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Print Form Reset Form MAGELLAN COMPLETE CARE Prior Authorization VIEIRA PAK (dasabuvir + ombitasvir/paritaprevir/ritonavir) Note: Form must be completed in full. An incomplete form may be returned.
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How to fill out a prescriber fax number:

01
Locate the section on the form or document that requires the prescriber's fax number. This is usually found in the contact information section or a specific section designated for prescriber information.
02
Ensure you have the correct fax number for the prescriber. This can typically be obtained from the prescription or by contacting the prescriber's office directly.
03
Enter the prescriber's fax number in the designated field on the form. This may be a blank space, a box to enter the number, or a specific format to follow. Make sure to accurately input the digits without any errors.
04
After entering the fax number, double-check for any mistakes or typos. It is crucial to provide the correct fax number to ensure the document reaches the intended recipient.
05
If required, provide any additional information related to the fax transmission, such as a cover sheet or relevant instructions. This may be necessary if there are specific details or attachments that need to accompany the fax.
06
Once you have filled out the prescriber fax number and any additional necessary information, review the entire form for accuracy and completeness before submitting it.

Who needs a prescriber fax number:

01
Healthcare professionals: Prescriber fax numbers are commonly used in medical settings by healthcare professionals such as doctors, nurse practitioners, and physician assistants. They use fax machines to send prescriptions, medical records, referrals, and other important documents to pharmacies, specialists, and healthcare facilities.
02
Pharmacies: Pharmacies rely on prescriber fax numbers to receive prescriptions directly from the prescribers. This allows for efficient communication and ensures that medications are dispensed accurately and in a timely manner.
03
Healthcare institutions and facilities: Hospitals, clinics, and other healthcare institutions often require prescriber fax numbers to facilitate the transmission of important medical information, such as lab results, imaging reports, or treatment plans. This allows for seamless communication between different healthcare providers involved in a patient's care.
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Prescriber fax number is the fax number of the healthcare provider or prescriber.
Healthcare providers or prescribers are required to file their fax number.
Prescriber fax number can be filled out on the appropriate forms provided by the governing agency or online portals.
The purpose of prescriber fax number is to provide a direct contact method for sending prescriptions or other medical information.
The prescriber fax number should include the area code, phone number, and any extensions or additional contact information.
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