Get Start Form

This guide will assist users in completing the Start Form online effectively. By following these instructions, users can navigate each section with ease and ensure that all necessary information is accurately submitted.

Follow the steps to complete the Start Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the patient information section. Input the patient's name, date, ID, and date of birth accurately to ensure proper identification.
3. In the physician section, provide the physician's name, specialty, NPI number, and office contact details such as telephone and fax numbers.
4. Answer the diagnosis questions by selecting the appropriate options for the patient's condition, such as psoriatic arthritis or plaque psoriasis. Please also provide the relevant ICD-10 code.
5. If the prescribed medication falls under a preferred product category, note whether the prescriber is willing to switch to a preferred product like or .
6. Continue through the form by indicating whether the patient has been receiving therapy with the requested medication for the required duration.
7. Provide responses for the patient's clinical history regarding their treatment with other biologics or synthetic DMARDs, as required by the form.
8. Confirm the patient’s history with the prescribed drug therapy, ensuring to provide accurate details for therapy outcomes.
9. Upon completion, attest that the information provided is accurate and include a signature. Remember to date the signature accurately.
10. Finally, save the changes, download, print, or share the completed form as necessary.

Complete and submit your forms online to ensure timely processing of authorizations.