Employee Portal

Medication Re-Order Form

Thank you for completing the Medication Re-order Form. You may add multiple medications by clicking the + sign to the right of the “Reason for Missing Pills” section.

If you have any troubles with this form, please email Tasha Miller – tmiller@TECHinc.org.

Name(Required)

First Last

Email(Required)

Location(Required)

Medications Needed(Required)

Can add multiple medications for one or more clients by selecting the plus sign at the right.

Client Name

Prescription Name

Reason for Missing Pills

Office Use Only

Received

Picked Up/Delivered