Get Referral Form - Omnicare Scg

Filling out the Referral Form - Omnicare SCG online is a straightforward process designed to streamline the referral of patients for medication. This guide will provide you with clear and concise instructions on how to effectively complete each section of the form online.

Follow the steps to complete the Referral Form - Omnicare SCG online:

1. To obtain the Referral Form - Omnicare SCG, select the ‘Get Form’ button. This will allow you to access the form and prepare to fill it out.
2. Begin with the Patient Information section. Provide the patient’s full name, date of birth, gender, and address. Ensure to include the preferred phone numbers and email address, and identify the best time for contact.
3. Fill out the Prescriber Information section by entering the prescriber’s full name, specialty, practice name, and contact details. Provide the Medicare/Medicaid number, Tax ID number, and NPI number as applicable.
4. In the Insurance Information section, check if the patient has insurance or not. If applicable, enter details such as the Prescription Drug Insurer’s name, policy ID, and include copies of the patient’s insurance cards.
5. Complete the Prescription Information by selecting the correct dosage of capsules and indicating the number of refills needed. You must also select a Specialty Pharmacy from the provided list.
6. If opted for, provide information for the Bridge Program prescription. Indicate the prescription details and the number of refills.
7. Finally, ensure to sign and date the prescriber authorization section. Remember that signature stamps are not acceptable, and if required, attach any necessary state-specific prescription forms.
8. Once the form is completed, save the changes, and proceed to download, print, or share the form as needed. Make sure to fax the completed form to the chosen Specialty Pharmacy.

Ready to submit your forms online? Follow the steps above to complete the Referral Form - Omnicare SCG today.