Get Health Systems Quality Assurance - Washington State Department...

This guide provides comprehensive instructions on how to complete the Health Systems Quality Assurance form online. By following these detailed steps, you will ensure that your submission is accurate and compliant with Washington state requirements.

Follow the steps to fill out the form correctly

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Fill in the prescriber’s name at the appropriate section of the form. Ensure that the name is clearly written and matches the official documents.
3. If applicable, include the clinic name in the designated area. This helps identify the practice context for the prescription.
4. Enter the practice site address accurately to ensure correct communication and validation.
5. Provide a valid phone number for the clinic or prescriber, enabling easy contact if needed.
6. Indicate whether substitution is permitted or if it should be dispensed as written, using the respective fields provided.
7. Fill in the date of issue for the prescription. This field is crucial for tracking and validity.
8. Complete the patient’s name and address accurately to ensure the prescription is issued to the right individual.
9. Include all details for the drug prescribed, such as its name, strength, dosage form, and the quantity prescribed.
10. Provide clear directions for use to facilitate optimal medication adherence.
11. Specify the number of refills authorized, if any, in the respective area of the form.
12. Add the manual signature of the prescriber in the designated area, ensuring authenticity.
13. Verify all filled fields for accuracy and completeness before finalizing your document.
14. Once the form is complete, you can save changes, download, print, or share it as necessary.

Begin your online submission process by filling out the Health Systems Quality Assurance form today!