Get the free abbvie lupron order form

Address: 1 North Waukegan Road, AP5 NE, D-LP90 North Chicago, IL 60064 Bringing you DEPOT-PED (acetate for depot suspension) Phone: Fax: (888) 857-0668 (800) 266-2065 THIS FORM IS FOR REQUESTING THE

How to fill out abbvie lupron order form

How to fill out abbvie lupron order form:

1. Start by downloading the abbvie lupron order form from the official website or obtain a copy from your healthcare provider.
2. Read the instructions carefully and gather all the necessary information required for filling out the form, such as your personal details, healthcare provider information, prescription details, and any other required information.
3. Begin by entering your personal information accurately, including your full name, date of birth, address, and contact details.
4. Provide your healthcare provider's information, including their name, address, and contact details. You may also need to include their license number or any other relevant information.
5. Enter the specifics of your prescription, such as the medication name (Lupron), dosage, frequency, and duration of treatment.
6. If applicable, provide any insurance or billing details, including your insurance ID number, group number, and any other relevant information.
7. Carefully review all the information you have entered to ensure its accuracy and completeness.
8. Sign and date the form at the designated space, acknowledging that all the information provided is true and accurate to the best of your knowledge.
9. Make a copy of the completed form for your records before submitting it to your healthcare provider or the designated abbvie lupron ordering channel.

Who needs abbvie lupron order form:

1. Patients who have been prescribed Lupron by their healthcare provider.
2. Healthcare professionals who need to order Lupron on behalf of their patients.
3. Pharmacies or medical facilities that stock and dispense Lupron.

People Also Ask about

Does Lupron require prior authorization?

Prior authorization is required for Lupron Depot — Pediatric. Payment will be considered for patients when the following is met: 1. Patient has a diagnosis of central precocious puberty (CPP).

How can I get Lupron?

You cannot fill this prescription in a regular pharmacy. Your doctor, hospital, or clinic will provide this medication. This drug is likely to be covered under your medical benefit if you have insurance.

What is CPT J9217 used for?

HCPCS code J9217 Leuprolide acetate (for depot suspension), 7.5 mg may be used when the drug is used for a chemotherapeutic purpose, and the IM administration would be reported with CPT® code 96402 Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic.

Do you need a prescription for Lupron?

Advanced Prostate Cancer LUPRON DEPOT is a prescription medication that must be administered in your doctor's office.

Where do I get Lupron?

LUPRON DEPOT is given at your doctor's office LUPRON DEPOT is administered as an intramuscular injection by a healthcare professional at your doctor's office.

How to order Lupron?

To order LUPRON DEPOT directly from AbbVie, call Customer Service at 1-800-621-1020.

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What is abbvie lupron order form?

The AbbVie Lupron order form is a document used by healthcare providers to prescribe and order Lupron, a medication used to treat conditions related to hormone regulation, such as certain cancers and endometriosis.

Who is required to file abbvie lupron order form?

Healthcare providers, including physicians and clinic administrators, who are prescribing Lupron for their patients are required to file the AbbVie Lupron order form.

How to fill out abbvie lupron order form?

To fill out the AbbVie Lupron order form, healthcare providers need to provide patient information, dosage instructions, and provider details, ensuring all required fields are accurately completed.

What is the purpose of abbvie lupron order form?

The purpose of the AbbVie Lupron order form is to facilitate the proper prescription and distribution of Lupron to patients, allowing for accurate tracking and management of medication usage.

What information must be reported on abbvie lupron order form?

The information that must be reported on the AbbVie Lupron order form includes patient name, date of birth, prescription details, dosage, treatment duration, healthcare provider's information, and any specific instructions related to the medication.