Request a prescription refill by phone or app
When to use this goal
For high school and transition students who take a regular medication and will need to keep it filled as adults, but rely on a parent to call the pharmacy. Present levels and family wishes decide fit. The student requests the refill; the family and pharmacy handle payment and approval.
- Baseline
- Ask the family how refills happen now and run one practice call or app request. Real refills come about once a month, so practice calls supply most early data.
- Tips
- Use the family's real pharmacy and tools. Teach what to do when the pharmacy says a refill needs the doctor's approval (tell a family member). Controlled medications may have extra rules; the family leads.
- Limits
- The student does not change, stop, or choose medications. Refill rules differ by medication and pharmacy. This goal never replaces the individualized health plan, medication orders, or an emergency action plan; the nurse, the family, and the student's health care provider decide care, and the goal follows their plan.
Original IEP Atlas template based on general measurement principles; not copied from any goal bank. ID fn-hlt-022.
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Goal
By the annual IEP review date, when their medication bottle shows about one week left, at home with the family, the student will request a refill by phone or app and write down the pickup date, performing at least 5 of 6 steps independently, across 3 consecutive refills or practice calls, as measured by a task-analysis checklist collected at each refill, with monthly practice.
Baseline: 1 of 6 steps independently.
- Condition
- Observable behavior
- Criterion
- Measurement method
Measurability check11 of 11 met
Met: Observable behavior. Stated as an action.
Met: Condition. Stated.
Met: Unit fits the behavior. Task-analysis steps fits this behavior.
Met: Explicit criterion. Number and unit stated.
Met: Mastery rule and schedule. Both stated.
Met: Method produces the metric. Task-analysis checklist gives task-analysis steps data.
Met: Review timeframe. Stated.
Met: Baseline and target compatible. Same unit, change in the right direction.
Met: Aligned with area of need. Still about Health & Self-Management.
Met: Level of support. Defined.
Met: Blanks filled in. Nothing left to fill in.
Checks structure and wording only. Whether the goal fits the student is the team's call.
Short-term objectives (optional)
When are objectives required?Required for students on alternate assessments (34 CFR §300.320(a)(2)(ii)); some states require them for everyone.
Paste into your IEP system
Most district systems have a separate box for each part of a goal. Copy them one at a time, or all at once as labeled text.
- Area of need
- Functional & Independence Skills - Health & Self-Management
- Baseline
- 1 of 6 steps independently.
- Annual goal379 characters
- By the annual IEP review date, when their medication bottle shows about one week left, at home with the family, the student will request a refill by phone or app and write down the pickup date, performing at least 5 of 6 steps independently, across 3 consecutive refills or practice calls, as measured by a task-analysis checklist collected at each refill, with monthly practice.
- Timeframe
- By the annual IEP review date
- Condition
- When their medication bottle shows about one week left, at home with the family
- Behavior
- The student will request a refill by phone or app and write down the pickup date
- Criteria
- Performing at least 5 of 6 steps independently, across 3 consecutive refills or practice calls
- Evaluation method
- A task-analysis checklist
- Schedule
- At each refill, with monthly practice
Copied as plain text, with straight quotes and plain dashes.
Matching data sheet
Task-analysis checklist. Marks each step in each session.
Task-analysis checklist
Task-analysis steps- Student label:
- Target:
- performing at least 5 of 6 steps independently
- Mastery rule:
- across 3 consecutive refills or practice calls
- Collection schedule:
- at each refill, with monthly practice
- Method:
- Task-analysis checklist
- Data collector:
Goal: By the annual IEP review date, when their medication bottle shows about one week left, at home with the family, the student will request a refill by phone or app and write down the pickup date, performing at least 5 of 6 steps independently, across 3 consecutive refills or practice calls, as measured by a task-analysis checklist collected at each refill, with monthly practice.
Key: I completed independently · S completed with support (note prompt type, e.g., G gesture, V verbal, M model, P physical) · N not completed
| Step | Session 1 Date: | Session 2 Date: | Session 3 Date: | Session 4 Date: | Session 5 Date: | Session 6 Date: | Session 7 Date: | Session 8 Date: |
|---|---|---|---|---|---|---|---|---|
| 1. Notices the supply is low by checking the count or the label | ||||||||
| 2. Finds the prescription number on the label | ||||||||
| 3. Calls the pharmacy or opens the app | ||||||||
| 4. Gives their name, birth date, and the prescription number | ||||||||
| 5. Asks when the refill will be ready | ||||||||
| 6. Writes the pickup date in their calendar and tells a family member | ||||||||
| Steps independent (I) | ||||||||
| Initials / notes |
Preview shows 4 of 12 rows.
- Write the date at the top of each session column. Mark each step I, S, or N.
- Total the number of I marks for the session. The goal counts steps completed independently (target: 5 of 6).
- Use the least intrusive prompt first and record the prompt actually needed.
The CSV opens in Excel or Google Sheets, with formulas. Sheets print blank; no student data is stored.