Follow the steps to complete the Medco Pharmacy New Prescription Form.

1. Click ‘Get Form’ button to obtain the form and open it in your selected editor.
2. Begin by providing prescriber information. Enter the prescriber's name, DEA number (if applicable for CIII-CV medications), secure fax number, and NPI.
3. Next, move to the member information section. Fill in the member number, ensuring to include all characters and leaving box blank for any spaces. Enter the member's name as it appears on their card.
4. In the patient information section, provide the patient’s name, date of birth, and contact telephone number.
5. Fill in the prescription information by completing or attaching the prescription details, including medication name, dosage, and instructions. Specify the shipping address for the medications.
6. Indicate any allergies the patient may have by checking the relevant boxes or writing down other allergies in the provided space.
7. List any medical conditions that may be relevant to the prescription by checking the appropriate boxes.
8. Finally, return to the final section. Fill in prescriber name, address, city, state, and zip code. Include telephone number, issue date, and specify the number of refills.
9. Ensure the prescriber signs the form, marking either 'substitution permissible' or 'dispense as written' as applicable. Note that signature stamps are not acceptable.
10. Fax this completed page only to the number provided (1 800 837-0959) without a cover sheet. Remember, Medco cannot accept CII prescriptions via fax.

Complete the Medco Pharmacy New Prescription Form online today for quick and efficient processing.