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How to use or fill out express scripts prior authorization form for 2011
- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient’s last name and ID number in the designated fields. This information is crucial for identifying the patient.
- Fill in the primary diagnosis and ensure that you provide accurate details about the patient's condition.
- Next, complete the prescriber information section, including their name, DEA/NPI number, phone number, and fax number. This ensures that communication can be established easily.
- Indicate which drug and strength is being requested by checking the appropriate boxes for Nuvigil or Provigil.
- Provide directions for use and complete the clinical assessment questions thoroughly to support the prior authorization request.
- Finally, have the prescriber sign and date the form before submitting it as instructed at the top of the document.
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