Follow the steps to successfully complete the order form.

1. Press the ‘Get Form’ button to download and open the CIGNA Specialty Pharmacy Services Fax Order Form in the editor.
2. In the 'Physician Information' section, provide the required details including the physician's name, phone number, fax number, and DEA number, ensuring accuracy for proper communication.
3. Fill in the 'Patient Information' section by entering the patient's name, date of birth, health care ID number, sex, and full address. It is important to include all available patient phone numbers for scheduling delivery.
4. Indicate whether the patient has any allergies. If no allergies are specified, this implies the absence of known allergies for new customers or no changes for existing customers.
5. Select whether home health services are required and provide the local home health agency's telephone number if applicable.
6. In the 'Prescription Information' section, choose the appropriate dosage and fill out the quantity and refills for the prescription as applicable. Consider specifying a three-month supply to reduce copays.
7. If medication is to be administered at home, check the box next to 'Supplies Needed' and specify any additional supplies required.
8. Provide any additional medication orders pertinent to the patient in the designated section.
9. Ensure that the physician’s printed name, date, and signature are included at the bottom to confirm the accuracy and completeness of the prescription.
10. Include documented progression of the disease and any prior therapies for justification of the drug. Choose the appropriate diagnosis and answer relevant questions regarding the patient's treatment plan.
11. Once all sections are completed, users can save their changes, download the form for personal records, print it for faxing, or share it as needed.

Complete your CIGNA Specialty Pharmacy Services Fax Order Form online today for efficient processing.