Loading
Get Php-187c 2009-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the PHP-187C online
The PHP-187C is a prescription drug prior authorization request form that must be completed accurately to avoid processing delays. This guide will walk you through each section of the form, ensuring that you have the necessary information to fill it out correctly.
Follow the steps to complete the PHP-187C online.
- Click the ‘Get Form’ button to access the PHP-187C form and open it for completion.
- In the 'Patient Information' section, enter the patient's name, member ID, and date of birth accurately.
- Proceed to the 'Requesting Provider Information' section. Fill in the requesting physician/provider's name, NPI, specialty, tax ID number, address, phone number, fax number, contact name, and their phone and fax numbers.
- Complete the 'Pharmacy Information' section by providing the pharmacy name, phone number, and fax number.
- In the 'Drug Information' section, enter the requested drug name and strength, quantity needed, ICD-9 code, usage directions, length of therapy, and diagnosis.
- List any previous drugs that the patient has tried in the space provided. Make sure to provide the drug name and dosage.
- Provide a medical rationale for the requested drug. Include relevant chart notes and supporting lab results, as well as a justification for why a formulary alternative is not acceptable.
- Lastly, the requesting provider must sign and date the form to ensure it is valid.
- After completing the form, save your changes, then download, print, or share the completed PHP-187C form as needed.
Complete your prescription drug prior authorization request online with the PHP-187C.
Inserting data in a table can be done using the SQL INSERT statement. This command allows for single or multiple row additions, depending on your needs. Ensure to include all required fields to prevent errors. For practical applications, PHP-187C can guide you through inserting data efficiently into your tables.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.