Get Us Bioservices Amerisourcebergen Rheumatology Referral Form (a-h) 2020-2025

Filling out the US Bioservices AmerisourceBergen Rheumatology Referral Form (A-H) online can seem daunting, but with the right guidance, you can complete it easily and accurately. This guide provides step-by-step instructions to help you navigate each section of the form seamlessly.

Follow the steps to successfully complete the referral form online.

1. Click the ‘Get Form’ button to access the referral form and open it for completion.
2. Enter the patient's home information in the designated fields, ensuring to include their last name, first name, phone numbers, and home address, along with the date of birth and social security number.
3. Fill in the patient's insurance information. Provide the details for both medical insurance and prescription insurance, including policy numbers and contact information.
4. Complete the prescriber information section by entering the prescriber's name, license number, NPI, DEA number, practice name, and contact details.
5. Document the diagnosis and clinical information thoroughly, including ICD-10 codes and details regarding any medications tried or failed, concurrent medications, and patient allergies.
6. In the prescription information section, specify the required medications, doses, directions, and any refills needed.
7. Ensure that the patient signs and dates the form in the designated space for the patient support programs.
8. Obtain the prescriber’s signature in the appropriate section, ensuring to follow the rules regarding signatures and dates.
9. After filling out all sections, review the form for accuracy, and once satisfied, save your changes, download or print the completed form for submission.

Complete your forms online today for a smoother referral process.