New prescription physician fax form

Use this form to order a new mail service prescription by fax from the prescriber's office


Mail order prescription physician fax form

Before you send us a prescription and to minimize any delays or outreach…

  • Verify with your patient OptumRx is their home delivery pharmacy
  • Verify the medication is covered by your patient’s health care plan or if it will require a prior authorization
  • Verify prescription medication name, formulation, strength, directions, quantity, and refills are complete
  • Verify all prescriptions for diabetic supplies are coordinated and provide specific brand and directions (i.e. maximum times a patient is to test daily)
  • Verify collaborating / supervising physician information is included as required by your state for midlevel practitioners

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