> ## 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. 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 **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 *** ### 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 * 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. *** ### 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, or Renew | | 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)