Get Ohsu Mail Order Pharmacy

Completing the Ohsu Mail Order Pharmacy prescription refill request form online is a straightforward process. This guide will walk you through each section to ensure that you fill it out accurately and efficiently.

Follow the steps to complete your prescription refill request.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter today's date in the designated field to indicate when you are submitting the request.
3. Fill in your name and address. Include your last name, middle name, and first name, along with your apartment number (if applicable), street address, city, state, zip code, and any P.O. box details.
4. Provide your email address and phone number. Ensure that you format your phone number correctly.
5. Enter your member ID and Rx bin number in the specified fields. This information is crucial for processing your request.
6. Indicate your sex and select if there are no changes since your last order by checking the appropriate box.
7. List any drug allergies you may have and describe any relevant health conditions. This helps the pharmacy ensure your safety.
8. In the prescription refill request information section, provide details for your prescription by entering each prescription number and the associated drug name and strength, if applicable.
9. Select your delivery preference by indicating where you would like to receive your medications. Options include home delivery or specific pharmacy locations.
10. For payment information, input your credit card details, including your credit card number, expiration date, and CVV number. Ensure your card is accepted, and provide a signature to authorize the payment.
11. Finally, review all entered information for accuracy. Once you are satisfied, save the changes, and download or print the form if needed.

Complete your prescription refill request online today!