for supervising physicians, controlled prescriptions a nurse practitioner or physician assistant has routed for your signature (Signature requested; see Supervisory signing). 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. Refill requests that patients send from the portal are not here — they have their own Refills view with a checklist and one-click Prescribe (see The Refills worklist).

1. 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.
2. 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 — on a change request that card is replaced by an Order card listing your original order’s Medication, NDC, Sig, Quantity, Days Supply, Refills, and Substitution — and a Timeline. The right panel adds Status, an AI Summary of the request, Pharmacy Details, and Routing / Identifiers.
3. 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.
4. Or reject with a reason. Reject reveals a Select denial reason dropdown listing the twelve standard Surescripts denial reasons — among them “Patient unknown to the prescriber”, “Patient has requested refill too soon” (the pre-selected default), “Refill not appropriate”, “Medication is discontinued”, and “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.”

Work patient refill requests in Inbox > Refills

Patients ask for refills from the patient portal (Profile > Medications > Request refill). Each request lands in the Refills view of the Inbox — a worklist, not a message thread. Every request has an owner and an age, a checklist that checks the chart for you, and a Prescribe button that opens the normal prescription editor already filled in. When the request is decided, the patient is told the outcome. What patients may request, who reviews first, and how late is “late” are all set in Refill settings; nothing reaches patients until an administrator turns on Allow patients to request refills.

1. Open Inbox > Refills. Refills sits under Rx in the inbox sidebar. Providers (every active physician, NP, or PA in the practice) and practice administrators always have it; staff need the Review and route refill requests permission, which the Medical Assistant and Nurse role profiles include. The view stays hidden until the practice turns on portal refill requests (or has received one). Its badge counts requests waiting for you, not unread ones.
2. Pick a folder tab. With staff triage off (the default) there are two tabs, Open and Completed. With triage on there are three: To triage, Ready for provider, and Completed; providers land on Ready for provider, everyone else on To triage. Open tabs list the oldest request first; Completed shows decisions from the last 30 days, newest first.
3. Choose Mine or All, and search. Mine means assigned to you or still in the shared queue (for triage staff: owned by you or unclaimed). All shows the whole practice and adds a provider (or owner) filter. The search box, Search patient or medication, starts matching after two characters.
4. Read the row. Each row shows the patient, the medication, a controlled-substance chip (C-II to C-V, or Controlled when the schedule is unknown), and the request’s age (45m, 5h, 2d). The age pill turns amber with Due soon and red with Overdue at the hours you set. A stage chip says where it is: New, In triage · <staff member>, Ready · <provider>, or Ready · Shared queue. Completed rows show the outcome instead: Prescribed, Not approved, Visit needed, or Cancelled.
5. Open a request. Click the row. The detail pane on the right holds the request, the last prescription, the checklist, the activity log, and the action bar — see Review & decide.

Check the request, then prescribe, ask for a visit, or decline

The detail pane has four cards. Refill request shows the patient and date of birth, the medication and directions, Quantity, Days supply, Refills (last Rx), the Pharmacy (marked confirmed when the patient confirmed it), when it was Requested, who it is Assigned to, the Triage owner, how many days the patient says are left, and the patient’s note. Last prescription repeats the prior script. Checklist and Activity follow.

The checklist

The checklist looks things up in the chart so nobody has to. Each item shows a status — Met, Missing, Check, or Info — and the evidence it found. Items marked Required block Prescribe until they are met or someone clicks Mark reviewed (with an optional note such as “Reviewed outside records”). A reviewed item records who and when, and Undo review removes it.

The action bar

The buttons you see depend on who you are and the practice settings; Hero EMR works this out for you, so a button that is shown is one you may use.

1. Prescribe (providers). Prescribe opens the prescription editor titled Refill · <medication>, filled in from the last prescription the same way the chart’s Renew action works, with the pharmacy the patient asked for. Adjust anything, then send it as usual — Send 1 Order for a non-controlled drug, or Sign & Send with EPCS for a controlled one. Sending closes the request as Prescribed in the same step. Tick Also ask to book a visit first to add a booking link to the approval message (a bridge supply). If required checklist items are open, Hero EMR stops with “Complete the required checklist items before prescribing.” and highlights them.
2. Needs visit. Opens Visit needed before this refill with a Message to the patient (pre-filled: “Your care team needs to see you before this refill. Please schedule an appointment.”), an optional internal note, and Text/email the patient a booking link (on). Click Visit needed. Providers can always do this; triage staff can when Staff may mark “needs visit” is on (the default).
3. Deny. Opens Don’t approve this refill. Pick a Reason — Needs an appointment, Medication stopped, Too early, Refills remain at the pharmacy, or Other — write the required Internal note (care team only), and check the Message to the patient, which is pre-filled from the reason. Click Not approved. Staff may deny only when Staff may deny non-controlled requests is on, and never a controlled drug.
4. Reassign, Claim, Send to provider. Reassign picks a provider (or Shared queue (any provider)) and, for triage staff, a triage owner; providers who cannot sign a controlled drug are marked — no EPCS. Triage staff also get Claim and Send to provider (see Staff triage). Open chart and Message are always there; Message starts a portal message with the subject “About your refill request”.

Let staff triage first, work in bulk, and catch late requests

Practices where a nurse or medical assistant checks each request before the provider turn on Staff triage before provider review (see Refill settings, or apply the Group practice · nurse triage preset). New requests then wait in To triage, and providers only see what staff send them.

1. Claim a request. Open a New request in To triage and click Claim — or just start working: adding a note, marking a checklist item reviewed, or sending it on claims it for you automatically. The stage changes to In triage with your name.
2. Do the chart work. Mark checklist items reviewed (for example the PDMP), use Send agreement if the controlled-substance agreement is missing, and leave internal notes in Activity (“Add an internal note (not visible to the patient)”).
3. Send to provider. Send to provider moves it to Ready for provider, either to the provider it was routed to or to one you pick. Staff can also close requests themselves with Needs visit, and with Deny for non-controlled drugs when the practice allows it.

Bulk actions

Tick the checkboxes on open rows to get a bulk bar: Assign provider, Assign owner and Send to provider (triage practices), and Needs visit. Up to 50 requests at a time; each one is re-checked, and the result reads, for example, “12 updated, 1 skipped (already changed or not allowed)”. Prescribe and Deny are never bulk actions.

Deadlines, escalation, and live alerts

While Hero EMR is open, in-app toasts announce New refill request, Refill request ready for you, Refill request assigned to you, and Refill request overdue, each with an Open button. Toasts name the patient as first name and last initial and say “controlled medication” when relevant — never the drug. Notify the assigned provider controls the provider alerts and Notify the staff pool the alerts to triage staff; the person who took the action is never alerted.

Refill requests from the patient’s side

Patients request refills under Profile > Medications in the portal. The Request refill button appears only when the portal’s Refill Requests feature (Admin > Patient Portal Configuration) and Allow patients to request refills are both on, and only for medications the rules allow. The request form asks them to confirm the pharmacy, how many days of medication are left, an optional note, and an attestation.

1. Track it. Each medication shows the latest request, for example “Requested Sep 20 · Being reviewed”. A Refill requests section lists the history with plain statuses: Sent, Being reviewed, Approved, Approved – sent to pharmacy, Not approved, Appointment needed, and Cancelled.
2. Read the care team’s message. For Not approved and Appointment needed the patient sees the message you wrote in the dialog; a Book a visit button appears when you asked for a visit and online self-scheduling is on.
3. Cancel. While a request is still pending, the patient can cancel it (“Cancel refill request?” → Cancel request). It moves to Completed as Cancelled on your side.

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.

1. 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.
2. 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”.
3. 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. Frequency offers the whole clinical range — Daily, Twice daily, Three times daily, Four times daily, Every 4 hours through Every 12 hours, Every morning (QAM), Every evening (QPM), At bedtime (QHS), Every other day (QOD), Every 48 hours, Every 72 hours, Weekly, Every 2 weeks, Monthly, and As needed (PRN) — and every one of them is stored with the prescription, so a bedtime medication comes back as At bedtime (QHS) when you Reorder it rather than as a blank field.
4. Add a clinical note (optional). A Clinical note box sits under Diagnosis in the prescription dialog, and a matching Clinical note panel with an Add a note button sits under the diagnoses in the modal body — the same note, shown twice. Dot phrases work here: type . then a few letters and pick from the list. The helper line states the contract: “filed as a signed progress note on an Orders-only encounter when the order is sent · visible to the patient in the portal”.
5. 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.
6. 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).

Review the chart’s Medications tab

The chart’s Medications tab shows the patient’s medication list with the Medication Timeline above it. It is the same list you see in the encounter’s Medications section and in the reconciliation workspace. Rows sit in the same groups everywhere, and every count agrees with this tab, including the encounter footer chip, the timeline’s Current only button and patient-list columns. Only the medications in Current are counted.

1. Pick the view. The Medication list menu offers Current medications (the default), All medications and Past medications. Current medications shows Needs review, Current, Scheduled and On hold, and leaves Past collapsed at the bottom. All medications opens Past too, and Past medications shows Past alone. Hero remembers your choice for every chart you open, and each user keeps their own.
2. Search or sort. Search medications matches the medication’s name, its ingredient and what the patient wrote. While you search, the group counts show the matches, and Past opens if anything in it matches. By default, rows that carry a chip come first, then the most recently prescribed. The A–Z button sorts alphabetically instead. The summary next to it reads, for example, 16 current · 2 to review · 1 on hold.
3. Read the name. Each medication shows the product: the ingredient (every ingredient of a combination), a release badge such as IR, ER, XL, XR or DR, then the strength and form. Hero shows IR whenever the drug comes in more than one release form, so a missing badge never hides the difference. When the chart doesn’t say which release the patient takes, an amber dashed ER / IR? chip takes the badge’s place. Click it (or Specify) to open Specify the medication, pick the exact product and click Use this product.
4. Look for duplicates. A blue Possible duplicate chip means another entry on the list is the same drug, often an old strength left behind after a dose change. Click the chip to open Merge duplicate entries. Choose the entry to Keep, tick Merge on the others and click Merge N entries. The merged entries end as merged into the one you kept, and their history moves with them. Two strengths the patient really takes together are not duplicates. Prescribe them with Take alongside and Hero stops flagging them.
5. Read the supply line. For a prescription sent from Hero, the middle column describes it, for example Rx 9/3 · 30 days · 0 refills, and then how long the supply lasts, for example 12 days left · runs out 10/3, with a thin bar. The bar turns amber in the last seven days, when an amber N days left chip also appears, and red once the supply is gone (Ran out Sep 18). est. means the dates were worked out from the directions and quantity. An as-needed prescription reads As needed · authorized through and the date. A medication with no prescription behind it (patient-reported or imported) starts the line with Started and its start date instead of Rx, and reads Supply timing unknown. A green Renewal sent line appears once a renewal has gone out. The prescriber is on the right.
6. Check the other chips. Where the medication came from: eRx, Patient-reported, Staff-reported, Imported, Outside or Fullscript. An amber Unmatched chip marks a patient-reported medication that is not yet matched to the drug database. Its tooltip reads “Not matched to the catalog: match it before refill requests are allowed.”, and the patient cannot request refills of it until it is matched. Not confirmed since and a date appears on a patient-reported or imported medication that nobody has confirmed in 180 days. Click it to record Still taking. If the patient said they take no medications, the list says so, with the date.
7. Work the Needs review group. Every row states its reason and offers only the buttons that fit it:

   What the row says	Why	Buttons
   Ran out Jun 7 (30-day supply, no refills)	The prescription’s supply and refills are used up and nothing newer covers today. If a later fill is already scheduled, it reads Out since … next fill scheduled …	Renew · Still taking · Stopped
   Patient reports not taking · reported and the date	Someone recorded that the patient isn’t taking it, from the chart, the encounter or the patient’s own report.	Stopped · Still taking
   Prescription couldn't be matched to one chart entry	A prescription arrived that could belong to more than one entry, so Hero kept it separate rather than guess.	Specify · Merge
   Imported without a status	An imported record didn’t say whether the medication is still being taken.	Still taking · Stopped
   Confirm medication status	A records clean-up flagged the entry for a person to check. Hover the line for the detail.	Mark reviewed · Stopped

8. Know what each button does.
   • Renew opens order entry (titled Renew · and the medication), filled in from the last prescription with the product, directions, quantity, days’ supply and pharmacy. Review it and send. If no prescription is on file, for example for an imported or patient-reported medication, order entry opens empty so you can pick the product. Only prescribers see Renew. Inside a visit, Renew works differently (see the encounter’s Medications section).
   • Still taking confirms the patient still takes it, and the row returns to Current. It also clears a “not taking” report and an import without a status. For a prescription that ran out, the confirmation holds until a new prescription or fill changes the dates, or for 180 days. If a clinician stopped the medication, Hero won’t reopen it. It explains, “This medication was stopped by a clinician; renew it instead.”, and offers Renew.
   • Stopped opens Discontinue medication with an optional Reason for stopping. When a prescription for it is still live at a pharmacy, the dialog first checks with the pharmacy and then offers Also cancel the prescription at and the pharmacy’s name. That box sends an electronic cancellation. It is ticked for you on controlled substances. Outside Needs review, the same dialog opens from Discontinue… in the row’s ··· menu.
   • Specify and Merge open the two dialogs described above. Mark reviewed records that you checked the entry.
9. Recover a past course. Past rows read Stopped or Ended with the date and any recorded reason, or End date unknown when the record never said. Every past course offers Renew. It also offers Still taking when Hero closed the course on its own, because the prescription ran out and wasn’t renewed or a newer prescription replaced it. Still taking reopens such a course. A course a clinician stopped can only be renewed.
10. Read the timeline. The Medication Timeline draws one bar per course, coloured by drug category, with a red Today line. Current only (with the current count) narrows it to current medications, and the category chips filter it further. A stopped medication ends at its stop date. A course that ran out ends on its run-out date, and the stretch from then to today is hatched (“Ran out: no supply covers this period”). A course whose end date is unknown fades out with a dashed edge, and its tooltip reads Ended: Unknown (last known and the date). Only courses still running carry the arrow into today. The legend under the chart names each style: Current (ongoing), Needs review, Ran out, Ended and End date unknown.

How Hero decides what is current

Hero works out where each medication belongs every time the list loads. It uses the prescriptions that actually reached the pharmacy and anything a clinician has recorded. The day changes at midnight in your practice’s time zone, so a prescription runs out on the right day for your office, wherever the viewer is.

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.

1. 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 #.
2. 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.
3. 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.
4. 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.

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.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.

Set practice-wide refill rules

The Refill settings tab of the Prescriptions workspace (“Control how patients request refills and how controlled substances are reviewed.”) decides what patients may request from the portal, which chart checks a controlled refill needs, whether staff triage requests before the provider, where requests are routed, when a request counts as late, and what patients are told. Together these rules drive the Refills worklist.

1. Open it from the Admin menu. In the top toolbar, open Admin (shield icon) and choose Prescriptions. The Prescriptions workspace opens in its own tab with Prescription status, Refill settings, and Supervisory signing (plus Compound formulas when compound prescribing is on). Refill settings is offered to organization administrators — practice admins, office managers, and practice owners, including a solo owner who signs in as a physician — and to staff granted Manage clinic information, insurance, and branding. Staff with only the prescriptions-registry permission see Prescription status.
2. Start from a preset. Start from a preset (“Pick a policy that fits your practice, then fine-tune below.”) offers five policies: Standard Primary Care, Conservative Controlled Substance, Maintenance Med Friendly, Portal Disabled, and Group practice · nurse triage — “Nurses or MAs triage every request first, then send it to the patient’s primary provider. Overdue requests are escalated to the practice admins.” The preset that matches your current values shows an Active badge.
3. Tune each group, then save. Work through the cards below. A footer bar tracks your state — Unsaved changes or All changes saved — with Discard changes and Save changes; saving confirms with “Refill preferences saved.”

“Unavailable” means inactive or hidden — and, for Schedule III–V drugs while EPCS-enabled approvers only is on, not able to sign controlled prescriptions. Group practices no longer fall back to the longest-serving physician; unroutable requests wait in the shared queue.