Visco precert form aetna 2026

1. Click ‘Get Form’ to open the visco precert form in the editor.
2. Begin with Section A, where you will enter patient information. Fill in the first and last name, date of birth, allergies, current weight, and contact details including phone and email.
3. Move to Section B for insurance information. Input the Aetna Member ID, group number, and indicate if there is other coverage by providing the necessary details.
4. In Section C, provide prescriber information. Include the prescriber's name, address, phone number, and relevant credentials such as NPI and state license numbers.
5. Proceed to Section D for dispensing provider information. Specify where the medication will be administered and include contact details for the provider.
6. Complete Section E by selecting the requested product from the list provided. Ensure all fields are filled accurately.
7. In Section F, indicate diagnosis information by entering primary ICD-9 codes and any additional codes as applicable.
8. Finally, fill out Section G with clinical information regarding treatment history and responses to previous therapies before signing in Section H.

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