Get Optum Rx New Rx Form

This guide provides clear instructions on how to complete the Optum Rx New Rx Form online. Follow these steps to ensure a smooth and efficient process for submitting your prescription information.

Follow the steps to successfully complete the Optum Rx New Rx Form.

1. Press the ‘Get Form’ button to obtain the form and open it in your document editor.
2. In Section 1, fill out your personal details including your primary member ID number, secondary member ID number (if applicable), first name, last name, middle initial, delivery address, city, state, date of birth, gender, and ZIP code. Ensure all information is accurate.
3. Provide your email address and phone number, including the area code, in the designated fields. This is important for communication regarding your prescription.
4. Indicate any medication allergies you may have by checking the appropriate boxes next to the listed options.
5. List any health conditions you have, including any over-the-counter or herbal medications you take regularly. If there are other conditions not listed, make sure to specify them.
6. In Section 2, your physician must fill out their information, including the patient's name, date of birth, physician's phone number, office address, and fax number.
7. The physician must also provide their NPI number, DEA number (if applicable), and sign the form with the date.
8. Once all sections are complete, prepare to send the completed form. It must be faxed to 1-800-491-7997 for processing.
9. Finally, you may save changes, download, or print the completed form for your records.

Complete your Optum Rx New Rx Form online now for efficient prescription processing.