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Home Phone Gender M F Date of Birth // Patient Name Alternate Email PLEASE ATTACH ALL PRIMARY AND SECONDARY INSURANCE INFORMATION CLINICAL INFORMATION Please send recent clinical notes current medications labs and tests to expedite the Prior Authorization. Diagnosis ICD-10 Height Weight lbs HCV Genotype Q80K Polymorphism Treatment Naive HCV RNA IU/mL Fibrosis Stage Non-Responder Partial Responder Compensated Responder/Relapser NS5A Polymorphism Yes No Co-Infected Patient HIV RNA copies/mL...
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01
Open the eprescribe application on your device.
02
Log in with your credentials.
03
Search for the patient in the database.
04
Choose the medication from the available options or manually enter a new one.
05
Enter the dosage, quantity, and any specific instructions.
06
Verify the patient's information and ensure accuracy.
07
Click on 'Submit' to send the prescription electronically to our pharmacy.
08
You will receive a confirmation once the prescription is successfully received.
09
The prescription will be processed and prepared for the patient's pickup or delivery.
10
Notify the patient once the prescription is ready for collection.

Who needs eprescribe to our pharmacy?

01
Doctors and healthcare professionals who want to send prescriptions electronically.
02
Patients who prefer the convenience of receiving their medications through an eprescription.
03
Individuals who require frequent medication refills and want to streamline the process.
04
Pharmacies that have partnered with our facility and accept eprescriptions.
05
Insurance companies and third-party payers interested in efficient prescription management.
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ePrescribe to our pharmacy is the electronic transmission of prescription information from prescriber to pharmacy.
All prescribers are required to file ePrescribe to your pharmacy in order to send electronic prescriptions.
ePrescribe to your pharmacy can be filled out using an electronic prescribing software or platform.
The purpose of ePrescribe to your pharmacy is to improve efficiency, accuracy, and safety in the prescription filling process.
ePrescribe to your pharmacy must include patient information, prescribed medication, dosage instructions, and prescriber details.
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