Get the free General Medication Request Form - Aetna

Medication Request Customer Service: 1-866-782-2779 (1-866-782-ASRX) Aetna Specialty Pharmacy 503 Support Lane Orlando, FL 32809 www.AetnaSpecialtyPharmacy.com Fax Order Submission: 1-866-329-2779

How to fill out general medication request form

1. To fill out a general medication request form, start by obtaining the form from the appropriate healthcare provider or institution. This may involve visiting a doctor's office, pharmacy, or hospital, or accessing the form online.
2. Begin by carefully reading the instructions provided on the form. These instructions will typically outline the information required and any specific guidelines for filling out the form accurately.
3. Fill in your personal details accurately, including your full name, date of birth, contact information, and any relevant identification numbers such as your patient or insurance number.
4. Provide information about the medication being requested. This may include the name of the medication, the prescribed dosage, and the frequency of use. If the medication has any specific instructions, such as taking it with food or at a particular time of day, make sure to include these details as well.
5. If necessary, provide information about your medical history or any existing conditions that may be relevant to the medication request. This could include known allergies, previous adverse reactions to medications, or current medications you are taking that may interact with the requested medication.
6. If the medication request requires approval from a healthcare provider, ensure that any necessary sections for their signature or approval are completed. This may involve contacting your doctor to request their authorization before submitting the form.

Who needs a general medication request form?

1. Patients who require a new or refill prescription for a medication not available over the counter may need to fill out a general medication request form. This includes individuals with chronic conditions, acute illnesses or infections, or those undergoing specific medical treatments.
2. The form may also be necessary for healthcare providers and institutions to track and monitor medication use, prevent misuse or abuse of controlled substances, and ensure patient safety and proper medication management.
3. Additionally, insurance companies or healthcare administrators may require the completion of a general medication request form for reimbursement or coverage purposes, particularly for expensive or specialized medications.

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