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FIELDS CARE MEDICATION REQUEST FORM FOR ANTIHEPATITIS C (CV) AGENTS, 10/1/2018 Copies of this form and additional information available at http://www.fideliscare.org/pharmacyComplete this form and

How to fill out fidelis care medication request

How to fill out fidelis care medication request

1. To fill out a Fidelis Care medication request, follow these steps:
2. Start by obtaining the necessary forms. You can request the medication request form from Fidelis Care directly or download it from their website.
3. Fill out the patient information section accurately. Provide the required details such as name, address, date of birth, phone number, and Fidelis Care ID number.
4. Provide the prescribing physician's information. This includes their name, address, phone number, and DEA number.
5. Specify the medication details. Write the name of the medication, strength, dosage instructions, and the reason for the prescription.
6. Attach any supporting documents if necessary. This can include medical records, test results, or a letter of medical necessity from the prescribing physician.
7. Review the completed form to ensure all information is accurate and legible.
8. Submit the medication request form by mail or fax to the designated Fidelis Care address or fax number.
9. Wait for the approval or denial notification from Fidelis Care. They will inform you about the decision regarding your medication request.
10. In case of approval, you will receive the medication through Fidelis Care's designated pharmacy or mail order service.
11. If the request is denied, you may consider contacting Fidelis Care to understand the reason and explore alternative options if available.

Who needs fidelis care medication request?

1. Anyone who is a member of Fidelis Care and requires a medication that is not readily available over-the-counter or requires a doctor's prescription may need to fill out a Fidelis Care medication request. This applies to individuals who have health insurance coverage through Fidelis Care and need specific medications that may not be covered automatically under their plan.

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What is fidelis care medication request?

Fidelis Care medication request is a form used to request coverage for prescription medications under Fidelis Care health insurance plan.

Who is required to file fidelis care medication request?

Members of Fidelis Care health insurance plan who need coverage for prescription medications are required to file the medication request form.

How to fill out fidelis care medication request?

To fill out the Fidelis Care medication request form, you need to provide information about the prescribed medication, dosage, prescribing physician, and reasons for the prescription.

What is the purpose of fidelis care medication request?

The purpose of the Fidelis Care medication request is to ensure that members receive coverage for necessary prescription medications as part of their health insurance benefits.

What information must be reported on fidelis care medication request?

Information such as the name of the prescribed medication, dosage, prescribing physician, medical necessity, and any other relevant details must be reported on the Fidelis Care medication request form.