Get Foundation (gatcf) Free () Program - Needymeds

Navigating the Foundation (GATCF) Free Program requires precise completion of the necessary forms. This guide provides user-friendly instructions to help you accurately fill out the confirmation of infusion or injection form online.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form for completion. This will open the document for you to start filling it out.
2. Begin by entering the 'Date of Service' in the designated field. This denotes the specific date when the infusion or injection occurred.
3. Input the 'Amount Infused/Injected' for the corresponding date in the next field. Use the appropriate measurement (mg) for the substance administered.
4. If multiple infusions or injections occurred, repeat the process by filling out subsequent 'Date of Service' and 'Amount Infused/Injected' fields as required.
5. Complete the required fields labeled 'Print Patient Name,' 'Patient’s Date of Birth,' 'Authorized HCP Signature,' 'Date of Signature,' and 'Next Scheduled Infusion (if applicable)'. Ensure all information is accurate and clearly written.
6. Review the certification statement included in the form. By signing, you confirm the accuracy of all provided information and acknowledge the potential for audits. Ensure the physician's signature is included where required.
7. Once all fields are completed, save your changes. You may then choose to download, print, or share the document as necessary for submission.

Complete your forms online today to ensure successful participation in the program.