Medical Directive Support
Therapeutic Substitution
Document pharmacist-directed therapeutic substitutions under medical directive. Generates a clinical PMS note, physician notification PDF, and dispensing prescription.
Directive & Service Details
Data
Patient Information
1. Original Prescription
2. Reason for Substitution (select at least one)
3. Exclusion Criteria Screen
Patient meets one or more exclusion criteria — refer directly to the physician. Do not proceed with substitution under this directive.
Patient does NOT meet any of the following. Check all that apply — patient must be referred to physician if any are present.
4. Summary of Issue / Relevant Patient Information
Describe the specific issue (e.g., backorder details, coverage issue). Include relevant patient factors such as allergies, comorbidities, or previously failed therapies.
Assessment
Clinical Rationale for Selected Alternative
Provide a concise justification for the chosen therapy. Reference clinical guidelines, patient-specific factors, or formulary preferences.
Plan
1. Therapeutic Substitution Details
2. Quantity / Duration Rationale
e.g., 30-day supply per expected backorder timeline, synchronized with existing chronic meds, etc.
3. Monitoring & Follow-Up Plan
Outline recommended monitoring or follow-up actions.
4. Patient Consent & Education