Get the free Growth Hormone Enrollment Form - Anthem

Growth Hormone Enrollment Form Fax completed form to: Precision Rx Specialty Solutions Fax no. (800) 824-2642 Phone no. (800) 870-6419 Part I Patient Information Patient s last name First name Address

How to fill out growth hormone enrollment form

How to fill out growth hormone enrollment form:

1. Start by carefully reading the instructions provided on the form. Make sure you understand the requirements and any supporting documents that may be necessary.
2. Begin by filling out your personal information, such as your name, address, contact details, and date of birth. Provide accurate information to avoid any potential issues or delays.
3. Next, provide your medical history, including any pre-existing conditions, current medications, and any previous use of growth hormone. This information is crucial for the healthcare provider to assess your eligibility for growth hormone therapy.
4. If you have a healthcare provider prescribed growth hormone, include their contact information on the form. This allows the necessary communication between the healthcare provider and the pharmacy or insurance company.
5. If you are applying for insurance coverage or financial assistance for growth hormone therapy, provide the required insurance information or financial documents as requested. This helps determine your eligibility and coverage options.
6. Lastly, carefully review the completed form for any errors or missing information before submitting it. Double-check that you have signed and dated the form, if required.

Who needs growth hormone enrollment form?

1. Individuals who have been prescribed growth hormone therapy by their healthcare provider for various conditions such as growth hormone deficiency, Turner syndrome, Prader-Willi syndrome, short stature, or other medical conditions.
2. Those who are seeking insurance coverage or financial assistance for growth hormone therapy may also be required to fill out a growth hormone enrollment form.
3. The form is necessary for anyone who wants to initiate or continue growth hormone treatment and must provide required information to healthcare providers, pharmacies, or insurance agencies.

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