Prescriber Order Forms

To begin the referral process, find the correct prescriber order form by therapy and product name in the list below. Then, fill in the required prescription and fax it to us at your local Care Management Center. If your therapy is not listed below, use this form or consider electronically prescribing the medication to us. Prescriptions must be sent from licensed prescribers, accompanied by the patient’s insurance information and in accordance with your state prescribing laws.

We are committed to providing extraordinary care for your patients.

Download

  • * Your email address will never be shared with anyone or used for marketing proposes.
  • This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Download

  • * Your email address will never be shared with anyone or used for marketing proposes.
  • This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

1.

Download

Download the PDFs you need from the list below.

2.

Fill, Print & Sign

Complete the forms online or by hand, print the completed form and sign the prescription.

3.

Fax Signed Forms

Fax your signed form to the patient’s nearest Option Care Health location

Find Location Near You