Fillable Alabama Medicaid Form 369


(4.7 / 5) 48 votes
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Get your Alabama Medicaid Form 369 in 3 easy steps

  • 01 Fill and edit template
  • 02 Sign it online
  • 03 Export or print immediately

What is an Alabama Medicaid Form 369?

Alabama Medicaid Form 369 is a blank form required to get prescription medicines in all drugstores on Alabama’s territory. The form is issued by the Alabama Medicaid Agency, which works in association with the Alabama Department of Public Health. You can fill it for free on PDFLiner right now.

What do I need the Alabama Medicaid Form 369 for?

Medical Form 369 is required to purchase prescribed drugs. Their list includes:

  • ADHD Agents.
  • Antihypertensives.
  • Narcotic analgesics.
  • Prenatal vitamins, and so forth.

The form is valid only on the state’s territory. It is not necessary if you need to buy over-the-counter or OTC medications: aspirin, pain relief acetaminophen, allergy relief nasal, and others. 

How to fill out Alabama Medicaid Form 369?

The form can be filled by a qualified medical specialist with a license only. It is exclusively valid and can be used within the state of Alabama.

Form filling requires:

  • Patient info. Full name, phone number, area code. (Address is optional)
  • Medication info. Requested drug, quantity, strength, days of supply.
  • Drug name. Check the box next to the of the requested drug.
  • Previous therapy. Information regarding the previous usage of prescribed drugs: reason, period, etc.
  • Specific information. Patient’s biometric parameters, therapy duration, etc.

The pharmacy-related details are usually provided by the apothecary.

Organizations that work with Alabama Medicaid Form 369

Alabama Department of Public Health.

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Fillable online Alabama Medicaid Form 369
(4.7 / 5) 48 votes
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