Follow the steps to complete the online form successfully.

1. Press the ‘Get Form’ button to access the form and open it in your preferred document management tool.
2. In the patient information section, enter the patient's full name, patient ID number, date of birth, phone number, and email address. Ensure all information is accurate to prevent any delays.
3. Proceed to fill in the physician information. Provide the prescribing physician's name, address, phone number, specialty, DEA number, NPI number, and email address.
4. In the medication section, select the appropriate medication option, for instance, or Spanules, by marking the checkbox next to the chosen option.
5. Specify the strength of the medication as well as the dosing directions clearly in the designated fields.
6. Indicate the quantity of medication needed per 30 days in the provided space. Be explicit about the quantity to avoid any misunderstandings.
7. In the diagnosis section, write in the specific diagnosis, in this case, attention deficit hyperactivity disorder.
8. Check all applicable approval criteria boxes, especially confirming whether the patient has a diagnosis attention deficit hyperactivity disorder and providing additional information where necessary.
9. Finally, secure the form with the physician's signature along with the date to validate the request. Ensure that all fields are completed before submission.
10. Once all fields are filled out, save the changes to the document, and prepare to download, print, or share the form as required.

Complete the form online today to expedite your prior authorization process.