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Pharmacy New Prescription YOUR PATIENT WOULD LIKE TO RECEIVE THEIR PRESCRIPTION MEDICATION FROM MEDICO. 34202 Please complete ALL information below. Questions? Call 1.888.EASYRX1 Prescriber Information
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Fax this page only is a document that needs to be faxed without any additional pages or attachments.
Only individuals or entities specifically instructed to do so by the recipient of the fax.
Simply include the required information on the designated page and then fax it to the recipient.
The purpose is to ensure that the recipient receives only the designated information without any extra pages or attachments.
Only the information requested by the recipient should be reported on fax this page only.
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