Get 800 716 3230

This guide provides comprehensive instructions for completing the 800 716 3230 form for prior approval or non-formulary medication requests. Follow these steps to ensure accurate submission and timely processing.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to access the form in an editable format.
2. Begin by entering the date in the designated field using the format MM/DD/YYYY.
3. Fill in the patient's name, followed by their ID number and date of birth in the respective fields. Ensure this information matches the patient's records.
4. Provide a comprehensive diagnosis for the patient in the designated section. This should be clear and concise.
5. In the medication requested field, write the name of the medication being requested. Double-check for spelling errors to avoid delays.
6. Complete the dosage and regimen prescribed section with specific details about how the medication should be administered.
7. Indicate the anticipated duration for the medication request, noting that approvals may vary based on individual circumstances.
8. If applicable, justify the request by listing previous medications tried along with any relevant allergies or therapeutic measures attempted. Attach any additional supporting documentation, such as lab reports or test results.
9. Print the prescribing physician's name clearly in the respective section. Ensure they sign the form where indicated.
10. Fill in the physician's DEA number, provider number, and contact information, including telephone and fax numbers.
11. Review the form for accuracy. Once completed, save any changes, and consider downloading or printing the document for records before submission.

Complete the 800 716 3230 form online to ensure a smooth medication request process.