Get the free CIGNA Tel-Drug Prescription Order Form - pace

This form is used to request new and refill prescription medications from CIGNA Tel-Drug. It includes sections for insurance information, allergies, shipping methods, payment methods, and prescription

How to fill out cigna tel-drug prescription order

How to fill out CIGNA Tel-Drug Prescription Order Form

1. Obtain the CIGNA Tel-Drug Prescription Order Form from the CIGNA website or your healthcare provider.
2. Fill out the patient's personal information including name, date of birth, and insurance details.
3. Provide the prescribing physician's information, including name, contact number, and signature.
4. List the medication requested, including the dosage and quantity needed.
5. Include any necessary clinical information or diagnosis supporting the prescription.
6. Indicate the preferred pharmacy for medication delivery, if applicable.
7. Sign and date the form to ensure its validity.
8. Submit the completed form via fax, mail, or through your healthcare provider, following the submission guidelines.

Who needs CIGNA Tel-Drug Prescription Order Form?

1. Patients with CIGNA health insurance who require medications not available at retail pharmacies.
2. Individuals with chronic conditions needing maintenance medications delivered directly to their home.
3. Healthcare providers who are prescribing long-term medications for their patients.

For pdfFiller’s FAQs

What is CIGNA Tel-Drug Prescription Order Form?

The CIGNA Tel-Drug Prescription Order Form is a document used to facilitate the ordering of prescription medications through CIGNA's telephonic pharmacy service.

Who is required to file CIGNA Tel-Drug Prescription Order Form?

The form is typically required to be filled out by healthcare providers, such as doctors or nurse practitioners, who are prescribing medications for patients covered by CIGNA.

How to fill out CIGNA Tel-Drug Prescription Order Form?

To fill out the form, the prescriber needs to provide patient information, medication details, dosage instructions, and their own contact information, ensuring all required fields are completed accurately.

What is the purpose of CIGNA Tel-Drug Prescription Order Form?

The purpose of the form is to streamline the prescription ordering process for patients, ensuring they receive their medications in a timely manner while also complying with CIGNA's policies.

What information must be reported on CIGNA Tel-Drug Prescription Order Form?

The form must include the patient's name, date of birth, medication name, dosage, quantity, prescribing physician's information, and any special instructions related to the prescription.