Ordering is as easy as 1 – 2 – 3.
1. Fill out the patient information section at the top left of the Rx form. Include an insurance card copy if you like (front and back). Our office handles all insurance approvals.
2. Indicate which medications your patient needs. Many physicians prescribe two or more. (e.g. a cortico-steroid and an antibiotic) One check to the left of the medication indicates the dose TID for 21 days.
3. Check the box for the nebulizer if required. (The Sinus Science™ nebulizer is required on all first time orders.)
4. Check the box for the current diagnosis.
5. Include additional information about medication allergies and other comments as necessary.
6. Sign and date the physician information section. Check for accuracy.
Then simply fax to 1-866-442-7579.
That’s it. We do the rest!
ASL Medication Rx Form
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