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HSRX116SHARP HEALTH PLAN MEDICARE ADVANTAGE POLICY AND PROCEDURE Product Line (check all that apply):Title: Part D Coverage Determination Policy and ProcedureGroup HMO Individual HMO PPO POS Medicare

How to fill out hs-rx-116

How to fill out hs-rx-116

1. Read the instructions carefully before starting to fill out the hs-rx-116 form.
2. Gather all the required information and documents such as personal details, prescription details, and insurance information.
3. Start by filling out the patient's personal information, including their name, address, contact details, and date of birth.
4. Provide the necessary details regarding the prescription, such as the name of the medication, dosage, and frequency.
5. If applicable, include any specific instructions or notes from the prescribing doctor.
6. Fill in the insurance information if required, including the insurance company name and policy number.
7. Review the completed form for any errors or missing information.
8. Sign and date the form as required.
9. Submit the filled-out hs-rx-116 form to the appropriate authority for processing.

Who needs hs-rx-116?

1. The hs-rx-116 form is required by individuals who are seeking prescription medication.
2. Patients who need to have their prescription filled or refilled may need to fill out the hs-rx-116 form.
3. Healthcare providers and pharmacies may also need this form for record-keeping and verification purposes.

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