BPH Medication Refill Request

Simplify BPH Medication Refill Management with Paperform

Managing benign prostatic hyperplasia (BPH) requires ongoing medication management, regular monitoring of urinary symptoms, and coordination between patients and urology specialists. This BPH Medication Refill Request template brings structure and efficiency to the refill process, ensuring all clinical data is captured accurately while streamlining specialist approval workflows.

Why healthcare providers choose this template

For urology practices, men's health clinics, and primary care providers managing BPH patients, this template eliminates the back-and-forth of phone calls, faxes, and incomplete refill requests. Patients can submit comprehensive refill requests that include current symptom assessments, urinary flow data, and medication compliance information—all in one secure, professional form.

The template captures essential clinical indicators including International Prostate Symptom Score (IPSS) questions, quality of life assessment, urinary flow measurements, and prostate volume tracking. This ensures prescribers have the complete picture before authorizing refills, improving patient safety and treatment outcomes.

Built for urology practices and men's health specialists

Whether you're a solo urology practice, multi-provider men's health clinic, or hospital-based urology department, this template adapts to your workflow. The conditional logic ensures patients only answer relevant questions based on their specific medication regimen and symptoms, while the structured format makes it easy for clinical staff to review and process requests efficiently.

The form includes dedicated sections for:

• Current medication verification with dosage and frequency confirmation
• IPSS symptom scoring to track disease progression
• Urinary flow study results for objective measurement
• Prostate volume documentation from recent imaging
• Side effect and compliance assessment
• Specialist approval routing with clear next steps

Automate your refill workflow with Stepper

Connect this form to Stepper to transform each submission into a complete approval workflow. Automatically route urgent requests (high IPSS scores, new severe symptoms) to specialists for immediate review, send routine refills to nursing staff for processing, update patient records in your EHR system, and trigger pharmacy communications—all without manual intervention.

You can set up workflows that flag patients requiring follow-up appointments, send automated status updates to patients, create tasks for ordering additional testing, and maintain comprehensive audit trails for compliance. Stepper's healthcare-specific automations mean your team spends less time on administrative tasks and more time on patient care.

Professional, HIPAA-friendly form design

While Paperform is not HIPAA compliant, this template is designed with healthcare best practices in mind, featuring clear privacy notices and secure data handling. The professional medical interface builds patient confidence, while the mobile-responsive design ensures patients can submit refill requests from any device.

The form's conditional logic minimizes patient burden—if someone reports no side effects, they skip detailed symptom questions. If they're on combination therapy, additional medication fields appear automatically. This intelligent design improves completion rates while capturing all necessary clinical data.

Trusted by urology practices nationwide

Over 500,000 teams worldwide trust Paperform for their operational workflows, including healthcare providers who need sophisticated forms without technical complexity. This BPH refill template is part of Paperform's library of 30,000+ professional templates designed for specific use cases.

With SOC 2 Type II compliance and enterprise-grade security, you can deploy this template with confidence. Use Paperform's role-based permissions to control who accesses sensitive patient data, and leverage custom success pages to provide patients with clear expectations about processing times and next steps.

Get started in minutes

Simply customize this template with your practice information, medication lists, and approval workflows. Add your branding with custom colors and fonts to match your practice website. Connect to your existing tools—whether that's your EHR, pharmacy system, or internal communication platforms—and start processing refill requests more efficiently today.

For urology specialists, primary care physicians managing BPH, nurse practitioners, and physician assistants, this template delivers the perfect balance of clinical thoroughness and operational efficiency. Transform your medication refill process from reactive and chaotic to proactive and streamlined.