Prescriber Order Forms
Referring a patient to Option Care Health is easy. To begin the referral process, simply select a medication from the alphabetized list below.
1
Download the form
2
Fill out, print and sign it – either online or by hand
3
Fax the completed form to the Option Care Health location most convenient for your patient
Find Location
If the required medication is not listed, please complete the Generic Order Form or electronically prescribe the medication.
For general questions or to learn more about our services, please call 844.624.4584 or submit a Contact Us Form.
- ANAPHYLAXIS KIT Download Form
- APRETUDE NURSING ORDER FORM Download Form
- BLEEDING DISORDER Download Form
- CABENUVA NURSING ORDER FORM Download Form
- DIABETES IN PREGNANCY Download Form
- ENTERAL THERAPY Download Form
- FABRY'S DISEASE Download Form
- GAUCHER'S DISEASE ENZYME REPLACEMENT Download Form
- GENERAL ENZYME REPLACEMENT ORDER FORM Download Form
- GENERIC ORDER FORM Download Form
- GENETIC TESTING ORDER FORM Download Form
- HEART FAILURE INFUSION SERVICES ENROLLMENT Download Form
- HOME INFUSION PHARMACY ORDER FORM Download Form
- HOME INFUSION PHARMACY STANDING ORDER FORM Download Form
- HYPERTENSION IN PREGNANCY Download Form
- INFUSION CLINIC – ARIZONA PRESCRIBER ORDER FORM Download Form
- INFUSION CLINIC – COLORADO PRESCRIBER ORDER FORM Download Form
- INFUSION CLINIC – TEXAS PRESCRIBER ORDER FORM Download Form
- INFUSION CLINIC – UTAH PRESCRIBER ORDER FORM Download Form
- IV IRON ONLY Download Form
- PARENTERAL THERAPY (adult patients) Download Form
- PARENTERAL THERAPY (pediatric patients) Download Form
- POST-ACUTE ORDER FORM Download Form
- SEVERE ASTHMA Download Form
Medication Order Forms
A
- Actemra® (tocilizumab) Download Form
- Amondys 45® (casimersen) Download Form
- Amvuttra® (vutrisiran) Download Form
- Apretude® (cabotegravir) Download Form
B
- Benlysta (belimumab) Download Form
- Berinert® (c1 esterase inhibitor) Download Form
- Blincyto® (blinatumomab) Download Form
- Briumvi™ (ublituximab-xiiy) Download Form
C
- Cabenuva® (cabotegravir-rilpivirine) Download Form
- Cimzia® (certolizumab) Download Form
- Cinryze® (c1 esterase inhibitor) Download Form
D
- Dalvance® (dalbavancin) Download Form
E
- Efgartigimod (vyvgart & vyvgart-hytrulo) Download Form
- Entyvio® (vedolizumab) Download Form
- Evenity (romosozumab) Download Form
- Exondys 51® (eteplirsen) Download Form
H
- HyQvia SubQ (adult & pediatric patients) Download Form
I
- Imaavy™ Download Form
- Imfinzi® (durvalumab) Download Form
- Immune Globulin (adult patients) Download Form
- Immune Globulin (pediatric patients) Download Form
- Infliximab (remicade®, inflectra®, renflexis®) Download Form
K
- Kalbitor® (ecallantide) Download Form
- Kanuma® Download Form
- Keytruda® (Pembrolizumab) Download Form
- Krystexxa® (pegloticase) Download Form
- Kyprolis® (carfilzomib) Download Form
L
- LEQEMBI MRI CONFIRMATION DOCUMENTATION Download Form
M
- MENINGOCOCCAL VACCINATION TO INITIATE THERAPY Download Form
N
- NAUSEA VOMITING IN PREGNANCY Download Form
- Nulojix® (belatacept) Download Form
- Nuzyra® (omadacycline) Download Form
O
- Ocrevus® (ocrelizumab) Download Form
- Omvoh™ (mirikizumba) Download Form
- Opdivo® (nivolumab) Download Form
- Orencia® (abtacept) Download Form
P
- Poteligeo Download Form
- Prolia® and Xgeva® (denosumab) Download Form
R
- Radicava® (edaravone) Download Form
- Reclast (zoledronic acid) Download Form
- Regen-covtm (casirivimab-imdevimab) Download Form
- Rituximab (rituxan®, truxima®) Download Form
S
- Saphnelo® (anifrolumab) Download Form
- Sarclisa (isatuximab-irfc) Download Form
- Simponi Aria® (golimumab) Download Form
- Skyrizi (risankizumab-rzaa) Download Form
- Soliris® (eculizumab) Download Form
- Stelara® (ustenkinumab) Download Form
T
- Tecentriq Hybreza Download Form
- Tecentriq® (atezolizumab) Download Form
- Tepezza® (teprotumumab-trbw) Download Form
- Tremfya® (guselkumab) Download Form
- Trogarzo® (ibalizumab) Download Form
- Tysabri® (natalizumab) Download Form
U
- Ultomiris® (ravulizumab) Download Form
- Uplizna® (inebilizumab-cdon) Download Form
V
- Viltepso® (vitolarsen) Download Form
- Vyepti® (eptinezumab-jjmr) Download Form
- Vyjuvek™ (beremagene geperpavec) Download Form
- Vyondys 53® (golodirsen) Download Form
Y
- Yervoy® (ipilimumab) Download Form
For General Patient Questions
As with the branded drugs, if the required therapy is not listed, please call us at 844.624.4584 or electronically prescribe the medication.
All Option Care Health pharmacies are able to accept electronic prescriptions (e-prescribing).
Prescriptions must be sent from licensed prescribers, accompanied by the patient’s insurance information and in accordance with your state prescribing laws.
For general questions about our services, please call us at 844.624.4584 or submit a Contact Us Form.