Get Accredo Referral Form - Avmed - Avmed

The Accredo Referral Form is essential for processing medication referrals through AvMed. This guide provides clear instructions to help users efficiently complete the form, ensuring all necessary information is submitted correctly.

Follow the steps to accurately fill out the Accredo Referral Form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the patient's details. Provide the member ID or SSN, patient name, date of birth, and contact information including address and phone number.
3. Next, complete the doctor's or prescriber's information, including their name, DEA number, and contact details.
4. In the insurance section, specify the primary insurance details, including AvMed Health Plans, insurance phone number, and policy holder's name.
5. Provide the diagnosis information, including primary and secondary diagnoses, along with the corresponding ICD9 codes.
6. Fill out the medication details in the Rx Form section. List the drug name, strength, and quantity required.
7. Ensure the prescriber's signature is included where required, marking if substitution is permissible or if dispensing is to be done as written.
8. Specify the preferred delivery method, providing any necessary shipping details including address and contact information.
9. Once all sections are filled out, review the information for accuracy before saving changes, downloading, printing, or sharing the completed form.

Take the next step in your digital document management by completing the Accredo Referral Form online.