Refill Request - Metformin
Sarah Johnson • 58F • DOB: 03/15/1967
Collected Information
Medication
Metformin 500mg
Dosage
2x daily with meals
Last Fill
Dec 28, 2025
Quantity
60 tablets (30-day)
Pharmacy
CVS - Main Street
Refills Left
3 refills
Twin Assessment
Labs mildly overdue (HbA1c due 2 weeks ago). Last value 6.8%. No
contraindications. Safe to approve pending physician review.
Linked Documents
Pharmacy Fax Request
Last HbA1c Results
Patient Chart
Activity Log
Task started
10:30 AM
Sarah M. (MA)
Patient chart reviewed
10:28 AM
Twin Assessment
Labs mildly overdue. Safe to process with physician
approval.
Task assigned
10:15 AM
Auto-routed to MA queue
Task created
10:15 AM
Pharmacy fax received