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This guide provides clear and actionable steps for completing the Physician Medical Waiver online through Livetheorangelife Com. By following these instructions, you will be able to efficiently navigate the form and ensure that all necessary information is submitted accurately.

Follow the steps to successfully complete the Physician Medical Waiver online.

1. Press the ‘Get Form’ button to access the Physician Medical Waiver and open it in your browser for filling out.
2. Begin with Part I, which captures the prescribing physician’s information. Clearly print the physician's first and last name, UPIN/NPI number, address, ZIP code, and phone number.
3. Mark the items on the Personalized Healthy Living Checklist for which the physician is providing a waiver. Ensure that the selection is clear and accurately represents the patient's situation.
4. The physician must attest to the appropriateness of the waiver by signing and dating the form at the designated section.
5. Proceed to Part II, where the patient’s information is required. The patient should print their first and last name, date of birth, Healthy Living ID, phone number, and email address.
6. The patient must acknowledge the statement regarding falsification of company records by signing and dating the form.
7. Once all fields are completed, review the document for any missing information. It is crucial to have a complete and accurate form before submission.
8. After reviewing, send the completed waiver by fax to 847-883-8269 before the deadlines indicated in the document.
9. Retain a copy of the form for personal records. You will receive a confirmation of receipt from the Benefits Choice Center within 48 hours.

Complete your Physician Medical Waiver online today to ensure your eligibility for health program discounts.