Keystone first form 2026

1. Click ‘Get Form’ to open the keystone first form in the editor.
2. Begin by entering the patient’s name and ID number in the designated fields. This information is crucial for identifying the patient.
3. Fill in the prescriber’s details, including name, specialty, phone number, fax number, license number, and address. Ensure accuracy to avoid any delays.
4. Input the dispensing pharmacy's name, phone number, and fax number. This allows for seamless communication regarding medication fulfillment.
5. Specify the medication name and strength requested along with directions for use. Clearly state the quantity requested and anticipated length of therapy.
6. Provide a diagnosis and list any preferred medications that have been tried previously, including their strength, frequency, and duration.
7. Add any additional rationale or relevant information that may assist in reviewing this prior authorization request.
8. Finally, ensure you sign and date the form before submitting it via fax or returning it to PerformRx at Keystone First.

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