Medipense » RxPense Care Portal Patient Registration

RxPense Care Portal Patient Registration

RxPense Care Portal Patient Registration Form

Registering a patient for an account on the RxPense Portal is simple. Purchase a subscription, then register yourself and your caregivers.

Step 1: Purchase your RxPense Portal subscription by requesting a Quote. Record the Order number or save a copy of your proof of purchase.
Step 2:Complete this RxPense Care Portal Patient Registration Form and submit it so we may properly validate your account and then set it up. You will be sent an email invitation from the RxPense portal as soon as your account has been established.

Too complicated? Call or chat with us and we will help you! Remember, Clinician access is FREE. Clinicians should register here.

"*" indicates required fields

SECTION 1: Details of the patient

Enter the patient information here. The patient is the one prescribed medications. The Patient must authorize all access to their personal and health data by those specified on this form.

Name*

First Middle Last

Last Name at Birth*

Last Name at Birth

If you were born with a different name, please enter

Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Mobile or home phone. In order to receive SMS notifications, the phone must be a mobile phone. If you do not have a mobile phone, enter your main contact telephone number.

Type*

Email*

Email is required in order to receive email notifications and notices from Medipense. Once your account is activated, you must verify your email in order to receive these notices.

Enter Email Confirm Email

SECTION 2: Invite a Caregiver, Clinician, Pharmacist or other Support Worker

A Caregiver is usually the person who monitors and manages the patient on a daily basis. The Caregiver will receive alerts and notifications. The Caregiver can enter or update prescriptions on behalf of the patient.

Up to 4 Caregivers may be added by the patient to their Circle of Care. Additional members may be invited after the account has been established and login permitted to the portal.

Name (of Caregiver 1)

First Middle Last

Email (of Caregiver 1)

Enter Email Confirm Email

Role (of Caregiver 1)

Select the primary role of each person: Caregiver, Clinician, Pharmacist, Health Care Provider, Physician or other member. This can be updated in the Portal once your account is established.

Phone (of Caregiver 1)

Mobile or home phone, if known. In order to receive SMS notifications, the phone must be a mobile phone. If you do not have a mobile phone, enter your main contact telephone number.

Name (of Caregiver 2)

First Middle Last

Email (of Caregiver 2)

Enter Email Confirm Email

Role (of Caregiver 2)

Select the primary role of each person: Caregiver, Clinician, Pharmacist, Health Care Provider, Physician or other member. This can be updated in the Portal once your account is established.

Phone (of Caregiver 2)

Mobile or home phone, if known. In order to receive SMS notifications, the phone must be a mobile phone. If you do not have a mobile phone, enter your main contact telephone number.

Name (of Caregiver 3)

First Middle Last

Email (of Caregiver 3)

Enter Email Confirm Email

Role (of Caregiver 3)

Select the primary role of each person: Caregiver, Clinician, Pharmacist, Health Care Provider, Physician or other member. This can be updated in the Portal once your account is established.

Phone (of Caregiver 3)

Mobile or home phone, if known. In order to receive SMS notifications, the phone must be a mobile phone. If you do not have a mobile phone, enter your main contact telephone number.

Name (of Caregiver 4)

First Middle Last

Email (of Caregiver 4)

Enter Email Confirm Email

Role (of Caregiver 4)

Select the primary role of each person: Caregiver, Clinician, Pharmacist, Health Care Provider, Physician or other member. This can be updated in the Portal once your account is established.

Phone (of Caregiver 4)

Mobile or home phone, if known. In order to receive SMS notifications, the phone must be a mobile phone. If you do not have a mobile phone, enter your main contact telephone number.

SECTION 3: ORDER NUMBER

Please enter your order number or proof of payment for the RxPense Care Portal subscription.

ORDER NUMBER*

Notes or Comments

Please enter any information about the patient, this signup process or expectations you would like to share.

SECTION 4: Declaration

Please read these documents carefully, ask any questions, upload required proof and express any concerns prior to establishing your account.

I have read and agree to Medipense's*

Terms & Conditions

Cookie Policy

Limited Warranty

Signed*

Enter your name to signify your agreement and confirmation of data, as of the date submitted.

Date*

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RxPense® Care

RxPense® Care is our software based service, to help you manage your medications, help caregivers and clinicians to monitor you and to help family member remain connected and updated with your adherence data.

Complete this form after you have selected and purchased the appropriate package by Requesting a Quote. We will use the information you provide to setup your new RxPense Portal account, to validate your entries and to record authorized permissions.

Request Quote

RxPense Care Portal Patient Registration Form

SECTION 1: Details of the patient

SECTION 2: Invite a Caregiver, Clinician, Pharmacist or other Support Worker

SECTION 3: ORDER NUMBER

SECTION 4: Declaration

RxPense® Care

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