__________________________________________________ Patient First and Last Name A special service for employees of the University of Pennsylvania Health System with Caremark prescription benefits You know that as an employee of Penn you save the most money by filling your prescriptions — especially for those you take regularly — at our outpatient pharmacies. However, the hours or locations of our pharmacies may not be convenient for everyone. The Penn Medicine at Radnor outpatient pharmacy w.
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How to fill out the Penn Medicine Randor Pharmacy Mail Order Form online
This guide provides comprehensive instructions on how to effectively fill out the Penn Medicine Randor Pharmacy Mail Order Form online. It aims to support users in navigating the form's components accurately to ensure a smooth ordering process.
Follow the steps to complete your mail order form successfully.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the patient’s first and last name in the designated field at the top of the form.
- Provide the complete street address, city, state, and zip code to ensure proper delivery.
- Fill in the home phone number and birthdate of the patient in the respective fields.
- Input Caremark information including the ID number and group number accurately.
- List any existing prescriptions intended for refill. Record the Rx number and the medication name for each prescription as specified.
- In the comments section, indicate if there is a preference against generic substitutions for any medication.
- Complete the payment section by selecting a credit card type and entering the corresponding card number, expiration date, and security code.
- Sign the form to authorize the payment and confirm the order.
- Finally, review the completed form for accuracy, save changes, and prepare it for mailing along with your prescriptions in an envelope addressed to the specified location.
Complete your documents online to ensure a seamless pharmacy mail order experience.
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