Mobile Injection Care · Rex Pharmacy

Request Mobile Injection Care

Mobile Injection Care is one coordinated service across our pharmacy organization. Your local pharmacy and specialized care team work together to review the referral, coordinate medication and injection logistics, and keep the right people informed.

One connected care team

Different members of our pharmacy organization may support intake, medication coordination, scheduling, or follow-up based on the patient's needs. Rex Pharmacy remains part of that coordinated process. Submitting a referral starts a review; it does not schedule an appointment or enroll anyone in services.

Patient information

Only the essentials needed for our team to follow up.

First name

Last name

Date of birth

MM/DD/YYYY

Gender

Used to establish the patient profile.

Preferred contact

Patient phone

Injection information

Medication and timing help us prepare the referral.

Medication or injection name

Choose from the catalog, select Unknown, or enter a medication name manually.

Last known injection date (if known)

MM/DD/YYYY

Next injection due date (if known)

MM/DD/YYYY

Your information

Who is submitting this referral?

Your name

Your relationship to the patient

This helps us understand who is submitting the referral.

Supporting documents (optional)

Attach referral orders or recent notes. PDF, CSV, Excel, Word, JPG, PNG, and TIFF files are accepted; up to 5 files, 4 MB each.

Choose documents

For your privacy, uploads are sent only to restricted referral storage for staff review. Do not attach insurance card numbers, government IDs, payment information, or unrelated records.

AcknowledgementsI have read the Notice of Privacy Practices and understand this referral will be reviewed before services are arranged.