Homepage Fill Out Your Cataramaran Fax Order Form
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The Cataramaran Fax Order form plays a crucial role in facilitating the prescription process for patients in need of medication. It begins by gathering essential member information, such as the Cardholder ID and name, which are required for verification purposes. Following this, the form requires input from the prescriber, including their name and fax number, ensuring that prescriptions can be securely transmitted. Notably, this form is structured to handle only non-controlled substances, as indicated by the warning against prescribing CII drugs. Each section is clearly marked and guides the prescriber in detailing the patient's information, including the drug name, strength, quantity, and instructions for use. Furthermore, prescribers must indicate any required refills and adhere to guidelines regarding brand name prescriptions, necessitating specific hand-written notes for those unique circumstances. To complete the form, essential identifiers such as the prescriber’s National Provider Identifier (NPI) and Drug Enforcement Administration (DEA) numbers for certain prescriptions are mandatory. The form also includes patient information like date of birth and contact details, ensuring comprehensive documentation. Finally, the signing and faxing steps are outlined, reminding users of the importance of using secure fax lines to protect confidential patient information. Such clarity ensures that the form aids in the efficient processing of prescriptions while maintaining compliance with privacy standards.

Cataramaran Fax Order Example

NEW PRESCRIPTION FAX FORM

Member Information

Cardholder ID #:

86125 *86125*

(Include all characters. Leave box blank for spaces.)

Cardholder name:

STEP 1 Complete all information below. Prescriber Information

Prescriber Name:

Fax#:

Not for CII prescriptions

STEP 2 Fill in or attach prescription below

Prescriber Name

Address

City, State, Zip

Write or stamp here

(Fill out one form for each Rx)

Patient Name: ___________________________________

Drug:

Strength: ____________________

Quantity: ____________________

Directions:

Refills: ________(up to 3 refills)

X

Date: / /

 

(Stamps are not accepted. Signature required.)

In order for a brand name product to be dispensed, the prescriber must handwrite "brand necessary" or "brand medically necessary" in the space below.

NPI #:

(NPI required for all prescriptions)

DEA #:

 

(DEA required for CIII-CV prescriptions)

Telephone #:

-

-

Patient Information

Date of birth:

Telephone #:

Ship to address:

STEP 3

Indicate number of medications on this page.

Have questions?

Call 1 866 834-0449.

For reporting allergies or

medical conditions, press option 5

(Monday-Friday 9:00 am - 8:00 pm Eastern.)

STEP 4

Sign this prescription and fax to:

1 866 996-4921

¨Fax from the prescriber's secure fax line.

¨Do not fax with a cover sheet.

¨Incomplete forms will cause a delay in processing.

When applicable PRINT Supervising Physician name here é

*86125*

Confidentiality Notice: This communication and any attachments are intended solely for the use of the addressee named above and contains confidential and legally privileged information. If you are not the intended recipient, any dissemination, distribution or copying is strictly prohibited. If you received this communication in error, please notify Catamaran Home Delivery by fax or phone immediately. Catamaran Home Delivery facsimile machines are secure and in compliance with HIPAA privacy standards.

The provision of the information requested in this form is for your patient's benefit. Catamaran Home Delivery does not compensate for completing this form.

Form Characteristics

Fact Name Detail
Cardholder ID Requirement The form requires a complete Cardholder ID, which must include all characters, leaving blanks for spaces.
Prescriber Information Prescriber details such as name and fax number must be filled out. Note that this form is not valid for CII prescriptions.
Patient Details Patients must provide their name, date of birth, and contact number, ensuring accurate processing.
Drug and Prescription Details The form must specify the drug, its strength, quantity, directions, and requested refills (up to 3).
Signature Requirement A signature from the prescriber is mandatory for validation, and stamps are not acceptable.
NPI and DEA Numbers Prescribers must include their NPI number for all prescriptions. A DEA number is required for Controlled Substances III to V.
Fax Instructions Instructions clearly state that the completed form should be faxed from a secure prescriber’s fax line without a cover sheet.

Guidelines on Utilizing Cataramaran Fax Order

Filling out the Cataramaran Fax Order form requires attention to detail to ensure that all necessary information is correctly provided. Following the steps below will guide you through the process of completing the form properly.

  1. Step 1: Enter the Cardholder ID # in the designated space, including all characters and leaving the box blank for any spaces.
  2. Complete the Cardholder Name: Write the name of the cardholder in the appropriate field.
  3. Step 2: Fill in the Prescriber Information: Enter the prescriber’s name and fax number. Note that this form is not for CII prescriptions.
  4. Attach or Fill in the Prescription: Write or stamp the prescription in the space provided, ensuring to fill out one form for each Rx.
  5. Patient Name: Fill in the patient’s full name.
  6. Drug Information: Specify the drug name, strength, quantity, and directions for usage. Include the refills if applicable (up to 3 refills).
  7. Date: Write the date, ensuring that the prescriber’s signature is included as stamps are not accepted.
  8. Brand Name Products: If necessary, the prescriber must handwrite “brand necessary” or “brand medically necessary” in the specified area.
  9. NPI #: Provide the National Provider Identifier number, as it is required for all prescriptions.
  10. DEA #: If applicable, enter the Drug Enforcement Administration number for CIII-CV prescriptions.
  11. Telephone Number: Add a contact telephone number for the prescriber.
  12. Patient Information: Complete the patient's date of birth, telephone number, and ship-to address.
  13. Step 3: Indicate the number of medications on the form.
  14. Step 4: Sign the prescription and fax it to 1 866 996-4921 from the prescriber’s secure fax line.
  15. Important: Do not fax with a cover sheet. Incomplete forms will cause a delay in processing.
  16. If applicable, print the Supervising Physician's name in the designated area.

Once the form is filled out, ensure all signatures are present before faxing. For any questions about allergies or medical conditions, you can reach out through the provided contact number.

What You Should Know About This Form

What information is required on the Cataramaran Fax Order form?

The Cataramaran Fax Order form requires several pieces of information for processing. First, you need to provide the cardholder ID number and the cardholder's name. Additionally, fill in the prescriber's details, including their name and fax number (note that this is not applicable for CII prescriptions). The medication details must also be included, such as the patient's name, drug name, strength, quantity, directions for use, and the number of refills. Finally, the form must include the prescriber's NPI and, where applicable, the DEA number along with their telephone number.

How should the prescription be submitted once completed?

After completing the form, the signed prescription should be faxed to 1-866-996-4921. It is crucial to use the prescriber's secure fax line and to avoid including a cover sheet. If the form is incomplete, processing will be delayed, which could affect timely medication delivery for the patient.

Are there any restrictions or important notes regarding prescriptions on this form?

This form specifically disallows CII prescriptions, and it is important that if a brand name medication is necessary, the prescriber must handwrite "brand necessary" or "brand medically necessary" on the form. Moreover, for any prescriptions classified as CIII through CV medications, the prescriber's DEA number must be included as part of the submission.

What should I do if I have questions or need assistance while filling out the form?

If any questions arise during the process of filling out the Cataramaran Fax Order form, you can call the Catamaran Home Delivery support at 1-866-834-0449. They are available to assist from Monday to Friday, between 9:00 am and 8:00 pm Eastern. For reporting allergies or any specific medical conditions, simply select option 5 when calling for assistance.

Common mistakes

Filling out the Cataramaran Fax Order form requires careful attention to detail. A common mistake is overlooking the requirement to include all characters in the Cardholder ID field. This includes numerals and characters, and leaving out any will result in an incomplete submission. Every character matters, and those who omit them can expect a delay in processing.

Another frequent error occurs in the Prescriber Information section. It is essential to provide both the Prescriber Name and Fax Number. Sometimes, individuals fill in one and leave the other blank. Omitting either piece of information not only complicates the prescription but may also cause it to be rejected altogether.

When filling in the prescription details, errors often arise in the Drug and Strength sections. Those completing the form sometimes forget to jot down the name of the drug or its specified strength. An incomplete medication order could lead to potential issues in fulfilling the prescription, thereby affecting the patient's access to necessary medications.

Refills are another area prone to mistakes. The form stipulates that up to three refills can be indicated, yet some individuals mistakenly mark an incorrect number. Failing to provide the refill count or recording an incorrect amount can hinder patient care needs and cause unnecessary frustration.

A less obvious but serious oversight includes the requirement for a handwritten note for brand-name medications. The prescriber must write “brand necessary” or “brand medically necessary” if that is their directive. Neglecting to do this can lead to generic substitutions that may not align with the patient's treatment plan.

In the Patient Information section, listing the date of birth is crucial. If this space is left unfilled, or if the information provided is inaccurate, processing can come to a standstill. This information is essential for verifying patient identity and ensuring correct medication administration.

Additionally, the form requires a signature before faxing. Some may attempt to fax without signing, which is a critical misstep. The submission will not be valid without a signature, and any attempt to bypass this requirement will delay the process significantly.

Finally, sending the fax without a cover sheet is another common blunder. While the instructions specify not to use a cover sheet, misunderstandings can lead people to send one anyway. Following the instructions closely, including which fax line to utilize, is imperative for ensuring the order is received promptly and securely.

Documents used along the form

When working with the Catamaran Fax Order form, several other forms and documents may be required to facilitate the prescription process and ensure compliance with healthcare regulations. Each of these documents plays an important role in providing comprehensive information regarding patients and prescriptions.

  • Patient Information Form: This document collects essential details about the patient, including personal information, medical history, and existing allergies. Accurate information helps ensure proper medication management.
  • Prior Authorization Request Form: In some cases, a medication may require approval from an insurance provider before it can be prescribed. This form outlines the patient's medical necessity for the medication and ensures coverage.
  • Electronic Prescription Form: This secure form allows prescribers to send prescriptions electronically, enhancing efficiency and reducing the risk of errors associated with handwritten prescriptions.
  • Medication History Report: This report provides a comprehensive overview of the patient's medication history, including past prescriptions and current medications. It is invaluable for avoiding harmful drug interactions.
  • Insurance Verification Form: This form is used to confirm the patient's insurance coverage and eligibility before processing a prescription. It helps prevent issues with coverage later on.
  • Patient Consent Form: Gaining the patient's consent is crucial, especially when sharing medical information with pharmacies or other healthcare providers. This form typically explains the scope of consent and protects patient privacy.

Utilizing these forms in conjunction with the Catamaran Fax Order form ensures a smooth process for obtaining and managing prescriptions. Proper documentation ultimately benefits patients by enhancing the accuracy and safety of their medication care.

Similar forms

  • Medication Order Form: Similar to the Cataramaran Fax Order form, a medication order form is used by healthcare providers to request medications for patients. Both require information such as patient details, prescriber information, and medication specifics.
  • Prescription Pad: A prescription pad allows prescribers to write down a patient's medication needs. Like the fax order, it must include patient identification, drug name, and quantity, but it is used in person rather than through fax.
  • Refill Authorization Form: This document requests refills for existing prescriptions. Both forms require patient information and medication details, ensuring that the prescribing physician maintains control over the patient's medication.
  • Prior Authorization Request: Designed to obtain approval from insurance companies for specific medications, this document also includes patient information and drug specifics, just as the Cataramaran form does.
  • Controlled Substance Prescription Form: For medications classified as controlled substances, this form collects similar information but has additional requirements regarding security and tracking, especially for CIII-CV medications.
  • Patient Information Sheet: This document gathers detailed information about the patient’s medical history and allergies. It complements the fax order form by providing context around medication requests.
  • Fax Cover Sheet: Although the Cataramaran form specifies not to use one, a fax cover sheet often accompanies faxed documents. It typically includes sender and recipient information, but lacks the detailed medication orders found in the order form.

Dos and Don'ts

When filling out the Catamaran Fax Order form, there are essential dos and don’ts to ensure the process runs smoothly. Consider the following guidelines:

  • Do complete all required fields accurately, including Cardholder ID and prescriber information.
  • Do use the patient’s full name when filling out the form.
  • Do specify drug strength and quantity clearly to avoid confusion.
  • Do indicate directions for use and the number of refills needed.
  • Do sign the prescription before faxing to validate it.
  • Don't send the fax without including the prescriber's name and fax number.
  • Don't submit the form with a cover sheet, as it may cause delays.
  • Don't leave any sections blank, as incomplete forms can result in processing delays.
  • Don't forget to note that "brand necessary" must be handwritten by the prescriber, if applicable.

Misconceptions

Misconceptions about the Cataramaran Fax Order Form can lead to confusion and delays. Here’s a list of common misunderstandings, along with explanations to clarify them.

  • Misconception 1: All prescriptions can be faxed without restrictions.
  • Not all prescriptions can be sent via fax. Specifically, prescriptions for controlled substances, designated as CII, cannot be faxed. Always check the guidelines for controlled medications.

  • Misconception 2: A cover sheet is required when faxing the order form.
  • In fact, the form specifically states not to include a cover sheet. This is to ensure the form remains confidential and reduces processing delays.

  • Misconception 3: You can fill out multiple prescriptions on one form.
  • Only one prescription per form is allowed. This means if you have multiple prescriptions, you must complete a separate form for each one.

  • Misconception 4: Stamps for signatures are accepted.
  • Stamps are not accepted. A handwritten signature is mandatory on the order form to validate the prescription.

  • Misconception 5: It's unnecessary to provide an NPI number.
  • The form specifically requires the NPI number for every prescription. This helps guarantee accurate and efficient processing.

  • Misconception 6: Refills are unlimited as long as indicated on the form.
  • Only up to three refills can be authorized on the form. It is essential to indicate the correct number for the prescription.

  • Misconception 7: Any fax machine can be used to send the forms.
  • You must fax from a secure prescriber fax line. This requirement helps protect patient confidentiality.

  • Misconception 8: The patient's medical conditions do not need to be reported.
  • While this may seem minor, reporting allergies and relevant medical conditions is crucial. The form has a specific option for this.

  • Misconception 9: Catamaran compensates

Key takeaways

When filling out the Cataramaran Fax Order form, there are several key points to keep in mind to ensure a smooth process.

  • Complete All Required Information: Make sure to fill in all necessary fields, including Cardholder ID, prescriber’s name, and patient details. Incomplete forms can lead to delays in processing.
  • Signature Requirement: The prescriber must sign the form. Stamps are not accepted, so ensure that the signature is handwritten to validate the prescription.
  • Faxing Protocol: Fax the completed form directly from the prescriber’s secure fax line. Avoid using a cover sheet, as it may interfere with the processing.
  • Understanding Medication Rules: If a brand name drug is needed, the prescriber must specifically note “brand necessary” or “brand medically necessary” on the form. Also, include the correct NPI and DEA numbers when required.

For any questions or assistance, it's advisable to contact the provided customer service number during the specified hours. This can help clarify any uncertainties before sending in the form.