Get Care1st Prior Auth Form

The Care1st Prior Auth Form is a critical document used to obtain medication that is not on the Formulary or requires prior authorization. This guide provides step-by-step instructions for completing the form online, ensuring a smooth submission process for users.

Follow the steps to complete the Care1st Prior Auth Form online.

1. Click ‘Get Form’ button to obtain the Care1st Prior Auth Form and open it in the online editor.
2. Enter the patient's name in the 'Patient Name' field, which is required.
3. Input the patient's phone number.
4. Fill in the 'Patient ID#', which is a required field.
5. Provide the patient's date of birth.
6. Select the patient's sex by checking the appropriate box.
7. Enter the pharmacy name in the corresponding field.
8. If available, add the Pharmacy NABP Number, which is optional.
9. Include the pharmacy phone number.
10. If applicable, provide the pharmacy fax number.
11. Enter the prescribing physician's name, which is required.
12. Specify the physician's specialty, which is also required.
13. Fill in the state license number of the prescribing physician.
14. Optionally, include an email address for further correspondence.
15. Provide the prescribing physician's phone number, which is required.
16. Input the fax number of the prescribing physician.
17. Enter the drug requested in the 'Drug Requested' field, which is required.
18. Specify the strength of the requested medication, which is required.
19. Provide the diagnosis that justifies the need for the medication, which is required.
20. Detail the formulation of the medication.
21. Enter the quantity of medication required.
22. Indicate the duration of therapy.
23. Specify the days supply needed.
24. Indicate the number of refills requested.
25. Provide directions, sig, or a copy of the prescription, which is required.
26. List current medications being taken by the patient, which is required.
27. Detail previous medications tried and failed, which is required.
28. Provide medical justification for the request, which is required.
29. Obtain and include the signature of the requestor, which is required.
30. Enter the request date.
31. Once the form is complete, save changes, download, print, or share the form as needed.

Complete your Care1st Prior Auth Form online today!