WEF Submission


A red asterisk (*) indicates required questions.

  1. Submitting Rep's First name*


  1. Submitting Rep's Last Name*


  1. Location
    ABB
    Durant
    Humble
    Northgate
    Cary
    Frostburg
    Henderson
    Houston
    Madison
    Manila (Conduent)
    Chandler
    Kansas City
    Knoxville
    Nashville
    Nashville WFH
    Orlando WFH
    Pittsburgh
    San Antonio
    Solon
    Solon WFH


  1. CCR ID (Z, C or U followed by numbers/letters. Do not use G numbers).*


  1. PPT ID


  1. Internal ID (Can be located by accessing the Eligibility tab in PeopleSafe)


  1. PPT Name


  1. PPT DOB:


  1. Client Code


  1. Contact Phone Number


  1. PPT Email Address


  1. Device Type
    Computer
    Smartphone
    Tablet


  1. Other Browser (if not above)


  1. Smartphone Model
    Galaxy S7
    IPhone 6S
    LG
    G$
    Other


  1. Other Smartphone Model


  1. Desktop OS
    Windows
    Apple


  1. Mobile OS
    Android
    Apple


  1. Mobile App Version


  1. Latest Caremark App
    Yes
    No


  1. Browser
    Internet Explorer
    Chrome
    Firefox
    Safari
    Other


  1. Ship Consent Issue
    Yes
    No


  1. 1. Date and Time of Error


  1. 2. RX Number


  1. 3, RX Name


  1. 4. Order #


  1. 5. Did you ever provide ship consent through Caremark.com in the past?
    Yes
    No


  1. 6. Have you tried to access ship consent through Caremark.com multiple times?
    Yes
    No


  1. 7. Are you able to access other parts of the Caremark.com site?
    Yes
    No


  1. 8. Did the page load or not when clicking on provide consent?
    Yes
    No


  1. 9. No medications to provide consent for?
    Yes
    No


  1. Grievance filed?
    Yes
    No


  1. Spoke to POA?
    Yes
    No


  1. Comments


  1. Additional comments





Guy Macdonald