2020 multiple-2026

1. Click ‘Get Form’ to open the 2020 multiple in the editor.
2. Begin by filling out the Physician Information section. Enter the Physician Name, Specialty, and DEA, NPI or TIN. Ensure all asterisked (*) fields are completed for privacy compliance.
3. Next, complete the Patient Information section. Fill in the Patient Name, Cigna ID, Street Address, City, State, Zip Code, Date of Birth, and Phone Number.
4. Indicate the urgency of the request by selecting either 'Standard' or 'Urgent'. If urgent, confirm that applying standard review time may jeopardize health.
5. In the Medication Requested section, select from the list of medications. Specify Dose and Quantity as well as Duration of Therapy and Frequency of Administration.
6. Complete any additional sections regarding previous therapies and clinical information as required. Review all entries for accuracy before submission.

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