Order forms for express scripts 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Prescriber Information section. Enter the Prescriber Name, DEA Number (if applicable), Fax Number, and NPI Number.
3. Next, complete the Member Information section. Input the Prescription Drug Card Member Number and Member Name (Card Holder).
4. In the Patient Information section, provide the Patient Name and Date of Birth. Include any allergies and medical conditions as necessary.
5. Fill in the prescription details including Drug, Strength, Quantity, Directions, and Refills. Ensure all fields are completed accurately.
6. Finally, sign and date the form where indicated. Remember that stamps are not accepted; a handwritten signature is required.

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