Follow the steps to complete the enrollment form with ease.

1. Click ‘Get Form’ button to access the enrollment form and open it in your preferred digital editor.
2. Begin by entering the required patient information. This includes the patient's name, date of birth, home address, phone number, and insurance information. Make sure to provide both sides of the insurance card as required.
3. Next, fill in the prescriber information. Include the prescriber’s name, DEA number, NPI, and their contact details.
4. In the medical information section, provide a detailed diagnosis with its corresponding ICD-10 code. You may attach a separate sheet if additional space is required for other information such as weight, height, allergies, and previous therapies.
5. Proceed to the prescription information section. Here, input the medication details, dosage, and refills as prescribed. Carefully review the instructions for each medication to ensure accuracy.
6. Finally, review all entered information for completeness and accuracy. Once you have confirmed that the form is complete, you can save your changes, download a copy, print it, or share it as needed.

Complete the OPTUM Rheumatology Enrollment Form online today for efficient processing and care.