Get Cigna Tel Drug Fax Form And

The Cigna Tel Drug Fax Form And is essential for users seeking prior authorization for specific medications. This guide offers clear, step-by-step instructions to ensure that you can complete the form accurately and efficiently.

Follow the steps to complete the Cigna Tel Drug Fax Form And

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the provider information section. Include your name, specialty, DEA or TIN number, office contact person, office phone, and fax numbers. Also, specify if your fax machine is kept in a secure location and if you allow for fax responses.
3. Next, complete the patient information section with the patient's name, Cigna ID, date of birth, and contact details. Ensure the street address, city, state, and zip code are accurately filled in.
4. Indicate the medication requested by checking the relevant boxes for , , , , or other medications and provide the strength, dosing schedule, number ordered per month, and expected duration of therapy.
5. In the clinical data section, specify if the medication will be used for treatment, prevention, or both. Identify the patient's diagnosis and provide details on any first-line medications that have been tried, including their outcomes.
6. If applicable, indicate whether there are any contraindications to first-line medications and specify if the medication is for pregnancy-related nausea.
7. Complete the additional pertinent information section, including scheduled chemotherapy treatment cycles and the corresponding days for each cycle.
8. Review all information for accuracy before finalizing the form. Once you verify that all required fields are complete, you can save changes, download, print, or share the filled form.

Complete your Cigna Tel Drug Fax Form And online today for timely authorization.