Get Prior Auth Forms

Filling out a Prior Authorization Request Form is an essential step in ensuring timely access to necessary medications. This guide provides clear and informative instructions for completing the form online, making the process as smooth as possible for users.

Follow the steps to complete the Prior Authorization Form online

1. Press the ‘Get Form’ button to obtain the Prior Authorization Request Form and open it for editing.
2. Begin by entering the patient and prescriber information in the designated fields. Ensure you provide the date, patient name, prescriber name, patient date of birth, prescriber phone number, Unity ID number, prescriber fax number, and any allergies clearly.
3. Next, navigate to the diagnosis and medication information section. Fill in the patient's diagnosis, medication name, dose, schedule, duration of therapy, and provide a reason or clinical rationale for the request, including any relevant past medical history and medication trials. You may also include optional information about the pharmacy name, phone number, and fax number.
4. If applicable, move to the section for clinic or physician administered medications. This requires entering the administering provider name, provider phone number, provider fax number, providing facility name, facility phone number, facility fax number, and procedure code or description.
5. Lastly, review all entered information for completeness and accuracy. After ensuring that no details are missing, save your changes. You can now choose to download, print, or share the form as needed.

Complete your Prior Authorization Forms online today for a swift processing experience!