Decatur Memorial Hospiotal


ON-LINE PRESCRIPTION REFILL ORDER FORM


DMH PharmacyIf you are a current Physicians Plaza Pharmacy customer here is an easy and convenient way to refill your prescriptions. Use the form below to order your refill ahead of time. That way, you can be sure that you'll have your medication exactly when you need it. Simply fill in the required information in the boxes below, then pick up your prescription. It's that simple! You can submit your refill order 24 hours a day, seven days a week. Although during regular pharmacy hours your prescription should be ready within 24 hours from its submission, allowing more time assures that your prescription will be right on time! (Check your pharmacy's hours) Since your prescription is filled at the Physicians Plaza Pharmacy by the same pharmacists you've come to know, you can trust that you'll get the same great service you always expect. This service is available for refills only. If you're a current customer and are unable to get to the pharmacy, delivery service is available. Please make sure you check the box for "pick up" or "delivery".

CUSTOMER INFORMATION

Rx LabelIn order to refill your current prescription on-line you must provide the Rx number (this is the 7 digit number found on your current prescription bottle) and your phone number. Please make sure all information provided is correct to help you your pharmacist refill your prescription efficiently and accurately, ensuring your refill is ready on time! When ordering ahead, please allow your pharmacist at least 2 hours to refill your prescription.** Again, remember to check the pharmacy hours.

**If your prescription is not refillable, please allow additional time for physician approval.

A confirmation # will be given to you, notifying you that the pharmacy has received your refill request. If you're not certain of the exact time you submitted your refill request, you can call the pharmacy to make sure it is ready to be picked up.

Physicians Plaza Pharmacy 876-5566 Monday through Friday 9a.m. - 6p.m., Saturday 9a.m. - 12p.m.
Go to the On-Line Prescription Refill Order Form


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