Get E-prescribe: Exactus Pharmacy Solutions

Filling out the E-prescribe: Exactus Pharmacy Solutions form is essential for patients receiving prescriptions. This guide provides a step-by-step approach to ensure a smooth experience when submitting this important documentation online.

Follow the steps to complete the E-prescribe form accurately.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Fill out the patient information section, including the patient's name, sex, date of birth, and contact details such as address and phone numbers.
3. Complete the insurance information section. Provide the details for the primary and secondary insurance, including the cardholder's name, relationship to the cardholder, insurance company phone number, policy number, group number, and prescription drug insurer.
4. Enter the prescriber information. This includes the prescriber's name, specialty, practice name, and contact details. Ensure to include the Medicaid or Medicare provider number, tax ID number, state license number, and UPIN/NPI number.
5. Fill out the clinical information section. This entails entering the primary and secondary diagnoses. Additionally, evaluate tuberculosis status and provide any relevant comments or prior medications.
6. Complete the prescription information section. Specify the medication, dosage, and the requested ship dates. Note the number of refills requested.
7. Select the shipping address, indicating if the prescription should be sent to the prescriber or the patient.
8. Include the prescriber signature, date, and if applicable, the supervising physician's signature and name along with the date.
9. Review all entered information for accuracy. Once confirmed, you can save changes, download, print, or share the completed form.

Complete your E-prescribe forms online today for a hassle-free experience.