Get Cigna Specialty Pharmacy Services Fax Order Form Please Deliver By: Requests

This guide provides a professional and supportive overview of how to effectively complete the CIGNA Specialty Pharmacy Services Fax Order Form. By following these clear instructions, users can ensure they provide all necessary information accurately for timely processing.

Follow the steps to complete the order form efficiently.

1. Press the ‘Get Form’ button to obtain the CIGNA Specialty Pharmacy Services Fax Order Form and open it in your preferred document editor.
2. Begin by entering the delivery date in the 'Please deliver by' section. Keep in mind that requests received after 4 p.m. CT will start processing the next business day.
3. Fill in the Referral Source Code and Order # in the designated fields.
4. In the 'Patient Information' section, provide the patient's name, date of birth, health care ID number, sex, and contact information including home phone and address.
5. Next, complete the 'Physician Information' section by entering the physician’s name, DEA number, NPI, and contact details.
6. Indicate any known allergies for the patient. If there are no allergies, specify accordingly.
7. Determine the shipping address for the medications, ensuring it is a physician’s office as certain medications cannot be shipped directly to patients.
8. Respond to the question regarding fax responses to the physician’s office by selecting 'Yes' or 'No'.
9. In the 'Prescription Information' section, detail the medications, including the type (®, ®, ®, ®), dosage, directions, number of vials, and refills.
10. The prescriber needs to include their printed name and signature, affirming the accuracy of the prescription details.
11. Provide any documented progression of disease and prior therapies, including the diagnosis code (ICD-9) and specific locations for injections.
12. Answer all additional questions thoroughly to justify the need for the prescribed drugs.
13. Once all sections are completed, review the form for accuracy, and proceed to save changes, download, print, or share the final document as needed.

Complete your documents online now for efficient processing.