Get 18008473418

Filling out the 18008473418 form is an important step in ensuring proper prescription management. This guide will provide clear and detailed instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully fill out the 18008473418 online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Complete the patient and insurance information section. Ensure that you include copies of the front and back of insurance cards. Fill in the patient's first name, last name, middle initial, date of birth, contact numbers, and address details. Also, provide information regarding the primary and secondary insurance, including policy numbers and contact details.
3. Read and sign the patient authorization section. By signing, you will consent to the disclosure of protected health information for various purposes related to your treatment. Ensure that you enter the date and provide your signature, along with your relationship to the patient.
4. Fill out the patient eligibility information. Answer questions regarding the FDA-approved indication and record the current gestational age. Indicate whether the patient is receiving or compounded HPC, and record the date of this information.
5. Complete and sign the prescription section. Enter the prescriber's name, NPI number, and contact details. Specify the medication details, including dosage instructions and shipping preferences. Finally, sign and date this section as the prescriber.
6. Read and sign the prescriber authorization. This section allows Sonexus Health to act on your behalf regarding patient information. Ensure to sign and date this authorization.
7. Once all sections are completed and signed, finalize by faxing the completed form along with the insurance cards to the appropriate fax number provided.

Complete the 18008473418 form online today for efficient prescription management.