Get 800 956 2397

This guide provides a comprehensive overview of how to fill out the 800 956 2397 form online. It is designed to assist users through each section of the form, ensuring a smooth and efficient submission process.

Follow the steps to complete the 800 956 2397 form online.

1. Press the ‘Get Form’ button to access the form and open it in the document editor.
2. Begin by entering the patient's information, including their full name and phone number with area code. Ensure this section is clear and legible to avoid any processing delays.
3. Fill in the medication shipping address where the prescription will be delivered. This should be the complete address to ensure proper delivery.
4. List any known patient allergies in the designated field. Providing this information is crucial for the safety of the patient.
5. Enter the FLRx Patient ID number, the patient's birthdate, and the prescribing physician's details including their name, specialty, phone number, fax number, DEA number, and NPI number.
6. In the medical necessity section, specify the drug name applicable to this request, and check all relevant medication options from the list provided.
7. Indicate whether the patient is starting new treatment or continuing with ongoing treatment by selecting the appropriate option.
8. Select the diagnosis that pertains to the patient from the provided list, ensuring that it accurately reflects the patient's condition.
9. Detail any relevant information regarding growth velocity, bone age, and predicted mid-parental height if applicable. Attach any necessary documentation such as progress notes or lab results.
10. Indicate if the patient has any sensitivities or other medical complications by responding to the relevant questions provided in this section.
11. Finally, review the completed form for accuracy before adding your electronic signature or printing it to sign by hand. Include the date of submission.
12. Once all information has been filled out accurately, save the changes made to the form, then proceed to download, print, or share the form as needed.

Start filling out your document online today for a hassle-free experience.