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Transfer

Step 1 of 4

Whose prescription do you want to transfer?

First Name*

Last Name*

Date of Birth*

Patient's Phone*

Asterisks (*) indicate required fields.

Continue

Step 2 of 4

What pharmacy are you transferring from?

Publix

Somewhere Else

Add Individually

Enter the presciptions you want to transfer.

Medication Name*

Prescription Number

Medication Name*

Prescription Number

Medication Name*

Prescription Number

Medication Name*

Prescription Number

Medication Name*

Prescription Number

Where's my prescription number?

Add Another RX

Asterisks (*) indicate required fields.

Continue

Step 3 of 4

What pharmacy are you transferring to?

Choose Location*

Asterisks (*) indicate required fields.

Continue

Step 4 of 4

Is everything correct?

Patient

Change

Prescriptions

Change

Transfer All

From:

Change

To:

Change

Error: Please take the robot test.