Multiple Sclerosis DMT Refill Request

Streamline Your MS Disease-Modifying Therapy Refill Process

Managing multiple sclerosis requires careful coordination between patients, neurologists, and healthcare teams. This Multiple Sclerosis DMT Refill Request template helps neurology clinics, MS specialty centers, and healthcare providers create a seamless refill process that captures essential clinical data while ensuring timely medication access for patients.

Built for MS specialty care workflows

Unlike generic prescription refill forms, this template is specifically designed for the complex requirements of disease-modifying therapy management. It captures EDSS (Expanded Disability Status Scale) scores to track disease progression, coordinates MRI scheduling for monitoring treatment efficacy, and routes requests through the appropriate specialist approval workflow.

Healthcare administrators and MS nurses can use this form to standardize refill requests, reduce phone calls and paperwork, and ensure all necessary clinical information is collected before processing. The structured format makes it easy to identify patients who need urgent follow-up or additional monitoring.

Automate clinical workflows with Stepper

Once a refill request is submitted, you can use Stepper to automatically route approvals to the appropriate MS specialist, send reminders for pending MRI appointments, flag patients with concerning EDSS changes, and update your EMR or patient management system. This ensures nothing falls through the cracks while reducing administrative burden on your clinical team.

Secure, compliant patient data collection

Built on Paperform's SOC 2 Type II compliant platform, this template helps you maintain professional standards for patient data security. Customize the form to match your clinic's branding, integrate with your existing systems, and provide patients with a modern, accessible way to request refills from any device.

Perfect for neurology practices, MS specialty clinics, infusion centers, and healthcare networks managing patients on natalizumab, ocrelizumab, alemtuzumab, fingolimod, or other disease-modifying therapies.