Get Custom Compounding Fax Form

Filling out the Custom Compounding Fax Form online is a straightforward process. This guide provides you with detailed, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form, making sure to have all necessary information at hand.
2. Fill in the patient information section. Include the patient's name, date of birth, phone number, and address, as well as any face sheet and insurance cards.
3. In the prescription section, enter the date and any known allergies. Include specific medications and concentrations as requested, marking the appropriate boxes for options like ointment, cream, gel, or lotion.
4. Indicate the quantity of the prescribed medications and any alternative quantities if applicable. Be sure to specify the refill details and write down the directions for usage.
5. Complete the provider section by filling in the prescriber’s name, contact number, and fax information. Include their signature and either NPI or DEA number.
6. After reviewing all the entered information for accuracy, make sure to include any additional instructions based on the patient's needs.
7. Once all fields are completed, you can save your changes, download a copy, print the form, or share it as needed.

Complete your Custom Compounding Fax Form online now for efficient processing!