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Patient Direct Mailing Shipment
Please fill out this PDF form prior to printing. DateInternal Use Online:Lot #:Address:City:
State:Zip:Telephone:Fax:Email:
Referring Doctor:
Comments:Checkmated of
Remittance:
(Select
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How to fill out patient direct mail-in shipment
How to fill out patient direct mail-in shipment
01
Gather all necessary medical documents and paperwork, including any prescriptions or referral forms.
02
Obtain a patient direct mail-in shipment package from the designated healthcare provider or pharmacy.
03
Carefully read and follow the instructions provided in the shipment package.
04
Fill out all required information on the patient direct mail-in shipment form, ensuring accuracy and completeness.
05
Attach all relevant documents, prescriptions, or referral forms as required.
06
Package the shipment securely, ensuring it is properly sealed and protected.
07
Affix the provided shipping label to the package, making sure it is clearly visible and legible.
08
Contact the designated shipping company or courier for pickup or drop-off instructions.
09
Schedule a pickup or drop off the package at the designated location.
10
Keep a copy of the shipment form and tracking information for reference and future tracking purposes.
Who needs patient direct mail-in shipment?
01
Patients who are unable to physically visit a healthcare provider or pharmacy.
02
Patients who require medication, medical supplies, or healthcare services delivered to their location.
03
Patients who have been advised by their healthcare provider to use the patient direct mail-in shipment option.
04
Patients who prefer the convenience and efficiency of receiving healthcare-related items through mail or courier services.
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