Get - Express Scripts

Filling out the - Express Scripts form is an essential step in managing medication requests effectively. This guide provides clear, step-by-step instructions to help users navigate the form confidently and ensure all necessary information is submitted accurately.

Follow the steps to complete the form effortlessly.

1. Press the ‘Get Form’ button to obtain the form and open it for completion.
2. Begin with the patient information section. Fill in the patient’s first and last name, date of birth, phone number, and identification number.
3. Next, complete the prescriber information section. Input the prescriber’s name, phone number, fax number, and DEA/NPI number. Also, provide the prescriber’s address, including state and zip code.
4. Indicate the primary diagnosis and the corresponding ICD code in the designated fields.
5. Select which strength of is being requested by ticking the appropriate box. Options include 50mg, 100mg, 200mg, or 400mg.
6. Provide directions for use, such as daily dosage, frequency, and quantity, in the directions for use field.
7. Proceed to the clinical assessment section and answer the questions regarding the patient's current medication status and past NSAID usage.
8. Complete any additional questions pertaining to the patient’s health history, including any allergies or reactions to medications, chronic conditions, or other relevant information.
9. Finalize the form by obtaining the prescriber’s signature and inputting the date of completion.
10. Once all sections are completed, the form can be saved, downloaded, printed, or shared as necessary. Ensure it is faxed to the provided number or submitted as instructed.

Complete your documents online today to streamline the medication approval process.