Get M F (tasimelteon): An Instructional Guide

Filling out the M F (tasimelteon) form correctly is crucial for ensuring the prescription and services are processed efficiently. This guide provides step-by-step instructions to assist users in completing the form with clarity and ease.

Follow the steps to successfully complete the M F (tasimelteon) form.

1. Click ‘Get Form’ button to access the M F (tasimelteon) form online.
2. Complete the patient information section by filling in the first name, last name, date of birth, address, city, state, and preferred phone fields. Ensure all fields are accurately filled to avoid delays.
3. In the insurance information section, indicate whether the patient has insurance. If they do, fill in the fields for the primary medical insurance and ID number. It is recommended to attach copies of both sides of the patient's pharmacy and insurance card(s) for verification.
4. In the patient signature section, obtain the required signatures. For enrollment in HETLIOZSolutions™, ensure that the patient or their guardian reads the necessary sections before signing. This step is crucial for eligibility in financial assistance programs.
5. Fill in the prescriber information, including the prescriber’s name, phone number, fax number, address, city, state, and National Provider Identifier (NPI) number.
6. Complete the prescription information, detailing the dosage, number of capsules, refills, and the patient's known allergies. It is important to note that daily usage may be needed before benefits are observed.
7. Indicate any necessary diagnostic codes for accurate processing by HETLIOZSolutions™ and ensure the prescriber signature and date are filled in.
8. Fax the completed form to HETLIOZSolutions™ at 1-844-364-2424. Keep an eye out for the fax receipt confirmation, which signifies that the form has been received.
9. If there are any issues with the form, HETLIOZSolutions™ will contact you with a Missing Information Form to clarify any incomplete fields.

Begin filling out the M F (tasimelteon) form online today to ensure timely processing of your prescription and services.