> ## Documentation Index > Fetch the complete documentation index at: https://help.elationhealth.com/llms.txt > Use this file to discover all available pages before exploring further. # Requiring Action – How to Clear Items and Who Can Sign Off (by Item Type) > This article explains how to clear each type of item from the Requiring Action queue and who has permission to do so. **Requiring Action** collects many different types of items—reports, messages, letters, tasks, and more. This guide summarizes who can clear each item type and what action is needed. ## Overview ### What is Requiring Action? The **Requiring Action** queue appears at the top of every patient chart and in the **Practice Home**. It collects all open items assigned to you that require your review or sign-off before they can be moved to the [Chronological Record](/articles/store-everything-in-chronological-record). Items remain in **Requiring Action** until the appropriate user takes the required action to clear them. ### Who can clear items in Requiring Action? Who can clear an item depends on both the item type and the user's account level: * **Provider Level Users** can sign off on most clinical items by default. * **Staff Level Users** can clear certain items (such as letters and some office messages) and can sign off on others only when a provider has granted them delegate permissions. * **Authorized Delegates** are Staff Level Users explicitly configured by a provider to sign on their behalf for specific item types. If you do not see a **Sign Off** button on an item, your user type or delegate permissions may not include sign-off access for that item type. See the [Requiring Action & Open Items Queues](/articles/the-requiring-actions-queue-follow-up-on-action-items) article for troubleshooting steps. ## Workflow Instructions ### Lab Results **Where it appears:** * **Practice Home queue:** Reports * **Patient chart:** Requiring Action (if unsigned) **Who can clear it:** * Any Provider Level User can sign off on electronic lab results, even if they are assigned to a different provider * Staff Level Users can sign off if they have been delegated sign-off permissions by a provider **Required action:** * Click **Sign Off** (Provider Level User) or **Sign off on behalf of provider** (Staff Level User with delegation) * Optionally, click **Sign Off & Send to patient** or **Sign Off & Send to provider** to attach the report to a Patient Letter or Provider Letter *** ### Imaging Reports **Where it appears:** * **Practice Home queue:** Reports * **Patient chart:** Requiring Action (if unsigned) **Who can clear it:** * Provider Level User (ordering provider or any provider in the practice) * Staff Level Users with delegated sign-off permissions **Required action:** * Click **Sign Off** (Provider Level User) or **Sign off on behalf of provider** (Staff Level User with delegation) * Optionally, click **Sign Off & Send to patient** or **Sign Off & Send to provider** *** ### Faxed Documents **Where it appears:** * **Practice Home queue:** Reports (after filing from the Fax Inbox) * **Patient chart:** Requiring Action (if assigned for sign-off) **Who can clear it:** * Provider Level User assigned to the document * Staff Level Users can sign off if delegated by a provider * If the document was filed with **File on behalf of Provider** checked, no sign-off is required and the document goes directly to the [Chronological Record](/articles/store-everything-in-chronological-record) **Required action:** * Click **Sign Off** (Provider Level User) or **Sign off on behalf of provider** (Staff Level User with delegation) *** ### Office Messages **Where it appears:** * **Practice Home queue:** Office Messages * **Patient chart:** Requiring Action (if addressed to you) or Outstanding Items (if waiting on others) **Who can clear it:** * **Provider Level Users** can sign any Office Message thread, even if they are not a recipient * **Staff Level Users** can click **Mark Complete** only if the thread contains no Provider Level Users * Premium EHR users may configure Staff Level Users as Office Message Delegates to sign on behalf of providers **Required action:** * **Sign Off** – for Provider Level Users or Staff Level Users designated as Office Message Delegates (Premium EHR) * **Mark Complete** – for Staff Level Users when no providers are on the thread * **Acknowledge** – for recipients after a provider has signed and sent a final reply; all other recipients must acknowledge to dismiss the item Clicking **Mark Complete** (or **Sign Off** for a Provider Level User) on the thread clears an Office Message from your Requiring Action queue immediately, regardless of any checkbox state. If you instead close the thread by replying to a note you sent only to yourself, the **Keep in my Requiring Action list** checkbox on the reply form controls whether the thread stays in your queue — check its state before sending. See the [Office Message Feature Guide](/articles/Office-Message-Feature-Guide#replying-to-a-note-you-sent-only-to-yourself) for details. *** ### Refill Requests (Rx Requests) **Where it appears:** * **Practice Home queue:** Rx Requests * **Patient chart:** Requiring Action **Who can clear it:** * Provider Level User assigned to the request * Authorized Rx Delegates (Staff Level Users) can address non-controlled substance refill requests on behalf of a provider * Controlled substance refill requests can only be addressed by the Provider Level User with EPCS credentials **Required action:** * Click **Approve**, **Approve with modifications**, **Change Number of Refills**, **Deny**, or **Deny & add reason** for standard refill requests * Click **Reassign to Provider** to move an eRx renewal request to a different eligible provider before they approve or deny it * For controlled substance requests: click **Deny** or **Renew** (which opens a new prescription form requiring EPCS authentication) Only providers with active EPCS credentials can address controlled substance refill requests. Rx Delegates cannot approve or renew controlled substance prescriptions. **Reassign to Provider** is available on eRx renewal (refill) requests. Eligible targets are Provider Level Users with an ePrescribing account and an active Surescripts enrollment. For controlled substance renewals, the reassignment target must also be EPCS-capable — not only the original addressee. Prescription change requests cannot be reassigned. See [Reassigning an eRx renewal request](/articles/managing-electronic-prescriptions#reassign-renewal) for steps. *** ### Unsigned Visit Notes, Notes, Letters, and Orders **Where it appears:** * **Practice Home queue:** Draft Notes, Draft Letters, or Draft Orders * **Patient chart:** Requiring Action **Who can clear it:** * Provider Level Users can sign all draft clinical documents * Staff Level Users can send Letters * For Orders, Referrals, and Letters: Staff Level Users with appropriate delegate permissions **Required action:** * Complete the document and click **Sign** or **Sign & Close** *** ### Patient Letters and Provider Letters **Where it appears:** * **Practice Home queue:** Patient Letters or Provider Letters (when a response is received) * **Patient chart:** Requiring Action (when a response is received or action is needed) **Who can clear it:** * Provider Level Users * Staff Level Users (for Patient Letters and Provider Letters) * For Referrals: Staff Level Users with delegate permission **Required action:** * **Reply**, **Sign**, or **Acknowledge** for Provider Letters or Referrals * **Reply & Sign Off** or **Reply, Sign Off & End Conversation** to close the thread *** ### Quick Reference Table | **Item Type** | **Practice Home Queue** | **Patient Chart Section** | **Who Can Clear** | **Required Action** | | - | - | - | - | - | | Lab Result | Reports | Requiring Action | Provider; Staff Delegate | Sign Off | | Imaging Report | Reports | Requiring Action | Provider; Staff Delegate | Sign Off | | Faxed Document | Reports | Requiring Action | Provider; Staff Delegate | Sign Off | | Office Message | Office Messages | Requiring Action / Outstanding Items | Provider (Sign Off); Staff Delegate (Sign Off); Staff (Mark Complete, if no providers on thread) | Sign Off, Mark Complete, or Acknowledge | | Refill Request | Rx Requests | Requiring Action | Provider; Rx Delegate (non-controlled only) | Approve, Deny, Renew, or Reassign | | Unsigned Note/Order/Letter | Draft Notes, Draft Letters, Draft Orders | Requiring Action | Provider; Staff Delegate (Orders, Referrals); Staff (Letters) | Sign or Sign & Close | | Patient/Provider Letter | Patient Letters, Provider Letters | Requiring Action | Provider; Staff Delegate (for Referrals) | Reply, Sign Off, or Acknowledge | If you need to configure delegate permissions for staff, an Admin Level User can set up Staff Delegates in the practice settings. See the [Staff Permissions & Staff Delegates Guide](/articles/staff-permissions--staff-delegates) for details. ## Related Articles * [Requiring Action & Open Items Queues – Managing open action items for your patients](/articles/the-requiring-actions-queue-follow-up-on-action-items) * [Practice Home Guide – Checking for requiring action items](/articles/check-for-your-offices-daily-to-do-list) * [Office Message Feature Guide](/articles/Office-Message-Feature-Guide) * [Patient Chart Guide – Annotate and eSign Clinical Reports and Documents](/articles/Patient-Chart-Guide-Annotate-and-eSign) * [Staff Permissions & Staff Delegates Guide](/articles/staff-permissions--staff-delegates)