The Gulfstream Prescription History & Medical Provider Report contains a detailed five-year history of a specific patient, including data reflecting prescribing physicians and pharmacies. This information is compiled by the nation’s Pharmacy Benefits Managers, who have access to databases covering approximately 80% of prescriptions filled in the United States.

What the report includes:

• Name, address and telephone number of the pharmacy(ies) where prescriptions were filled
• Prescribing physician’s name, address, telephone number and specialty
• Drug name and dosage
• Date that the prescription was filled and the number of refills
• Drug detail (e.g., disease information, therapeutic class and side effects)

What is required to obtain the report:

• The full name, gender, date of birth, Social Security number and current ZIP code of the patient. (Please include any "a/k/a" information.)
• A completed Gulfstream HIPAA-compliant authorization form (Please note: This is the ONLY authorization that can be utilized to obtain a Gulfstream Prescription History & Medical Provider Report.)