Get Il Hfs 2803 2008-2025

The IL HFS 2803 form is an essential document used for optical prescription orders in the state of Illinois. This guide provides clear, step-by-step instructions on how to complete the form online effectively, ensuring you include all necessary information accurately.

Follow the steps to complete your optical prescription order form online.

1. Click ‘Get Form’ button to retrieve the IL HFS 2803 form and open it in your chosen editor.
2. Begin by entering the provider’s name in the designated field at the top of the form. Ensure that the name is accurate to avoid any processing issues.
3. Next, input the National Provider Identifier (NPI) number. This identifier is critical for billing and identifying the health care provider.
4. Record the date of service (DOS). This date is essential as it indicates when the prescription was written.
5. Fill in the address information for the provider, including street address, city, state, and ZIP code.
6. In the recipient section, enter the recipient’s full name, including first name, middle initial, and last name.
7. Provide the recipient’s identification number, which may be required for processing.
8. Enter the recipient’s birthdate. This is important for ensuring that the prescription is accurate and traceable to the correct individual.
9. Complete the fields for prism values and other specifications (DPD, NPD) for the prescription, ensuring the accuracy of each measurement.
10. Fill in the prescription details for each eye, noting the sphere, cylinder, axis, and additional information as necessary.
11. Indicate the height and base curve for each lens, ensuring this information is specific to the recipient’s needs.
12. Choose the lens material by checking the appropriate box. Options typically include glass, plastic, and polycarbonate.
13. Select the style of lens, such as regular or bifocal, based on the prescription.
14. Choose the frame material and fill in the corresponding information such as frame name and manufacturer.
15. Finally, sign the form to certify that all information provided is accurate, and date the signature. Ensure that you keep a copy for your records.
16. Once all sections are completed, you can save any changes, download a copy of the form, print it, or share it as needed.

Complete your IL HFS 2803 form online today and ensure timely processing of your optical prescription order.