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This guide provides a step-by-step approach to completing the Prior Authorization Criteria Form for through CVS-Caremark. Ensuring accuracy in filling out this form is crucial for a successful prior authorization process.

Follow the steps to successfully fill out the form.

1. Press the ‘Get Form’ button to access the Prior Authorization Criteria Form. It will open in your preferred document interface.
2. Begin by entering the drug name for the the medication being prescribed. In this case, specify ''.
3. Fill in the patient information accurately, including their name, patient ID, group number, and date of birth.
4. Complete the prescribing physician's details: their name, phone number, fax number, and full address including city, state, and zip code.
5. Provide the patient's diagnosis and the corresponding ICD code.
6. You will find a series of questions that require circling 'Y' for yes or 'N' for no. Answer each question based on the patient's conditions and medications.
7. If applicable, complete the comments section with any additional relevant information pertaining to the patient's condition or treatment.
8. Affirm the accuracy of the information by obtaining the prescribing physician's signature and date.
9. Once all fields are completed, review the form for accuracy. You can then save your changes, download, print, or share the form as necessary.

Complete your Prior Authorization Criteria Form online to ensure timely processing.