Get Express Scripts Fax Form

The Express Scripts Fax Form is essential for facilitating the prescription process for patients who wish to receive their medication. This guide provides clear and concise instructions on how to complete the form online effectively.

Follow the steps to complete the Express Scripts Fax Form online.

1. Press the ‘Get Form’ button to obtain the Express Scripts Fax Form and open it for editing.
2. Fill in the prescriber information section. Provide your full name, DEA number if applicable for CIII-CV medications, secure fax number, and NPI.
3. In the member information section, enter the member number, including all characters, and the cardholder's full name.
4. Complete the patient information section by entering the patient's name, date of birth, telephone number, and shipping address.
5. Specify any known allergies of the patient, as well as any relevant medical conditions, by checking the appropriate boxes.
6. In the prescription information section, indicate the prescribed medication and other necessary details.
7. For the return fax, ensure that you fax this page only to the specified fax number, and remember that no cover sheet is required.
8. Complete the prescriber signature section, ensuring that your signature is handwritten, as signature stamps are not accepted.
9. Finally, review all completed information for accuracy before saving, downloading, printing, or sharing the form as necessary.

Complete your digital documents online to streamline your prescription process.