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Health Services

Pharmacy Prescription Refills

It is recommended you submit prescription refill requests five work days before you need your medications; however, they will normally be ready two work days after they are requested (note the pharmacy is closed weekends). The prescription number is located in the upper left hand side of your medication label and begins with an "RXCA" (for prescriptions originating from the Alameda clinic). Please include the prefix (e.g. RXCA, RXD) that precedes the number on your request. The information may be typed in either lower- or upper-case letters. If you are out of refills please call the front desk of the clinic at 437-3581.

If you need more than five prescriptions refilled, you may submit this form twice for a total of ten maximum refill requests.

Today's Date: dd-mmm-yyyy

Prescription Numbers	Prescription 1	Prescription 2
Prescription 3	Prescription 4	Prescription 5
Last Name
First Name
Telephone Number

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Last Modified 7/16/2012