Fax-Form-Hypercholesterolemia-Cardiology- 2025

1. Click ‘Get Form’ to open the Fax-Form-Hypercholesterolemia-Cardiology in our editor.
2. Begin by entering the 'Patient Information' section. Fill in the patient's name, date of birth, and contact details accurately.
3. Next, complete the 'Prescriber Information' section. Include the prescriber's name, address, phone number, and DEA number.
4. In the 'Insurance Information' section, attach copies of both sides of the insurance card and fill in all relevant fields for primary and secondary insurance.
5. Proceed to the 'Patient Diagnosis/Clinical Information' section. Indicate any medications prescribed and their dosages as well as any relevant clinical information.
6. Fill out the 'Prescription Information' section with details about prescribed medications, including dosage and administration instructions.
7. Finally, ensure that you sign and date the form before submitting it via fax to ensure compliance with all requirements.

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