HOPESTAGE — MEDICATION REFILL CALL CHECKLIST
For adults asking a pharmacist or prescriber about an existing prescription.
Created 13 October 2026.

This is a place for your notes, not a prescription or a dosing guide.
If you are in immediate danger or cannot stay safe, contact local emergency
services or go to an emergency department. Do not wait for a routine reply.

1. INFORMATION FROM THE LABEL
Medicine name:
Strength and formulation (copy the label; ask if unsure):
Prescribed instructions:
How I have actually been taking it:
Amount remaining:
When I expect the supply to end:
Last dose taken — date, time and amount:
Any missed doses:
Symptoms or changes I need to mention:
Other medicines, supplements and known allergies:
Usual pharmacy and phone number:
Prescribing clinic and phone number:
Next booked appointment:
Country / state / province where I am now:

2. WHAT IS BLOCKING THE REFILL?
What the pharmacy or clinic told me:
What needs to happen next (ask them to confirm):
Is an assessment, monitoring result or document required?
Who needs to supply it?
Any cost or insurance issue to raise?

3. A CALL SCRIPT TO ADAPT
"I take [medicine and strength], prescribed as [instructions]. I have [amount]
left, and my last dose was [date and time]. My next appointment is [date].
The problem is [what I was told]. I have [missed doses / symptoms / neither].
Can a pharmacist or clinician advise me on the next dose and how to arrange
a supply? If you cannot help in time, who should I contact?"

Say "I do not know" if you cannot verify a detail.
Ask the professional for instructions for your exact medicine and situation.
Do not invent a rationing, missed-dose or restart plan yourself.

4. RECORD THE ANSWER
Date and time of contact:
Service and person / role:
Advice given by the pharmacist or clinician:
Next action:
Who will do it:
When I should hear back:
Who to call if that does not happen:
Where / when medicine can be collected, if supply is confirmed:
Cost confirmed:
Advice if symptoms change:
Out-of-hours contact provided by the service:

5. BEFORE THE NEXT REFILL
Who will prescribe:
When to request the next prescription:
Clinic's preferred request method:
Review / test / paperwork needed first:
Next follow-up date:

Keep completed notes somewhere private. Information you add to this file is
not sent to HopeStage. Share it with your care team as appropriate.

Guide and official sources:
https://www.hopestage.com/research/running-out-of-psychiatric-medication