Get Enexia Specialty Gastroenterology Referral Form

Filling out the Enexia Specialty Gastroenterology Referral Form online can be a straightforward process if you follow the instructions step-by-step. This guide will help you navigate through each section, ensuring that you provide all necessary information accurately to expedite the referral process.

Follow the steps to complete your referral form efficiently.

1. Click the ‘Get Form’ button to access the Enexia Specialty Gastroenterology Referral Form and open it in the suitable online editor.
2. Begin by filling in the patient information section. Input the patient’s name, date of birth (in the specified format), gender, and last four digits of their Social Security Number. Ensure the address is complete, including apartment number if applicable, and provide contact phone numbers and email address. Specify the patient's primary language, and if it is not English, list the alternative language.
3. Proceed to the prescriber information section. Include the prescriber’s name and title, office contact details, street address, and phone numbers. It is important to provide the prescriber’s NPI and license number accurately. Indicate where to deliver the medications and whether the patient should be enrolled in manufacturer support services.
4. Next, complete the clinical information section. Fill in the primary ICD-10 code, current weight and height of the patient, and note any known drug allergies or latex allergies. Make sure to input the patient’s eligibility for Medicare and any secondary insurance details. Include previous treatments if applicable.
5. Finalize by entering the prescribing information. Choose the medications and dosages as needed, ensuring all applicable enrollment services are selected. Review all the details you provided in previous steps for accuracy.
6. After filling out the form completely, you can save your changes. Depending on the options provided, download, print, or share the completed form with relevant parties to submit your referral.

Start filling out the Enexia Specialty Gastroenterology Referral Form online today to ensure a smooth referral process.