{"id":525,"date":"2025-12-11T06:59:11","date_gmt":"2025-12-11T07:59:11","guid":{"rendered":"https:\/\/www.dsah.sa\/telemedicine\/?page_id=525"},"modified":"2026-01-13T07:25:21","modified_gmt":"2026-01-13T08:25:21","slug":"refill","status":"publish","type":"page","link":"https:\/\/www.dsah.sa\/telemedicine\/refill\/","title":{"rendered":"Medication Refill"},"content":{"rendered":"\n\n\n<br>\n<p><span style=\"color: #ff0000;\"><\/span><\/p>\n<h6 style=\"color: #5e9ca0;  text-align: center;\"><strong><span style=\"color: #ff0000;\">Note: The report will be sent to E-Mail registered in the hospital <br> \u0645\u0644\u0627\u062d\u0638\u0629: \u0633\u064a\u062a\u0645 \u0625\u0631\u0633\u0627\u0644 \u0627\u0644\u062a\u0642\u0631\u064a\u0631 \u0625\u0644\u0649 \u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0627\u0644\u0643\u062a\u0631\u0648\u0646\u064a \u0627\u0644\u0645\u0633\u062c\u0644 \u0644\u062f\u064a\u0646\u0627 .<\/span><\/strong><\/h2>\n<br>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:80%\"><style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-border-style: solid;\n--wpforms-field-border-size: 1px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-border-color-spare: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-field-menu-color: #ffffff;\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-border-style: none;\n--wpforms-button-border-size: 1px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-border-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-page-break-color: #066aab;\n--wpforms-background-image: none;\n--wpforms-background-position: center center;\n--wpforms-background-repeat: no-repeat;\n--wpforms-background-size: cover;\n--wpforms-background-width: 100px;\n--wpforms-background-height: 100px;\n--wpforms-background-color: rgba( 0, 0, 0, 0 );\n--wpforms-background-url: none;\n--wpforms-container-padding: 0px;\n--wpforms-container-border-style: none;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-color: #000000;\n--wpforms-container-border-radius: 3px;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t\t}\n\t\t\t<\/style><style id=\"wpforms-css-vars-513-block-1fc8d186-9ee1-4ba3-8a18-1dd0690ba970\">\n\t\t\t\t#wpforms-513.wpforms-block-1fc8d186-9ee1-4ba3-8a18-1dd0690ba970 {\n\t\t\t\t\t--wpforms-container-padding: 15px;\n--wpforms-button-background-color: #00d084;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t\t}\n\t\t\t<\/style><style id=\"wpforms-custom-css-513-block-1fc8d186-9ee1-4ba3-8a18-1dd0690ba970\">\n\t\t\t\t.pagelayer-header{\n    display: none;\n}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-1fc8d186-9ee1-4ba3-8a18-1dd0690ba970 wpforms-render-modern\" id=\"wpforms-513\"><form id=\"wpforms-form-513\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"513\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/telemedicine\/wp-json\/wp\/v2\/pages\/525\" data-token=\"b38171cb33d7882e201a4ea1c1f16c52\" data-token-time=\"1778774337\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Medication Refill <\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-513-field_12-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"12\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Request Status \u0627\u0644\u062d\u0627\u0644\u0629 <\/legend><ul id=\"wpforms-513-field_12\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-513-field_12_1\" name=\"wpforms[fields][12]\" value=\"Open\" aria-errormessage=\"wpforms-513-field_12_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-513-field_12_1\">Open<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-513-field_12_2\" name=\"wpforms[fields][12]\" value=\"Done\" aria-errormessage=\"wpforms-513-field_12_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-513-field_12_2\">Done<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-513-field_12_3\" name=\"wpforms[fields][12]\" value=\"InProgress\" aria-errormessage=\"wpforms-513-field_12_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-513-field_12_3\">InProgress<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-513-field_12_4\" name=\"wpforms[fields][12]\" value=\"Re-Open\" aria-errormessage=\"wpforms-513-field_12_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-513-field_12_4\">Re-Open<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-513-field_12_5\" name=\"wpforms[fields][12]\" value=\"N\/A\" aria-errormessage=\"wpforms-513-field_12_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-513-field_12_5\">N\/A<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-513-field_2-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"2\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-513-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-513-field_3\">Patient\u2019s Name \u0627\u0633\u0645 \u0627\u0644\u0645\u0631\u064a\u0636  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-513-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-513-field_3-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-513-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-513-field_4\">File Number \/ ID Number \u0631\u0642\u0645 \u0627\u0644\u0645\u0644\u0641 \u0627\u0644\u0637\u0628\u064a \/ \u0627\u0644\u0647\u0648\u064a\u0629  <\/label><input type=\"text\" id=\"wpforms-513-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-513-field_4-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-513-field_9-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-513-field_9\">Date Of Visit \u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0632\u064a\u0627\u0631\u0629 <\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-513-field_9\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][9][date]\" aria-errormessage=\"wpforms-513-field_9-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-513-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-513-field_6\">Doctor\u2019s Name  \u0627\u0633\u0645 \u0627\u0644\u0637\u0628\u064a\u0628<\/label><input type=\"text\" id=\"wpforms-513-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-513-field_6-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-513-field_10-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-trigger\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-513-field_10\">Email \u0627\u0644\u0627\u064a\u0645\u064a\u0644 <\/label><input type=\"email\" id=\"wpforms-513-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" spellcheck=\"false\" aria-errormessage=\"wpforms-513-field_10-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-513-field_11-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-513-field_11\">Mobile Number \u0631\u0642\u0645 \u0627\u0644\u062c\u0648\u0627\u0644  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-513-field_11\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][11]\" aria-label=\"Mobile Number \u0631\u0642\u0645 \u0627\u0644\u062c\u0648\u0627\u0644 \" aria-errormessage=\"wpforms-513-field_11-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-513-field_13-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-513-field_13\">Note \u0645\u0644\u0627\u062d\u0638\u0627\u062a<\/label><textarea id=\"wpforms-513-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-513-field_13-error\" ><\/textarea><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"513\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.dsah.sa\/telemedicine\/wp-json\/wp\/v2\/pages\/525\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-513\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/www.dsah.sa\/telemedicine\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n<\/div>\n\n\n\n<style>\nbody  {\n  background-image: url(\"https:\/\/www.dsah.sa\/telemedicine\/wp-content\/uploads\/2025\/12\/Website-Header-1.webp\");\n  background-color: #1111;\nheight: 500px; \/* You must set a specified height *\/\n  background-position: center; \/* Center the image *\/\n  background-repeat: no-repeat;\n  background-size: cover;\n}\n.pagelayer-header{\n    display: none;\n}\nimg {\n  opacity: 0.7;\n}\n.pagelayer-footer{\n    display: none;\n}\n<\/style>\n","protected":false},"excerpt":{"rendered":"<p>Note: The report will be sent to E-Mail registered in the hospital \u0645\u0644\u0627\u062d\u0638\u0629: \u0633\u064a\u062a\u0645 \u0625\u0631\u0633\u0627\u0644 \u0627\u0644\u062a\u0642\u0631\u064a\u0631 \u0625\u0644\u0649 \u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0627\u0644\u0643\u062a\u0631\u0648\u0646\u064a \u0627\u0644\u0645\u0633\u062c\u0644 \u0644\u062f\u064a\u0646\u0627 .<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"pagelayer_contact_templates":[],"_pagelayer_content":"","footnotes":""},"class_list":["post-525","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.dsah.sa\/telemedicine\/wp-json\/wp\/v2\/pages\/525","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.dsah.sa\/telemedicine\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.dsah.sa\/telemedicine\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.dsah.sa\/telemedicine\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.dsah.sa\/telemedicine\/wp-json\/wp\/v2\/comments?post=525"}],"version-history":[{"count":21,"href":"https:\/\/www.dsah.sa\/telemedicine\/wp-json\/wp\/v2\/pages\/525\/revisions"}],"predecessor-version":[{"id":801,"href":"https:\/\/www.dsah.sa\/telemedicine\/wp-json\/wp\/v2\/pages\/525\/revisions\/801"}],"wp:attachment":[{"href":"https:\/\/www.dsah.sa\/telemedicine\/wp-json\/wp\/v2\/media?parent=525"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}