Provider Medication Portal Request with Sevocity

PROCESSING MAY TAKE UP TO TEN (10) BUSINESS DAYS AFTER THE COMPLETED PAPERWORK AND SCHEDULE A IS PROCESSED BY FINANCE. INCOMPLETE SUBMISSION OF PAPERWORK OR MISSING COPIES OF MEDICAL CREDENTIALS WILL NOT BE PROCESSED.  PLEASE ANSWER QUESTIONS CAREFULLY AS THIS COULD DELAY MEDICATION PORTAL ACCESS.

Mandatory Criteria Needed to Process a Provider Request:

  • Provider must be the person who completes and signs this form.
  • Provider must already be added as User within Sevocity. Contact Sevocity Support for assistance - 877-777-2298
  • Copy of Provider’s Medical License 
  • Copy of NPI (this can be found on https://npiregistry.cms.hhs.gov/search) 
  • Copy of  Provider's DEA (if the Provider wishes to prescribe controlled substances) 
  • Following the submission of this form you will be contacted to complete the applicable identity proofing process.
Copy of Medical License:*
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Copy of NPI:*
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Today's Date:*

Contact Sevocity Support at 1-877-777-2298 or support@sevocity.com if you have any questions.

Provider Credentials and Signature Form 

Please ensure the users have been set up in Sevocity prior to submitting this form. 

The practice Security Admin should be able to add users in Sevocity. 

Provider's Start Date:*
Title/Suffix:*
Is this a supervising provider?*
If answer is no, does this provider require a supervising provider?*

Electronic Refills Activation Request:

Does this provider wish to have refills sent electronically through the medication portal in Sevocity:
If yes, effective date?

EPCS (Standard Prescribing to include electronic controlled substance prescribing:

Did you/your practice request EPCS (standard prescribing to include electronic controlled substance prescribing for you)?
EPCS can take longer depending on provider being able to complete identity vetting and token activation portions of the process.

EPCS is a contracted service and can take longer to implement and approve depending on the provider’s ability to complete successful identity vetting and token activation portions of this process.         

Copy of DEA If EPCS:
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IMPORTANT: Is this provider currently registered or do they prescribe narcotics electronically with another software/EMR prior to implementing Sevocity?
If YES, will the Provider continue to e-prescribe with the software mentioned above after implementing Sevocity®?

By signing below, the provider acknowledges that he/she: is a licensed practitioner with the legal authority to write prescriptions in the state(s) in which he/she practices medicine. I also hereby affirm that except as set forth in this paragraph, I will personally prescribe and order the medications using the user identifier ("user ID") and password provided to me by Sevocity®. To the extent that someone other than myself uses the Rcopia system to order medications that I prescribe for patients who are under my care (for purposes of this agreement such person is referred to as the "Provider Agent") such person will be acting pursuant to my express written instructions and I agree that I am solely responsible for ensuring that adequate documentation exists verifying that I am the prescribing physician and that such documentation will be provided to the Pharmacy dispensing such medication, and/or Sevocity®, if requested.

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PDMP (Prescription Drug Monitoring Program)

If provider wishes to enroll in PDMP Services:  

This service allows for PDMP checking from the Sevocity medication portal, to ensure that provider is able to prevent prescription drug abuse and adhere to any state requirements for PDMP checking. Please note: Provider must be enrolled as an EPCS provider to add PDMP. To enroll for this contracted service, please contact Sevocity Support at support@sevocity.com or call 877-777-2298. 

Will you require any other person to enter and/or send medications on your behalf?

Provider Agent

  • Electronically send prescription on behalf of provider; copy is sent to provider for signature
  • Create prescriptions for provider to sign
  • Approve renewals, copy is sent to provider for signature
  • Add pharmacies to the practice list
  • Capable of performing Clinical Staff functions as well

Clinical, Non-Agent

  • Create prescriptions for provider to sign, but cannot send
  • Add or edit patient medication and allergy lists


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