Get 8773018207

Filling out the 8773018207 form online can streamline the process of managing osteoporosis treatment enrollment. This guide will provide step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the 8773018207 form online.

1. Click ‘Get Form’ button to access the enrollment form for osteoporosis. This will allow you to open the form in an editable format for completion.
2. Enter the patient's date and Social Security number in the designated fields. Ensure all personal details, including the first and last name, are spelled correctly.
3. Fill in the patient's address, including city, state, and zip code, in the appropriate sections. This information is essential for identification and communication purposes.
4. Provide the best and alternate phone numbers for the patient. Include the date of birth and weight, noting whether to use kilograms or pounds, as indicated.
5. List the caregiver's name and any known allergies under the relevant field. This helps medical professionals understand the patient's needs better.
6. Fax a copy of the patient's insurance card, including both the front and back sides, along with the completed form.
7. Document prior therapies the patient has undergone by checking the relevant boxes. Specific therapy codes for osteoporosis should be correctly indicated.
8. Complete the clinical information section, including diagnosis and BMD/T-score, and whether the patient is new to therapy or has a history of fractures.
9. Fill in the medication details, including dosage instructions, quantity, refill preferences, and any required training notes for injections.
10. Finally, ensure the physician's name, contact information, and signature are included at the bottom of the form, authorizing the pharmacy to initiate the insurance process.
11. Once all fields are completed, save any changes made to the document. You can then download, print, or share the form as needed.

Complete your enrollment process online by filling out the 8773018207 form today!