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PLEASE DO NOT FAX THIS PAGE BACKDATING ASSISTANCE PROGRAM INSTRUCTIONS Application must be completed, signed and dated by both the Healthcare Professional and Patient. Patient must submit Proof of
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Start by receiving the document that needs to be filled out.
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Read the instructions or guidelines provided along with the document.
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Identify if the document specifically states not to be faxed.
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Individuals who are required to fill out a specific document.
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What is please do not fax?
Please do not fax is a notice requesting that information not be sent via fax.
Who is required to file please do not fax?
Anyone who does not want information to be sent via fax is required to file please do not fax.
How to fill out please do not fax?
Please fill out the form provided with your name, contact information, and a statement requesting that information not be faxed.
What is the purpose of please do not fax?
The purpose of please do not fax is to ensure that sensitive information is not transmitted via fax.
What information must be reported on please do not fax?
You must report your name, contact information, and the request to not send information via fax on please do not fax.
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