Providers

Below are the forms needed to get your patient started with our therapies.

Why Providers Trust Amerita

  • Infusion Leader. We’re a leading provider of at-home and alternate-sites of care infusions.
  • In-Network. 250+ million lives covered across commercial and government payors.
  • Nationwide Coverage. Our 30 local pharmacies across 20 states provide coverage everywhere.*
  • Trusted Service. We provide infusion care for over 14,000 patients a month.
  • Expert Led. We use only 100% registered nurses and infusion certified pharmacists.
  • Ig Pioneer. We’re the first to earn the ACHC’s Distinction in Ig Therapy.

* Our 30 pharmacies provide local acute care in the communities we serve, as well as nationwide specialty infusion care.

Order Forms

Can’t Find What You Need?

To prescribe one of the hundreds of medications we dispense, but don’t have a form for, fax your local branch or find them in your e-prescribe system.

New Referral Check List – When a Referral Form is not available

  • An Order with:
    • Drug
    • Dose
    • Rate
    • Frequency
    • Stop Date
  • Patient name and Demographics
  • Insurance Information
  • Medical History and Physical (H&P)
  • Recent Labs
  • IV Line Access