Get Remplissable Formulaire D'inscription Au Programme De La Ligne Infosoins ... - Lillypro

Filling out the Remplissable Formulaire D'inscription Au Programme De La Ligne Infosoins ... - LillyPro online can be a straightforward process if you follow the right steps. This guide aims to provide clarity and support to ensure that you accurately complete the form and understand each section's purpose.

Follow the steps to effectively fill out the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin with the prescription section, where you will need to input the name of the prescribed medication, (tériparatide injectable), and specify the dosage as instructed, which is 20 µg daily.
3. Next, provide the diagnosis information by selecting the appropriate option from the list of conditions, such as severe osteoporosis in postmenopausal women.
4. In the physician authorization section, ensure the physician’s signature, license number, and date are filled in accurately. Indicate if consent from the patient was obtained.
5. Proceed to fill in the patient information section, capturing details such as first name, last name, date of birth, and other relevant contact information.
6. Confirm the provincial coverage criteria by selecting ‘Yes’ or ‘No’ as applicable for prior authorization and insurance coverage.
7. Review the consent information regarding patient privacy and sign where indicated, ensuring that the patient or their legal guardian understands and agrees.
8. Finally, once all sections are completed, you can save the document, print, or share it as required.

Start filling out the form online today to ensure a smooth application process.