Get Prescription Override Form - Gallagher Koster

Filling out the Prescription Override Form is essential for students needing to manage their prescriptions while traveling abroad. This guide provides clear and concise instructions to assist you in completing the form accurately online, ensuring your needs are met efficiently.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Prescription Override Form and open it in your document editor.
2. Begin by entering your full name in the 'Student Name' field, followed by your Student ID number. Ensure that this information is accurate to prevent processing delays.
3. Fill in the 'School Name' section with the name of your educational institution. This is critical for verifying your enrollment status.
4. Provide your best contact number in the 'Student Phone #' field along with your email address in the 'Student Email' section. This contact information will be used for communication regarding your request.
5. In the 'International Destination' field, indicate your travel location. Remember to attach proof of your departure, such as your ticket or travel itinerary.
6. Input the 'Departure Date' and 'Return Date' to specify your travel timeline. This helps facilitate the processing of your prescription needs.
7. State the 'Requested number of months of prescription'. Keep in mind this cannot exceed the plan's termination date; otherwise, you will need to pay for prescriptions upfront and seek reimbursement.
8. List the name and dosage of your first prescription in the designated section. Select whether it is a generic or brand name medication. Repeat the process for the second prescription.
9. Enter your desired pick-up date for the prescriptions. This cannot be more than 2 weeks prior to your departure date, as the Prescription Override is valid only for 48 hours after this date.
10. Provide the name and phone number of the pharmacy where you wish to pick up your medications.
11. Once all fields are complete, review your entries for accuracy, then save your changes. You can download, print, or share the form, or submit it directly to Gallagher Student Health via email or fax.

Complete your Prescription Override Form online today to ensure your medication needs are met while you travel.