Get To Find The Prior Exception Request Form. - Freedom Health

Filling out the To Find The Prior Exception Request Form is an important step in ensuring that your medication needs are met. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the patient information. Fill in the patient's last name, first name, middle initial, patient ID number, date of birth, pharmacy, and pharmacy phone number.
3. For the drug requested section, input the name and strength of the drug. Specify the quantity needed and the duration of therapy.
4. Indicate whether the patient has previously received this drug by selecting 'Yes' or 'No.' If 'Yes,' provide the duration of therapy and the start date.
5. Next, address the patient's documented allergy or intolerance to similar formulary medications by selecting 'Yes,' 'No,' or 'N/A.'
6. List any therapy failures related to one or more formulary drugs within the same therapeutic class in the designated area.
7. Fill in the patient's diagnosis, ensuring to include any relevant documentation such as tests, procedures, or previous therapies that support the request.
8. Provide the physician's information including first name, last name, phone number, NPI number, specialty, address, and fax number for notification.
9. Review the completed form for accuracy and completeness before submitting it. Ensure all desired documentation is included.
10. Once everything is filled out, save your changes. You may also download, print, or share the form as needed.

Complete the form online to ensure your medication needs are efficiently met.