Get Non Formulary Exceptions &

This guide provides comprehensive instructions on completing the Non Formulary Exceptions & form online, ensuring that all necessary details are accurately recorded. Following these steps will help facilitate the approval process for medication prescriptions.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling in the patient information section. Provide the patient's name, ID number, date of birth, phone number, and email address. Ensure all fields are completed to avoid delays in processing.
3. Fill in the prescribing physician's information, including their name, address, phone number, specialty, DEA number, NPI number, and email address.
4. Enter the medication details by specifying the name of the medication and the required strength.
5. Outline the directions for use and the quantity per 30 days. This section is crucial as it provides the necessary dosage instructions.
6. Document the diagnosis in the designated area, ensuring you include specific details that support the necessity of the non-formulary exception.
7. Review and check all applicable approval criteria boxes, noting that any incomplete areas could affect the outcome of the request.
8. If applicable, list any previously tried medications and specify the relevant dates for each trial to support the justification for the request.
9. Finally, ensure the physician signs the form and includes the date of signing, verifying that all information is accurate and complete.
10. After completing all sections, save your changes and prepare to download, print, or share the completed form as necessary.

Complete your forms online efficiently and ensure a smooth submission process.