Kroger Specialty Pharmacy Gastroenterology Referral Form 2020-2025 free printable template

Gastroenterology New Orleans, LA toll-free 888.355.4191 toll-free fax 888.355.4192 krogerspecialtypharmacy.com Date: Need By Date: Ship To: Patient Office Other Fax Copy: Rx Card Front/Back Clinical

How to fill out Kroger Specialty Pharmacy Gastroenterology Referral Form

How to fill out Kroger Specialty Pharmacy Gastroenterology Referral Form

1. Start by downloading the Kroger Specialty Pharmacy Gastroenterology Referral Form from the official website or obtaining a hard copy from your healthcare provider.
2. Fill in the patient's personal information, including their full name, date of birth, and contact details.
3. Provide the patient's insurance information, including the provider's name, policy number, and group number.
4. Indicate the reason for the referral by selecting the appropriate options or describing the patient's condition in detail.
5. Include any relevant medical history or prior treatment details that might assist the gastroenterology specialist.
6. Add the referring physician's details, including their name, contact information, and NPI number.
7. Sign and date the form to confirm the accuracy of the information provided.
8. Submit the completed form via fax or mail to the designated Kroger Specialty Pharmacy office.

Who needs Kroger Specialty Pharmacy Gastroenterology Referral Form?

1. Patients who require specialized gastroenterological care or therapy.
2. Healthcare providers who are referring patients to a gastroenterology specialist.
3. Insurance companies that need a formal referral for authorization purposes.

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What is Kroger Specialty Pharmacy Gastroenterology Referral Form?

The Kroger Specialty Pharmacy Gastroenterology Referral Form is a document used to refer patients to gastroenterology services at Kroger Specialty Pharmacy for specialized medication management and treatment.

Who is required to file Kroger Specialty Pharmacy Gastroenterology Referral Form?

Healthcare providers, such as physicians and nurse practitioners, are required to file the Kroger Specialty Pharmacy Gastroenterology Referral Form when referring patients for gastroenterology specialty services.

How to fill out Kroger Specialty Pharmacy Gastroenterology Referral Form?

To fill out the Kroger Specialty Pharmacy Gastroenterology Referral Form, complete all required fields, including patient information, referral reason, provider details, and any relevant medical history or medication information.

What is the purpose of Kroger Specialty Pharmacy Gastroenterology Referral Form?

The purpose of the Kroger Specialty Pharmacy Gastroenterology Referral Form is to facilitate the referral process for patients needing specialized gastroenterology care and to ensure that all necessary information is collected for effective treatment.

What information must be reported on Kroger Specialty Pharmacy Gastroenterology Referral Form?

The information that must be reported on the Kroger Specialty Pharmacy Gastroenterology Referral Form includes patient demographics, the reason for referral, relevant medical history, current medications, and provider contact information.