MasVida Health Care Solutions Forms
Please, completely fill out all sections of this form, then scan or take a picture of it and email to email@example.com or fax it back to 817-890-9098.
All forms will be sent to our Respiratory Therapists for approval. Once approved, orders will then be placed for delivery. The Nurse’s and Doctor’s first and last names must be legible or the script will not be processed.
PLEASE NOTE DURING BUSINESS HOURS: 8:30AM – 6:00PM
If you fax it to us please call 1-877-790-5994, select option 1 and confirm the script was received. No deliveries will be made until the script is processed by our RT team. This will ensure if we did not receive the script that we are working with you for a solution.
PLEASE NOTE FOR AFTER HOURS: 6:00PM – 8:30AM
DO NOT FAX. Please email the script to firstname.lastname@example.org. ALL ORDERS must be called into 877-790-5994, select option one. No delivery will be made if you do not call. After hours is considered ON CALL ONLY.
If you have any comments, questions or concerns please reach out to your local account manager.