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Member Name: Member ID: Member DOB: Drug Name: Strength: Directions: Physician Name: Physician Phone #: Specialty: Physician Fax #: Pharmacy Name: Pharmacy Phone: Horizon NJ Health Dupilumab (DuPont)
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How to fill out physician fax pharmacy name
How to fill out physician fax pharmacy name
01
To fill out physician fax pharmacy name, follow these steps:
02
Start by writing the name of the physician who is sending the fax.
03
Next, write the fax number of the physician.
04
Then, write the full name of the pharmacy where the fax is being sent.
05
Finally, include the fax number of the pharmacy if it is known.
Who needs physician fax pharmacy name?
01
Physicians who are sending faxes containing prescription information or other medical-related documents to pharmacies need to fill out the physician fax pharmacy name section. This helps identify the sender and the intended recipient of the fax.
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