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OPTIMA HEALTH PLAN PHARMACY PRIOR AUTHORIZATION/STEPPED REQUEST* Directions: The prescribing physician must sign and clearly print name (preprinted stamps not valid) on this request. All other information
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How to fill out including phone and fax

How to fill out including phone and fax:
01
Begin by providing your contact information like your name, address, and email address as requested.
02
Look for separate fields or sections dedicated to phone and fax numbers. In these fields, enter your phone number and fax number respectively. Make sure to include the country code if necessary.
03
In case there is only one field available for contact numbers, you can enter both your phone and fax numbers together. For example, you can write "(Phone) 123-456-7890 / (Fax) 987-654-3210" or simply separate them with a slash "/" if no specific indication is given.
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Double-check your entries to ensure accuracy before submitting the form. Mistakes in phone or fax numbers could result in missed communications or difficulties in contact.
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What is including phone and fax?
Including phone and fax refers to providing contact information for a business such as telephone number and fax number.
Who is required to file including phone and fax?
All businesses are required to provide their contact information, including phone and fax numbers.
How to fill out including phone and fax?
You can fill out the phone and fax information by entering the appropriate numbers in the designated fields on the form.
What is the purpose of including phone and fax?
The purpose of including phone and fax numbers is to provide a way for customers and other businesses to contact the company.
What information must be reported on including phone and fax?
The information that must be reported includes the business's phone number and fax number.
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