Awprx Temporary Prescription Form - Calhoun City Schools printable pdf download

Awprx Temporary Prescription Form - Calhoun City Schools

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AWPRx Temporary Prescription Form

GEORGIA MUNICIPAL ASSOCIATION – WCSIF

1)Instructions for the MUNICIPALITY:

Provide this form to your injured worker to have any prescription filled for a temporary 7 day

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supply and please fill out the information below:

Claimant Name: _________________________________SSN: _________________________

Claimant DOB: _____________ Claimant Home Phone #: ____________________________

Claimant Employer: __________________________________ Date of Injury: ___________

Claimant Address: _____________________________________________________________

City: _____________________________ State: ______________ Zip: _________________

Employer Representative: ____________________________________ Date: _____________

2)Instructions for the INJURED WORKER:

You, the injured worker will need to bring this form and provide it to the pharmacy. The pharmacy

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will need to call AWPRx to activate you within the system. Once active, it will take a few minutes to

process your medication(s). ***Please contact AWPRx customer service at 1-888-700-0922 if a

prior authorization is required to fill your medication.

3)Instructions for the PHARMACY:

Call AWPRx at 1-888-700-0922, so the injured workers eligibility can be turned on. After obtaining

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the injured workers information, AWPRx will provide the online processing information.

Prescription(s) will fill for a 7 Days Supply Here. If there is a remaining balance on the script after

the 7 Days Supply Here is filled, AWPRx will call back the following business day and let you know

if the balance has been approved.

***AWPRx office hours are Monday through Friday, 8:00AM EST to 8:00PM EST. We also have

representatives on call 24 hours/7 days a week. If you need to get a temporary fill outside of normal business

hours, please dial the 1-888-700-0922 number, and leave a message for our on-call team. Please state in your

message that you have a member with a temporary prescription form that needs to be set up, and please

also leave your pharmacy name and phone number.

Awprx Temporary Prescription Form - Calhoun City Schools