Ropheka Connect

Send prescription details to Ropheka

Enter the information below and send it directly to Ropheka Pharmacy. No document upload needed.

Prescriber & practice

Prescriber name Practice name Prescriber's practice address NPI Prescriber type Practice phone Practice fax (optional) Provider email (optional)

APRN / PA: supervising practitioner details (required)

Supervising practitioner nameSupervising practitioner addressSupervising practitioner phone

Patient

Patient full name Date of birth Patient address Patient phone (optional) What are you sending?

Medication & directions

Fill in the medication details below. Documents are optional.

Date Medication / formulation Strength / concentration Form / route Directions (Sig) Quantity Refills Intended use The prescriber determines that stating the intended use is not in the patient's best interest. Notes (optional)

Optional: transmit an existing signed noncontrolled Rx PDF

Most clinicians do not need to upload anything here. If you already have a signed noncontrolled prescription PDF, choose the signed PDF option above and attach it here (maximum 2 MiB). Otherwise, skip this section.

Optional existing signed prescription PDFOnly if attaching a signed prescription: I confirm this is the original prescriber-signed order, I am authorized to transmit it, and it is for a noncontrolled medication. I checked that the summary matches the attached order. Controlled substances use a separate lawful prescribing channel.

Send to pharmacy

Submitted by Your role I am the prescriber or authorized practice staff, and I confirm this information is accurate and may be reviewed by Ropheka Pharmacy.

Ropheka verifies prescription validity before dispensing. This form does not capture a prescriber signature.

For urgent requests, call 469-612-3827. Controlled-substance prescriptions must use an authorized prescribing channel.