FAAFP, DABOM · Medical reviewer of record · Updated September 14, 2026 · September 14, 2026
Prepare for a change of provider
Keep a checklist of records, contacts and unresolved questions during a care transition. A new clinician must decide whether to continue or change treatment.
Entries stay in this page and disappear when you clear or reload it. Downloads and printouts remain wherever you save them. Avoid names, birth dates, member IDs and other identifiers.
This worksheet organizes information for a conversation. It does not verify a prescription, choose treatment or assess safety.
A worked example
Fictional example, not personal medical information
Current practice contact (optional)
Example practice (fictional)
Marked complete by you
Confirm the new practice accepts your care needs and coverage or payment arrangement.
Still to check
Ask how to transfer records through a secure channel.
The example shows the output format. Use your own verified information and take unresolved questions to the appropriate professional.
Run your own numbers in the tool above.
Using this tool
Turn your entries into a useful record
Keep a checklist of records, contacts and unresolved questions during a care transition. A new clinician must decide whether to continue or change treatment. Entries are assembled into a downloadable worksheet. Marking a check complete records your own action; it does not certify a medicine, pharmacy or document.
This worksheet organizes information for a conversation. It does not verify a prescription, choose treatment or assess safety.
Assign every handoff
Write down which office is responsible for records, pending results and refill questions. A transfer request alone does not confirm that the receiving practice has accepted each task.
Before you finish
Build a continuity snapshot
Check
What to capture
Current care
Medication list, recent results and open follow-up items
Next practice
Appointment date, record-transfer method and evaluation requirements
Time-sensitive items
Who handles pending results and refill questions before the visit
This page keeps entered details in browser memory. It does not email them or save them to your account. Clear or reload the page to remove the entries. Downloaded files and printouts remain under your control.
Every medication on sipra is prescribed by a licensed physician, so your care always starts with a visit. Your sipra membership gives you ongoing access to those physician visits, so you can check in, adjust your plan, and ask questions whenever you need, without paying per visit. It is how we keep high-quality care convenient: one membership, physician access whenever you need it, and support at every step.
No. A new clinician must evaluate whether to continue or change treatment. Use the checklist to confirm record transfer, pending results, appointment details and refill responsibilities before a care gap.
Yes. Download a text file or use Print / save as PDF. Entries stay in browser memory and are not emailed or saved to your Sipra account. Clearing or reloading the page removes them from the page, while files and printouts you saved remain under your control.
No. Confirm that the receiving practice got the records it needs and knows about pending results. Write down which office owns each follow-up question.
No. Ask the current prescriber, new practice and pharmacy who can address the request and what evaluation is required. The receiving clinician decides whether a prescription is appropriate.
This worksheet organizes information for a conversation. It does not verify a prescription, choose treatment or assess safety. Medical reviewer of record: Jillian Foglesong Stabile, MD, FAAFP, DABOM. Updated September 14, 2026. Sources checked September 14, 2026.
Compounded medications are not FDA-approved and require a patient-specific prescription. Brand names are trademarks of their owners; sipra is not affiliated with them.
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