Get Lemed Specialty Pharmacy

Filling out the Lemed Specialty Pharmacy form online is a straightforward process that helps ensure that individuals receive the medications they need efficiently. This guide provides step-by-step instructions to assist users in completing the form accurately.

Follow the steps to complete the online form effectively.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Fill in the patient information section. Include the patient's name, birthdate, social security number, and preferred phone number. Indicate the patient's height and weight, as well as any known allergies. Complete the address information, including city, state, and zip code. If applicable, include an alternate caregiver's name and their preferred phone number.
3. Provide the insurance information for the patient by faxing the front and back copies of all insurance cards, both prescription and medical.
4. Complete the prescriber information section. Enter the provider's name, DEA number, address, phone number, and fax number. Don't forget to include the city, state, and zip code. Identify a key contact from the prescriber’s office and provide their phone number.
5. Fill in the diagnosis and clinical information. Include the NPI number and tax ID number. Attach recent clinical notes, lab results, and tests to expedite the prior authorization process. Specify the diagnosis and ICD-10 code, as well as the patient's CD4 count and viral load.
6. In the prescription information section, provide the necessary details for each medication being prescribed. Select the medications from the list provided, noting the dosage, the number of tabs or capsules to dispense, and the instructions for use.
7. Upon completion of all sections, review the information for accuracy. Make any necessary corrections.
8. At the end of the form, sign and date where indicated for both the patient and prescriber. Ensure that the prescription is valid and permissible as per NY State Board of Pharmacy regulations.
9. Finally, save changes, download the completed form, print it, or share it as required.

Start filling out the Lemed Specialty Pharmacy form online today for a smooth prescription experience!