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Get the free Illinois FHP New Prescription Order Form

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New Prescription Order Form Mail this form to: Primeval PO Box 650041 Dallas, TX 752650041 For added service: Visit www.MyPrimeMail.com or call 855.457.0174 TTY 711 Blame la pharmacy DE Primeval en
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How to fill out Illinois FHP new prescription:

01
Begin by obtaining the Illinois FHP new prescription form from a healthcare provider or pharmacist. This form can also be downloaded from the Illinois Department of Healthcare and Family Services website.
02
Provide your personal information, including your full name, date of birth, and address, in the designated sections of the form.
03
Fill in the details of the prescription, including the medication name, dosage, strength, and quantity.
04
Specify if any brand name substitution is allowed or if the prescription is to be dispensed as written.
05
Indicate whether the medication is for a brand-new prescription or a refill.
06
If it is a refill, provide the prescription number and the date of the original prescription.
07
If applicable, include any additional instructions or comments for the pharmacist.
08
Sign and date the form to certify the accuracy of the information provided.
09
Submit the completed Illinois FHP new prescription form to a participating pharmacy for processing.

Who needs the Illinois FHP new prescription:

01
Individuals enrolled in the Illinois Family Health Plan (FHP) who require medication prescribed by a healthcare provider.
02
Patients who need to obtain medications covered by the Illinois FHP insurance program.
03
Residents of Illinois who meet the eligibility criteria for enrollment in the Illinois Family Health Plan and require prescription medications for their healthcare needs.
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Illinois FHP New Prescription is a form required for prescribing certain medications under the Illinois Family Health Plan.
Health care providers are required to file Illinois FHP New Prescription when prescribing certain medications.
Illinois FHP New Prescription form must be filled out with the patient's information, medication prescribed, dosage, and healthcare provider's details.
The purpose of Illinois FHP New Prescription is to ensure safe prescribing and dispensing of medications covered under the Family Health Plan.
The Illinois FHP New Prescription must include patient's details, medication prescribed, dosage instructions, and healthcare provider's information.
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