Keystone first prior auth forms 2026

1. Click ‘Get Form’ to open the Keystone First Prior Authorization Form in the editor.
2. Begin by entering the Patient Name and Date of Birth (DOB) in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the Patient ID Number, followed by the Physician's Name and Phone number. This section helps establish communication between healthcare providers.
4. Complete the Specialty and Fax fields, along with the Physician's License Number and Address. This information is necessary for verification purposes.
5. In the Medication Name and Strength Requested section, specify the medication along with its dosage. Include clear directions for use.
6. Indicate the Anticipated Length of Therapy by selecting an option: Days, 3 Months, or 6 Months.
7. Provide a detailed Diagnosis and list any Preferred Medications that have been tried previously, including their strength, frequency, and duration.
8. Finally, add any Rationale or additional information relevant to this prior authorization request before signing and dating the form.

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