Get Pdf Oncology Prescription Referral Form - Biologics By Mckesson

This guide provides step-by-step instructions on how to accurately complete the PDF Oncology Prescription Referral Form - Biologics By McKesson online. Following these instructions will help ensure that the necessary information is submitted for timely processing.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'Patient Information' section, fill in the patient's full name, gender, shipping address, city, home phone, alternate phone, alternate contact name, relationship, date of birth, social security number, state, zip code, and indicate if the patient is part of the Oncology Care Model.
3. In the 'Insurance Information' section, attach copies of the front and back of the patient's medical and prescription insurance cards.
4. In the 'Clinical Information' section, provide the ICD-10 code, primary diagnosis/stage, height, weight, allergies, prior therapies, reasons for discontinuation, and confirm if the patient is receiving oral steroids, including any relevant dosing information.
5. Fill in the 'Prescriber Information' with the hospital or clinic name, office contact, complete address, fax number, tax ID, phone number, prescriber names, DEA number, zip code, and NPI number.
6. In the 'Prescription Information' section, specify the Rx start date, the method the prescription was sent (fax or e-Scribe), and provide details for each drug including the name, strength, quantity, number of refills, if the brand is medically necessary, and directions for use.
7. Sign the form in the 'Prescriber Signature' section. Note that signatures cannot be stamps. Include the date.
8. Review the completed form for accuracy and completeness. Save your changes, download a digital copy, print the form for faxing, or share it with relevant parties.

Start completing the PDF Oncology Prescription Referral Form online today to ensure timely processing of your patient's medication.