Get Medication Request Form - Soundpath Health

Filling out the Medication Request Form is an essential step in obtaining prior authorization for coverage of necessary medications. This guide will walk you through the process of completing the form accurately and efficiently.

Follow the steps to successfully complete the Medication Request Form

1. Press the ‘Get Form’ button to retrieve the Medication Request Form and open it for filling out.
2. Begin with the patient information section. Enter the patient's name, ID number, date of birth, health plan, and phone number. All fields marked with an asterisk (*) are required.
3. Next, fill in the physician information. Provide the physician's name, specialty, ID number or DEA number, and contact phone number. Ensure all required fields are completed.
4. In the requested drug information section, enter the requested drug's name, dosage, strength, quantity, dosage form, and reason for the medication request. Be specific to ensure clarity.
5. Detail any other medications that have been tried and/or failed by the patient, providing relevant information.
6. Complete the pharmacy information section by providing the pharmacy's name, contact phone number, and fax number.
7. Lastly, review all sections to confirm that all required fields are completed, then save your changes. Depending on your needs, download, print, or share the completed form.

Take the next step towards obtaining your medication by filling out the Medication Request Form online.