Stimulant prescriptions will be mailed ONLY to the pharmacy of your choice, not directly to patients.
When you request a stimulant refill between appointments, you must provide the following information (MANDATORY BY LAW for the pharmacist):
Name of Patient:
Date of birth of patient:
Home phone number:
Name of patient's health insurance company:
Insurance ID # of patient:
Phone number of patient's health insurance company:
Name of medication (specify whether it is XR or CD if applicable):
Milligrams per tablet or milligrams per capsule:
How many tablets or capsules per day and how often are they taken:
Last date on which this prescription was filled:
Name of the pharmacy:
Street address of the pharmacy:
City, state and zip code of the pharmacy:
Phone number of the pharmacy:
|SUBMIT THE INFORMATION|
You can submit this required information one of three ways:
FAX | 773.303.8242
EMAIL | email@example.com
MAIL | ATTN:
Zabrin Inan, MD 125 South Wacker Drive Suite 300
Chicago, IL 60606
REFILL YOUR PRESCRIPTION
1. ALL REFILLS OTHER THAN STIMULANTS
Have your pharmacy fax a refill request to 773.303.8242.
We will respond directly to the pharmacy.
2. ALL STIMULANT PRESCRIPTION REFILLS
(such as Ritalin (generic methylphenidate) or derived products: Concerta, Focalin XR, Metadate CD, Adderall (generic dextroamphetamine) or derived products such as Adderall XR or Vyvanse)
NOTE: (Provigil (generic modafinil) is the only stimulant that it can be phoned or faxed in; you can have your pharmacy fax a refill request to 312.280.8854)
The Law Regarding Stimulant Prescriptions (Class CII medication):
1. These prescriptions must be handwritten on tamperproof blanks. They cannot be faxed or phoned in.
2. These prescriptions can only be filled within a 6-day window, starting from the date written on the prescription.
After that, they are expired and will not be honored at a pharmacy.
3. A different prescription will be required for each of the above medications requested.
4. Only one prescription per specific medication can be filled every 30 days.
5. No refills are allowed.
6. A new prescription is required every month.