Research Pharmacy – Reminders for Using Outpatient Prescription Templates

May 22, 2023

Locating Prescription (Rx) Templates

Templates must be approved by the PI before they are posted for use. The current versions are available on the Clinical Homepage (Users must be logged into the Michigan Medicine network or VPN to access):

Filling Out the Rx Template

The template **must be downloaded from the websites above every time needed** to ensure that the correct, PI-approved version is used. All relevant patient information must be provided, along with drug, dose, and amount of drug to dispense. The template must be wet-ink signed and dated by an authorized prescriber for the study.

** Do NOT modify the Rx template in any way.** Please contact the lead pharmacist for the study to request changes to the template. 

Submitting the Completed Rx Template

Securely transmit the wet-ink signed prescription to Research Pharmacy via email ( or fax (734-647-9302). Sponsor drug assignments (IRT, IXRS, IVRS, etc.), if applicable, must be included with the Rx submission. If there are challenges complying with this process, contact the lead pharmacist to discuss options.