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Get Bayer Abandoned Unit Program Return Form
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How to fill out the Bayer Abandoned Unit Program Return Form online
The Bayer Abandoned Unit Program Return Form is essential for returning unopened units of Skyla® or ® that were not utilized. This guide provides a clear, step-by-step approach to assist users in completing the form effectively online.
Follow the steps to successfully fill out the form online
- Click the ‘Get Form’ button to access the Bayer Abandoned Unit Program Return Form and open it for completion.
- Begin by entering the prescriber information. This section requires the last name, first name, DEA number, NPI number, addresses, contact information, and email of the prescriber. Ensure that all information is legible and up to date.
- Proceed to fill out the patient information section. Enter the patient's last name, first name, date of birth, addresses, and contact number. Ensure the details match the prescription label.
- Complete the prescription label information. Input the prescription number, fill date shown on the prescription label, and the name and address of the pharmacy. A separate form is required for each abandoned unit.
- Read and acknowledge the statements regarding the conditions for returning an abandoned unit. By signing the form, you confirm that the unit meets the return requirements.
- After filling out all the necessary fields, sign the form and ensure that the healthcare provider's signature and date are included.
- Save changes to the form, and choose to download, print, or share the completed document as needed. Ensure that the form is faxed to the Specialty Pharmacy for verification.
Ensure to complete and submit your Bayer Abandoned Unit Program Return Form online for efficient processing.
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