Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the Alberta Blue Cross Special Authorization form and open it in an accessible editor.
2. Fill in the 'Patient Information' section. Enter the patient's last name, first name, coverage type, date of birth, and Alberta personal health number. Provide the street address, city, province, and postal code.
3. In the 'Identification/Client/Coverage No' field, enter the appropriate identification or client number.
4. Complete the 'Prescriber Information' section. Fill in the prescriber's last name, first name, initial, street address, and registration details, including their professional association and registration number.
5. Provide the prescriber's phone number, fax number, city, province, and postal code, ensuring the fax number is included for submission.
6. Select the drug being requested by checking the appropriate box under 'Drug Requested'. Depending on the choice, complete the relevant sections (I, II, and/or III) accordingly.
7. For Section I, answer the questions regarding the patient's condition: does the patient have non-valvular atrial fibrillation? Provide details related to use and any contraindications.
8. If applicable, complete Section II for requests concerning treatment of venous thrombotic events.
9. Fill out Section III if the request is for prophylaxis following elective total hip or knee replacement surgery.
10. Review all information for accuracy. Once verified, the prescriber must sign and date the form.
11. After completing the form, submit your request according to the provided instructions and ensure that it is transmitted only once.

Start filling out the Alberta Blue Cross Special Authorization form online today for timely processing.