Cataramaran Fax Order Form PDF Details

The Catamaran Fax Order Form serves as a critical tool in the streamlined facilitation of new prescription requests. Designed with both the member and prescriber in mind, it requires detailed information including the Cardholder ID, name, and all pertinent prescriber details such as the name, fax number, and necessary credentials like NPI and DEA numbers for specific classes of prescriptions. Emphasizing the need for comprehensive details, Step 1 and Step 2 guide the user through filling out patient information, drug dosage, quantity, and directions for use, including any refills up to three. Notably, the form stipulates explicit instructions for prescribing brand-name medications, where the prescriber must specifically state if a "brand necessary" or "brand medically necessary" product is needed. Additionally, the form highlights the importance of patient data, like date of birth and shipping address, ensuring the delivery is as efficient as the ordering process. Step 3 and Step 4 of the form specify the process for indicating the number of medications and underscore the critical nature of signing the prescription for validity before faxing it directly to Catamaran Home Delivery, all while adhering to strict confidentiality and compliance standards as dictated by HIPAA. This form not only serves to simplify the prescription process but also emphasizes the intricate balance between ensuring quick service delivery and maintaining the utmost standards of patient care and data protection.

QuestionAnswer
Form NameCataramaran Fax Order Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesfax form catamaran, form catamaran form, catamaran home intended, catamaran home delivery of texas

Form Preview Example

NEW PRESCRIPTION FAX FORM

Member Information

Cardholder ID #:

86125 *86125*

(Include all characters. Leave box blank for spaces.)

Cardholder name:

STEP 1 Complete all information below. Prescriber Information

Prescriber Name:

Fax#:

Not for CII prescriptions

STEP 2 Fill in or attach prescription below

Prescriber Name

Address

City, State, Zip

Write or stamp here

(Fill out one form for each Rx)

Patient Name: ___________________________________

Drug:

Strength: ____________________

Quantity: ____________________

Directions:

Refills: ________(up to 3 refills)

X

Date: / /

 

(Stamps are not accepted. Signature required.)

In order for a brand name product to be dispensed, the prescriber must handwrite "brand necessary" or "brand medically necessary" in the space below.

NPI #:

(NPI required for all prescriptions)

DEA #:

 

(DEA required for CIII-CV prescriptions)

Telephone #:

-

-

Patient Information

Date of birth:

Telephone #:

Ship to address:

STEP 3

Indicate number of medications on this page.

Have questions?

Call 1 866 834-0449.

For reporting allergies or

medical conditions, press option 5

(Monday-Friday 9:00 am - 8:00 pm Eastern.)

STEP 4

Sign this prescription and fax to:

1 866 996-4921

¨Fax from the prescriber's secure fax line.

¨Do not fax with a cover sheet.

¨Incomplete forms will cause a delay in processing.

When applicable PRINT Supervising Physician name here é

*86125*

Confidentiality Notice: This communication and any attachments are intended solely for the use of the addressee named above and contains confidential and legally privileged information. If you are not the intended recipient, any dissemination, distribution or copying is strictly prohibited. If you received this communication in error, please notify Catamaran Home Delivery by fax or phone immediately. Catamaran Home Delivery facsimile machines are secure and in compliance with HIPAA privacy standards.

The provision of the information requested in this form is for your patient's benefit. Catamaran Home Delivery does not compensate for completing this form.

How to Edit Cataramaran Fax Order Form Online for Free

We were developing our PDF editor with the notion of allowing it to be as quick to work with as it can be. That's the reason the procedure of filling in the brand direct health new prescription fax form will be smooth perform all of these steps:

Step 1: Search for the button "Get Form Here" on the following webpage and hit it.

Step 2: Now you will be within the file edit page. You can include, alter, highlight, check, cross, add or delete areas or words.

You'll have to provide the following information in order to fill out the file:

stage 1 to completing form catamaran form

Include the asked particulars in the Write or stamp here, Fill out one form for each Rx, Patient Name, STEP, Drug, Indicate number of medications on, Strength, Quantity, Directions, Refills, up to refills, Date, Stamps are not accepted Signature, When applicable PRINT Supervising, and Have questions Call segment.

Finishing form catamaran form stage 2

The application will ask for more information with the intention to effortlessly complete the area When applicable PRINT Supervising, Confidentiality Notice This, and The provision of the information.

Filling out form catamaran form part 3

Step 3: As soon as you click on the Done button, the finished document is conveniently transferable to any kind of of your devices. Or alternatively, you may send it by means of email.

Step 4: You should generate as many duplicates of your file as you can to stay away from possible troubles.

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