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Prescribe: HPC Specialty Pharmacy Mobile, AL 36602 NPI# 1174584544Phone: 8007579192 NABP# 0131893Fax to: 8558130583Midatech Direct Rx Form DesignationPrescriber Name NPI #Prescriber NameDesignationNPI
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01
To fill out the Midatech Direct RX form, follow these steps:
02
Start by providing your personal information, such as your name, date of birth, and contact details.
03
Specify the healthcare professional who is prescribing the medication to you. This includes their name, contact information, and their specialty.
04
Indicate the medication you need by providing its name, strength, and dosage form.
05
Include the quantity of medication you require and the directions for use.
06
If applicable, provide any additional information such as allergies, prior medications tried, or specific instructions.
07
Sign and date the form to certify that the information provided is accurate and complete.
08
Finally, submit the form according to the instructions given, either online or by fax/mail.
Who needs midatech direct rx form?
01
The Midatech Direct RX form is needed by individuals who require medication prescribed by a healthcare professional affiliated with Midatech Pharma. This form allows them to request the medication directly from Midatech for their specific needs.
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What is midatech direct rx form?
Midatech Direct RX form is a form used to request prescription medication directly from Midatech.
Who is required to file midatech direct rx form?
Patients who wish to receive prescription medication directly from Midatech are required to file the Midatech Direct RX form.
How to fill out midatech direct rx form?
To fill out the Midatech Direct RX form, patients need to provide their personal information, medical history, prescription details, and any other relevant information requested by Midatech.
What is the purpose of midatech direct rx form?
The purpose of the Midatech Direct RX form is to facilitate the process of requesting and receiving prescription medication directly from Midatech.
What information must be reported on midatech direct rx form?
The Midatech Direct RX form must include personal information, medical history, prescription details, and any other relevant information requested by Midatech.
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