These forms make sending prescriptions to Avella an easy process. Simply download the form, type or print the appropriate information and fax to Avella. We encourage you to e-prescribe to make the process even easier.
Prescription Referral Forms
Once we receive the completed prescription referral form Avella staff will:
- Verify insurance coverage (including co-pays) and files the claim with the insurance carrier.
- Provide prior authorization (PA) and financial assistance (FA) support to ensure patient access.
- Physician and patient family are notified of the status of the prescription within 48 hours of receipt.
- Avella will contact the provider to coordinate delivery of the medication and to review their support services during the course of therapy.
- Avella's specialty care coordinators will be a partner for the patient family throughout the course of therapy to monitor and report side effects, and ensure access to available resources.