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CATHERINE MCCARTHY, MD

Welcome
About
- Who is Dr. McCarthy?
- Approach
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- Portal Guides
- Portal Request Form
Refills
- Refill Policy
- Refill Request
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IMPORTANT: PATIENT PORTAL CHANGE

NOTICE TO PATIENTS

On July 12, Dr. McCarthy emailed patients an invitation to activate their new SimplePractice portal (sent from "yourprovider@simplepractice.com"). Please call or email Dr. McCarthy (703-288-3535 / operations@catherinemccarthymd.com) with any questions.
Thank you for your patience!

NOTICE TO PATIENTS

REFILL REQUEST FORM

Note: this remains the preferred refill request method even after the portal transfer to SimplePractice

OVERVIEW of THE REFILL REQUEST PROCESS

(the shortage has caused complications)

1. Call pharmacy to confirm medication is in stock.

2. Submit this refill request and notify Dr. McCarthy (703-288-3535).

3. Keep checking with pharmacy after 2-3 business days to confirm:

a) The Rx was received (sometimes lost in pharmacy backlog)

b) The Rx has been filled and is not in "backorder limbo."

4. Give Dr. McCarthy voicemail updates (703-288-3535).

NOTE: Only requests that follow
the will be considered.

Patient

Patient first name

Patient last name

Patient Date of Birth

Who is completing this form?

Requester Full Name

Requester Relation

Requester Phone

Requester Email

All fields Required

*

3 Business Days for Refill Requests

The medication "shortage" requires additional processing time (e.g., for repeated prescription resubmissions).

Medication

Medication Name

Dose (mg/ml)

Days Supply *

30 days

90 days

(If authorized by treatment plan and insurance)

Pharmacy

Pharmacy Name

Pharmacy Phone

Pharmacy Address

Pharm City

Pharm State

Pharm Zip

Reserved for specific prescription details. It is not for clinical questions or any non-prescription matters.

For 90-day requests, please confirm that this was discussed at your last visit and that you have confirmed authorization by your insurance.

Message

Required Acknowledgements

*

I understand and agree that:

I will comply with the refill policy to avoid delays.Refill Policy

I have confirmed with the pharmacy that the medication is in stock, and, after submitting this request, I will check that the prescription was received (and not in "backorder limbo," and I understand that it may take up to 3 business days to arrive in their system.

The national shortage, DEA regulatory obstacles, electronic prescription complications, and logistical delays are beyond the control of doctors and patients.About the Shortage

I will continue checking with the pharmacy until the prescription has been filled.

There is a $25 fee for repeated refill requests and pharmacy reroutes outside of appointments. Charges for clinical time may also apply for extensive prior authorization processing.

I will keep Dr. McCarthy informed of all developments at (703-288-3535) and follow the emergency contact policy.

I have notified Dr. McCarthy (703-288-3535) that I am submitting this request.

*

I have scheduled an appointment in compliance with the 3-month policy

I have exceeded the 3-month appointment window required for Dr. McCarthy to prescribe, but have scheduled the next available appointment on Dr. McCarthy's portal calendar.

NOTE: In compliance with federal regulations, and to minimize prescription delays, the next available appointment may be scheduled as a “parent-only” visit in the office or by telemedicine, especially if a child patient is unavailable.

*

My next appointment:

Date

Time

12:00 AM

Success!

Your request has been submitted

CATHERINE MCCARTHY, MD • 6723 WHITTIER AVENUE, SUITE 403 • MCLEAN, VA 22101 • 703•288•3535

© 2024 by CATHERINE MCCARTHY, MD

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