Get Patient Has A Diagnosis Of Benign Prostatic Hyperplasia (bph)

This guide provides clear and concise instructions on how to complete the Patient Has A Diagnosis Of Benign Prostatic Hyperplasia (BPH) form online. Following these steps will help ensure that your submission is accurate and complete.

Follow the steps to successfully fill out the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information in Section 1. This includes the patient's name, ID number, date of birth, phone number, and email address. Make sure all details are accurate and up to date.
3. Next, move to Section 2 for physician information. Fill in the prescribing physician's name, address, phone number, specialty, DEA number, NPI number, and email address.
4. Proceed to Section 3 and enter the medication details. Specify the strength of Cialis () that is being prescribed, selecting the appropriate dosage from the options provided.
5. In Section 4, indicate the strength of the medication the patient is prescribed. You can select either 2.5mg or 5mg.
6. In Section 5, provide directions for the medication's use. Describe how and when the patient should take the medication.
7. Section 6 requires you to specify the quantity of Cialis prescribed for a 30-day period. Ensure this reflects the physician’s recommendation.
8. In Section 7, confirm the patient's diagnosis by stating 'benign prostatic hyperplasia (BPH).'
9. For Section 8, check all approval criteria boxes that apply. This includes confirming that the patient has a diagnosis of benign prostatic hyperplasia and whether they have tried and failed preferred agents.
10. Finally, in Section 9, obtain the required signature from the prescriber and date the form. This confirms that all information provided is accurate and complete.
11. After filling in all sections, review the form for accuracy. Once confirmed, you can save your changes, download, print, or share the form as needed.

Complete your documents online to ensure a smooth process.