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906 South Monroe Street
Spokane, WA 99204
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Welcome to Jones Pharmacy
FACILITY FORMS

This page provides our facilities with access to forms used by Jones Pharmacy.  Each form is listed below with description of its purpose.  Forms may be printed out and faxed back to our prescription department at (509) 838-9787.

New Patient Intake Form - Provides pharmacy with patient information, billing information, responsible party, assignment of benefits and release of information. New Patient Intake Form

Notice of Privacy Practices - Provides a written Notice of Privacy practices as outlined by Jones Pharmacy. This is required to be signed by all patients or their legal guardians.New Prescription Order Form

Refill Request Form - Provides a standardized method for submitting refill requests which are not part of the standard cycle filling process.Refill Request Form

Med-Box Container Form - Provides a written resource for filling med-boxes based on the timing of how physicians, facilities, patients or caregivers wish to give or assist in medication administration.Med-Box Container Form

 
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