Get Optumrx New Prescription Mail-in Order Form - Uhcrivervalley.com

Filling out the OptumRx New Prescription Mail-in Order Form is a straightforward process that can be accomplished online. This guide provides clear and step-by-step instructions to assist users in completing the form accurately.

Follow the steps to successfully complete your order form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by providing the member and physician information. Use black or blue ink as specified. Complete the following fields carefully: Member ID Number, Secondary Member ID Number (if applicable), last name, first name, middle initial, delivery address, apartment number (if any), city, state, ZIP code, date of birth, and gender.
3. Next, enter your email address and phone number with area code to ensure proper communication.
4. Fill in the physician's name and their phone number with area code to facilitate further prescription correspondence.
5. In the health history section, indicate any medication allergies you may have by checking the appropriate boxes. If there are additional allergies, specify them in the designated area. Then, list any health conditions you have, ensuring you check 'None known' if applicable.
6. Moving on to the pharmacy processing section, specify whether you prefer generic substitution or brand-name medications. If brand-name medications are required, list them in the provided space. If there are prescriptions to keep on file, include those details here as well.
7. In the payment and shipping information section, choose your payment method carefully. You have options to pay by check or credit card, which must be filled out appropriately. Remember to check the box stating that you do not want to send cash.
8. Finally, after reviewing all entered information for accuracy, save your changes, download the completed form, print it out, and share it if needed. Remember to mail the completed order form along with your new prescriptions to the designated address provided in the document.

Complete the OptumRx New Prescription Mail-in Order Form online today for a seamless prescription ordering experience.