Get Instymeds Provider Authorization Form

Filling out the Instymeds Provider Authorization Form online is a crucial step for healthcare providers seeking access to Instymeds' services. This guide will provide you with clear and concise instructions to ensure you complete 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 editor.
2. Begin by entering the physician's name in the designated field. Ensure to print clearly for visibility.
3. Next, provide the name of the facility or facilities where Instymeds access is required. Remember to list all applicable locations.
4. Fill in the city and state associated with the facility for accurate identification.
5. Indicate your title (e.g., MD, DO, PA-C) in the appropriate section to affirm your professional status.
6. Write your DEA number in the specified field. This is essential for legal verification.
7. Provide your National Provider Identifier (NPI) number, which is required for identification purposes.
8. Enter your state license number where applicable to confirm your authorization.
9. If you are enrolled in Medicaid, please include your Medicaid number in the provided field.
10. Answer the security questions listed to help with future identity verification.
11. After filling out the form, ensure you sign in the designated area, confirming your submission.
12. Finally, provide your contact information, including your email and phone number, which Instymeds will use solely for notifying you of your new login information.
13. Once you have completed all the fields, save your changes, and choose to download, print, or share the form as needed.

Start completing your documents online today for seamless access to Instymeds services.