Follow the steps to successfully complete the enrollment form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the community name and room number as applicable. Enter the move-in date and indicate if this is for a future admission.
3. Proceed to the Resident Information section. Fill in the last name, first name, middle initial, date of birth, and phone number. Select the gender and provide the street address for billing, along with the city and zip code.
4. Enter the social security number and, if applicable, the Medicare ID number. Indicate whether Omnicare is the resident's primary pharmacy or if another emergency pharmacy is required.
5. Answer questions regarding the management of medications and financial responsibilities. Specify if the resident is self-administering medications and whether they are responsible for the pharmacy services bill.
6. If there is a financially responsible party other than the resident, complete their information, including last name, first name, email, phone number, billing address, city, state, and zip code.
7. List any individuals involved in the resident’s healthcare, along with their contact information. Check relevant options regarding their relationship to the resident.
8. Indicate if the resident has prescription insurance coverage and provide details for each applicable pay source.
9. Review the terms and conditions of Omnicare's prescription medication service. Acknowledge and sign by entering the resident's or representative’s signature, printed name, and date.
10. Once all information is completed, save any changes, and utilize available options to download, print, or share the form as required.

Complete the Omnicare Resident Pharmacy Enrollment Form online today to ensure a smooth enrollment process.