Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. In the 'Patient Name' field, enter the full name of the person receiving the prescription. This information is critical for identification purposes.
3. In the 'Day Phone' and 'Evening Phone' fields, provide contact numbers where the patient can be reached. Ensure the format of the numbers is maintained.
4. Fill in the prescription details for 'Phantom Limb Pain Cream Formula.' Indicate quantities for both the 60gm and 120gm options based on your requirements.
5. In the 'Sig' section, provide the dosage instructions. Ensure the instructions specify how much to apply and the frequency of application.
6. The 'Refill' section should be filled out according to the prescription needs. Indicate the number of refills if necessary, or leave blank if not applicable.
7. In the 'Prescriber Signature' field, the prescribing professional must provide their signature. Their 'Name,' 'Address,' 'City,' 'State,' and 'Zip' must also be accurately filled out.
8. The 'State License' and 'DEA' fields are required for specific medications, such as . Ensure these details are provided accurately.
9. Lastly, include the prescriber's contact information, including 'Phone' and 'Fax,' to facilitate any necessary follow-ups.
10. Once all sections are completed, review the information for accuracy. You can then save changes, download, print, or share the completed form as needed.

Start completing your CA Apothecary Options Prescription Order Form online today.