Follow the steps to complete the IL 6000 IL ADHD 0808 form online

1. Click the ‘Get Form’ button to access the IL 6000 IL ADHD 0808 document and ensure it opens in your online editor.
2. Fill in today's date at the top of the form to indicate when the request is being made.
3. Provide patient information by entering the patient's first name, last name, full address, date of birth in mm/dd/yyyy format, and telephone number.
4. Input the insurance information, including the Blue Cross Blue Shield ID number and group number.
5. Complete the physician and clinic information section. Enter the prescriber's full name, their National Provider Identifier (NPI) number, specialty, clinic name, full address, telephone number, the contact name, and the secure fax number.
6. Attach any necessary additional documentation that should be considered with the request.
7. In the diagnosis section, provide the ICD-9 code along with its description.
8. List the medication requested, its strength, dosing schedule, and the quantity per month.
9. Indicate whether the patient is currently receiving treatment with the requested medication by selecting 'Yes' or 'No'. If ‘Yes’, specify when the treatment started.
10. Provide detailed reasons for selecting the requested medication over alternatives, including any contraindications, allergies, or adverse drug reactions.
11. List all other medications the patient is currently taking for the diagnosis.
12. Document any other medications the patient has previously tried and failed, specifying if they were brand-name, generic, or over-the-counter.
13. Once all fields are completed, review the form for accuracy, then save any changes, download or print the form, and prepare to fax or mail it to the specified address of Blue Cross and Blue Shield of Illinois.

Complete your IL 6000 IL ADHD 0808 form online today to ensure a timely preauthorization process.