For Providers

What to include in a referral to Infuse One Ohio

Our team begins benefit investigations and prior authorization requests within 48 hours of receiving your referral, helping your patients avoid unnecessary delays in starting treatment.

01

Referral Form

Completed referral form with medical provider's signature

02

Face Sheet

Patient face sheet with all demographic information

03

Insurance

Copy of patient insurance card or insurance information sheet

04

Supporting Documentation

Any labs, medical history, or supporting documentation indicating need for referred medication

See a medication referral form for supporting documentation.

Fax Referrals To

614-929-7199

Specialty Script Pads

Branded script pads tailored to each specialty for easy ordering.

Referral Forms by Medication