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Get Green Shield Special Authorization 2020-2026
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How to fill out the Green Shield Special Authorization online
This guide aims to provide clear and supportive instructions for completing the Green Shield Special Authorization form online. By following these steps, users can ensure their requests for prescription drug coverage are submitted accurately and efficiently.
Follow the steps to complete the Green Shield Special Authorization form online.
- Press the 'Get Form' button to access the Special Authorization form and open it in your preferred editor.
- Begin by filling out Section 1, Patient Information. Include your surname, Green Shield I.D. number, employer name, first name, date of birth, telephone number, street address, city, province, and postal code.
- Sign and date the authorization section that grants permission for medical information to be shared with Green Shield Canada. If the patient is under the age of 14, the plan member's signature is required.
- Move to Section 2, Physician Information. Enter the physician's name, signature, street address, city, specialty, date, telephone number, province, postal code, and fax number.
- Proceed to Section 3, Drug Requested for Evaluation. Provide details regarding the product name, strength, dose, and duration of treatment. Indicate the injectable location of administration by checking one of the options.
- Include the diagnosis and previous therapeutic history related to the medical condition. Ensure to provide relevant lab results if applicable.
- Document any other coverage information, including whether coverage has been applied for, and the results of previous treatment, including prior medication details.
- Complete Section 4, Mailing Instructions, by ensuring the completed form and any original paid pharmacy receipts are prepared for submission.
- Choose your preferred submission method: return the form by mail to the specified address, or fax/email it to the provided contacts.
- Once everything is filled out accurately, save your changes and consider downloading or printing a copy for your records.
Complete your Green Shield Special Authorization form online today for efficient processing.
The special authorization process, such as the Green Shield Special Authorization, is designed to ensure that treatments meet insurance guidelines. This involves submitting detailed medical documentation to prove the necessity of the treatment. By following established protocols and using resources like uslegalforms, you can facilitate a smoother authorization experience.
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