Get Androgen And Anabolic Steroid Prior Authorization Physician Fax Form

Filling out the Androgen And Anabolic Steroid Prior Authorization Physician Fax Form is an essential step in securing necessary medications for patients. This guide provides clear instructions to help users fill out the form accurately and efficiently, ensuring all required information is included.

Follow the steps to complete the form efficiently.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the patient's information in the designated fields. Be sure to complete the following sections: Today's Date, Patient Name (First and Last), Patient Address, City, State, Zip, Date of Birth (mm/dd/yyyy), and Patient Telephone.
3. Fill in the insurance information. Include the BCBS ID Number and Group Number.
4. Provide the physician and clinic information, including Prescriber Name, Physician NPI#, Specialty, Clinic Name, Clinic Address, City, State, Zip, Phone Number, Contact Name, and Secure Fax Number.
5. Attach any additional documentation that may support the request for prior authorization.
6. Document the patient’s diagnosis. Include the ICD-9 code along with a brief description.
7. Specify the medication requested along with its strength and dosing schedule. State the quantity per month if needed.
8. For male patients, include free and serum levels, along with lab results that present reference ranges.
9. If the diagnosis is anemia, provide the patient's hematocrit value and elaborate on the cause of anemia.
10. Confirm and list any significant weight loss the patient has experienced and provide measurements such as weight, height, and BMI.
11. Detail all other medications the patient is currently taking, if applicable.
12. Answer questions related to liver disease, renal disease, cancer, hypercalcemia, and pregnancy status appropriately.
13. Once all sections are filled, review for accuracy and completeness, then save the changes, download, print, or share the form as necessary.

Complete your forms online today to ensure timely processing of prior authorizations.