Get 800 314 6223

Filling out the 800 314 6223 form is an essential step in the prior authorization process for . This guide provides a clear, step-by-step overview to ensure you complete the form accurately and efficiently, enhancing your chances of a successful authorization request.

Follow the steps to fill out the form correctly.

1. Use the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the patient’s name in the format of Last, First, and Middle Initial.
3. Input the patient's date of birth using the Month, Day, Year format.
4. Fill in the patient’s ID number and phone number, ensuring clarity in every entry.
5. Provide the physician’s name and fax number; please be sure to print these clearly.
6. Include the pharmacy’s phone and fax number for further communication.
7. Specify the physician’s specialty and indicate whether they are the patient’s primary care physician.
8. State the date the medication is needed and diagnose the patient's condition.
9. Enter the ICD-9 code, followed by the requested medication, which in this case is .
10. Detail the strength of the medication and the instructions for use.
11. Indicate where the medication will be administered, including options like the doctor's office or dialysis center.
12. Specify the quantity needed monthly and the duration of treatment.
13. Answer the questions about the patient's treatment initiation and provide Hct & Hgb levels with dates.
14. Confirm if the patient has adequate iron stores and if they are currently receiving supplemental iron.
15. Finish by signing the form with the physician’s signature and date.
16. Review the completed form for clarity and completeness before submitting.
17. Once all fields are filled out accurately, save your changes, download, print, or share the form as needed.

Begin filling out your authorization request online today.