Get Over-the-counter Self Care Request Form - Eisenhower Army - Ddeamc Amedd Army

Filling out the Over-The-Counter Self Care Request Form is essential for accessing self-care medications at the Eisenhower Army Medical Center. This guide provides a clear and instructive approach to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete your request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's full name and the sponsor's social security number in the respective fields. Ensure the information is correct to avoid any process delays.
3. Fill in the patient's age and weight. This information is crucial for medication eligibility and safety.
4. Complete the patient's date of birth. This helps confirm the identity and age-related requirements for medication.
5. Indicate the specific symptom or condition for which medications are being requested. Choose carefully from the categories such as pain/fever, cough/cold/allergies, gastrointestinal, topicals, and eye, ear, nose, throat medications.
6. Select the appropriate package size for each medication requested. Be mindful of age restrictions mentioned on the form.
7. Review all information provided for accuracy and completeness to ensure a smooth processing of your request.
8. Once all fields are filled out, you can save any changes made, then download, print, or share the form as needed.

Take action now to complete your forms online and ensure access to the medications you need.