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OPTIMA HEALTH COMMUNITY CARE AND OPTIMA FAMILY CARE (MEDICAID) PHARMACY PRIOR AUTHORIZATION/STEPPED REQUEST* Directions: The prescribing physician must sign and clearly print name (preprinted stamps

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How to fill out documents and forms for

1. Start by carefully reading the instructions provided with the document or form.
2. Gather all the necessary information and documents that are required to fill out the form.
3. Use a black or blue pen to fill out the form, unless specified otherwise.
4. Write legibly and neatly in the designated spaces provided.
5. Avoid errors by double-checking your entries before submitting the form.
6. If any sections or questions do not apply to you or are not applicable, mark them as N/A or leave them blank.
7. Sign and date the form, if required.
8. Make a copy of the completed form for your records before submitting it.

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