Get Global Prior Authorization Form. - Caremark

Filling out the Global Prior Authorization Form is a crucial step in securing necessary medication for patients. This guide provides clear, step-by-step instructions tailored to users seeking assistance in completing the form effectively.

Follow the steps to accurately complete the Global Prior Authorization Form.

1. Click the ‘Get Form’ button to access the Global Prior Authorization Form and open it for editing.
2. Begin by filling out the patient information section. Provide the patient's full name, ID number, date of birth, gender (indicate M or F), and contact details including home phone number and address.
3. In the prescriber information section, enter the prescriber's name, office address, office phone number, and office fax number.
4. Fill in the medication details by specifying the medication name, strength, dosage form, quantity, expected length of therapy, and frequency.
5. Describe the diagnosis and include relevant ICD code(s) in the corresponding section. Ensure that all clinical information required for evaluation is complete.
6. If this request is a continuation of therapy, indicate how long the patient has been on the medication and provide additional information about medication trials related to the diagnosis.
7. Check all applicable boxes regarding the patient’s medical history, chronic conditions, and any specified risks or contraindications.
8. Complete the corresponding section on page 2 for the specific drug or class listed. If the drug/class is not listed, prepare to attach supporting clinical documentation.
9. Finally, review all entered information for accuracy before providing your signature and the date to attest that the information is true and medically necessary.
10. Once completed, save the form, and download, print, or share it as needed.

Begin the process of filling out your Global Prior Authorization Form online today.