Get 800 310 6826

This guide will provide clear and comprehensive instructions on completing the 800 310 6826 form online. Whether you are a healthcare provider or a person supporting a patient, this step-by-step approach ensures a smooth submission process.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in the online editor.
2. Provide patient information by filling in all fields, including the patient’s name, insurance ID, date of birth, height, weight, address, phone number, and sex.
3. Complete the provider information section. Enter the provider’s name, provider ID number, address, specialty, and contact details.
4. In the medication information section, specify the medication, quantity, ICD-10 code, directions, diagnosis, and refills needed.
5. Affix the physician's signature in the designated area, indicating approval for the prescription and coordination of delivery.
6. Answer the questions regarding medication instructions and whether the patient has been instructed on self-administration. Provide other relevant dates if necessary.
7. Fill out the delivery instructions. Ensure that all provider and patient information is complete before submission.
8. Once the form is fully completed, save the changes, download, print, or share the document as needed.

Complete your request by filling out the form online today.