Get Cigna Form

Filling out the Cigna Form online can streamline your process for submitting medical requests efficiently. This guide provides clear, step-by-step instructions to help you navigate through the form seamlessly.

Follow the steps to accurately complete the Cigna Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information. Fill in the patient's name and Cigna Healthcare ID number in the dedicated fields. Ensure that this information is accurate for proper identification.
3. Next, provide the referral source code and order number, if applicable. This information can help track the processing of the request.
4. In the physician information section, fill in the physician's name, address, contact numbers, and DEA number. This is essential for communication purposes.
5. Indicate whether medications should be shipped to the physician's office or the member's home. Select the appropriate option to ensure correct delivery.
6. List any allergies the patient has. This information is crucial for their safety when administering treatments.
7. For health conditions, specify any home health services required and provide the local home health agency's telephone number if applicable.
8. In the prescription information section, choose the appropriate medication dosage and quantity required. Also, indicate any necessary supplies and refills.
9. Include documented progression of disease or prior therapies for justification of the drug prescribed, as this may be required for processing.
10. Select the relevant diagnosis by marking the appropriate box and providing the corresponding ICD-9 code.
11. Finally, the prescriber must print their name and provide their signature to confirm the accuracy and completeness of the prescription information.
12. Review all the provided information for accuracy, then save your changes, download, print, or share the form as needed.

Take the first step and begin completing your Cigna Form online today for a more efficient submission process.