Follow the steps to complete the Cigna Specialty Pharmacy Infertility form online.

1. Press the ‘Get Form’ button to access the Cigna Specialty Pharmacy Infertility form and open it for editing.
2. Begin by filling in the patient information section. This includes the patient's name and date of birth, which is essential for identifying the individual receiving treatment.
3. Next, provide the physician information. Enter the physician's name, DEA number, NPI, telephone, and fax number to ensure clear communication regarding the prescription.
4. In the patient details section, include contact information such as home phone and alternate phone numbers. This information is vital for scheduling medication delivery.
5. Select the address where medications should be delivered, either to the physician’s office or the patient’s home. If sending to the physician’s office, indicate if there are specific delivery days.
6. Indicate any allergies for both the patient and the anonymous donor, if applicable. If there are no allergies, select the appropriate option to communicate this.
7. Complete the medication orders by filling in the required medications, including quantity and refills for each type. Make sure to provide detailed directions for administration where necessary.
8. If the order includes supplies, specify the quantities needed for syringes, needles, swabs, or a sharps container.
9. Answer the required questions regarding the patient's diagnosis and type of treatment they are undergoing. This information helps in processing the order accurately.
10. Finally, include prescriber information, including the prescriber’s printed name, signature, and date. This confirms the accuracy of the prescription filled out.
11. Once all sections are completed, save the form. You can then download, print, or share it as needed.

Take the next step in your treatment journey by completing the Cigna Specialty Pharmacy Infertility form online today.