Get Optimumrx New Rx Request Form 3300

Completing the Optimumrx New Rx Request Form 3300 online is an essential step in ensuring your patient receives the medication they need. This guide provides a step-by-step walkthrough to help you fill out the form accurately and efficiently.

Follow the steps to complete the Optimumrx New Rx Request Form 3300

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering the OptumRx reference number at the top of the form. This information is essential for tracking.
3. In the 'Patient Information' section, fill in the patient's full name, member ID number, date of birth in the specified format, and phone number.
4. Next, move to the 'Prescriber Information' section. Enter your name, NPI, DEA number, and both your phone and fax numbers.
5. In the 'Medication(s) Requested by Your Patient' section, list the requested medications in the provided fields. Indicate if any of the requests are denied.
6. For each medication, specify the prescription details, including the medication strength, directions, quantity, and whether you want it dispensed as written. Also, choose the appropriate refill option.
7. After filling in all necessary medication details, you will need to sign the form in the designated area. Include the date of signing and, if applicable, print the name of the person signing if it is not you.
8. Finally, review the entire form for accuracy. Once confirmed, you can save the changes, download the document, and print or share as necessary.

Complete your documents online for a streamlined process.