Get 1 800 488 0134

Filling out the 1 800 488 0134 form online is an essential step in ensuring effective management of Hepatitis C treatment. This guide offers clear instructions to help users navigate each section and complete the form with confidence.

Follow the steps to complete the 1 800 488 0134 online

1. Click the ‘Get Form’ button to access the form. This will allow you to download the document and open it for editing.
2. Begin by entering patient information. Fill in the patient's name, date, CareSource ID, date of birth, address, city, state, zip, and phone number. Ensure all details are accurate to avoid processing delays.
3. In the medication information section, provide the medication name and strength, dosage directions, quantity, duration of therapy, and number of refills for each requested medication. Repeat this for all medications being prescribed.
4. The physician must sign the form on the designated line, confirming that a prescription is being provided for medication dispensing and coordination.
5. For clinical information, answer each question as accurately as possible, providing details where necessary. Ensure to submit any required documentation, including lab results or medical records, to support the answers provided.
6. Complete the physician information section with the physician's name, DEA number, address, phone number, office contact, specialty, NPI number, city, state, zip, and fax number.
7. Fill out the dispensing information by indicating the requested specialty pharmacy, its phone number, fax number, NPI or Tax ID, and address.
8. Review all entries for accuracy. Once confirmed, save your changes. You can then download, print, or share the completed form as needed for submission.

Start filling out the 1 800 488 0134 form online today to ensure timely processing for Hepatitis C treatment.