Il stlnesew home order 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your member information. Fill in your Member ID, Group, and email address for notifications regarding your prescription status.
3. Provide your name and complete address, including city, state, and ZIP code. If you have a new shipping address, include that as well.
4. In the Patient/Doctor Information section, fill out details for each patient with prescriptions. Include their first name, last name, birth date, sex, and relationship to the member.
5. For each doctor associated with the prescriptions, provide their last name and first initial along with their phone number.
6. Complete the payment section by selecting your preferred payment method (e-check, credit card, etc.) and providing necessary details like card number and expiration date.
7. Review all information for accuracy before submitting. Ensure that you follow mailing instructions provided on the back of the form.

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