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Enrollment Form and Prescription Information Complete and fax this form to 18007525896 For assistance or additional information, call 18778773536, Monday Friday, 8:00 am8:00 pm, ET 1. Patient Information2.

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1. To fill out the form completely, follow these steps:
2. Begin by reading through the instructions provided on the form to understand the requirements.
3. Use a pen or type directly into the digital form, whichever is applicable.
4. Provide accurate and complete information in each field or section of the form.
5. Double-check your entries for any mistakes or missing details.
6. If required, attach any supporting documents as mentioned in the instructions.
7. Review the filled-out form once again to ensure accuracy.
8. Once the form is complete, save a copy for your records.
9. Print the form and sign it, if necessary.
10. Locate a fax machine and ensure it is in working condition.
11. Dial the correct fax number of the receiver.
12. Carefully feed the printed form into the fax machine.
13. Wait for the confirmation receipt to ensure the successful transmission.
14. Keep a record of the confirmation receipt as a proof of sending.

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1. Individuals or organizations who require specific forms or documents to be filled out completely and submitted via fax.

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Complete and fax this refers to filling out a form or document completely and then sending it via fax to the intended recipient.

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To fill out complete and fax this, you will need to complete all required fields on the form or document accurately and legibly, then send it via fax to the designated fax number.

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The purpose of complete and fax this is to ensure that the recipient receives the necessary information or documentation in a timely manner.

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