OptumRx, on behalf of itself and affiliated companies, uses this form to get your permission to use 2025

Get Form
OptumRx, on behalf of itself and affiliated companies, uses this form to get your permission to use  Preview on Page 1

Here's how it works

01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

The best way to change OptumRx, on behalf of itself and affiliated companies, uses this form to get your permission to use online

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2

With DocHub, making changes to your documentation takes only a few simple clicks. Follow these quick steps to change the PDF OptumRx, on behalf of itself and affiliated companies, uses this form to get your permission to use online for free:

  1. Sign up and log in to your account. Log in to the editor with your credentials or click Create free account to evaluate the tool’s functionality.
  2. Add the OptumRx, on behalf of itself and affiliated companies, uses this form to get your permission to use for editing. Click the New Document button above, then drag and drop the sample to the upload area, import it from the cloud, or using a link.
  3. Adjust your template. Make any changes needed: add text and pictures to your OptumRx, on behalf of itself and affiliated companies, uses this form to get your permission to use , highlight information that matters, remove sections of content and substitute them with new ones, and add symbols, checkmarks, and fields for filling out.
  4. Complete redacting the template. Save the updated document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is very easy to use and effective. Try it out now!

See more OptumRx, on behalf of itself and affiliated companies, uses this form to get your permission to use versions

We've got more versions of the OptumRx, on behalf of itself and affiliated companies, uses this form to get your permission to use form. Select the right OptumRx, on behalf of itself and affiliated companies, uses this form to get your permission to use version from the list and start editing it straight away!
Versions Form popularity Fillable & printable
2020 4.8 Satisfied (127 Votes)
2018 4.3 Satisfied (52 Votes)
2016 4.3 Satisfied (46 Votes)
be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Who is Optum Rx? Optum Rx is a pharmacy benefit manager serving more than 65 million members.
Just sign in to your account and click on Pharmacy. From the Pharmacy page, click on Prescription Center and then select the Prescription History tab. On this page, youll see a detailed prescription history, including information on refills, date of last fill and amount paid. You also can print prescription records.
For Optum Rx members Call 1-800-356-3477 for 24/7 customer support, including questions about Optum Home Delivery Pharmacy.
Call 1-888-423-1079, TTY 711. Fill out our medical records release form and fax it to 1-920-593-3029 or mail it to the address on the bottom of the form. Requests can take up to 15 business days. If you need records quickly, please indicate that on the form.
If you need a list of the prescriptions you filled through OptumRx, you can view and print this information from your online account at .optumrx.com by logging in and selecting Claims History or by contacting customer service at the telephone number located on your health or pharmacy benefit plan ID card.