UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Sodium-Glucose Co-transporter 2 (SGLT-2) Inhibitors (canagliflozin, dapagliflozin)) Patient name:_____________________________________Medicaid ID - Canagliflozin - Document - PDFSEARCH.IO

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Date: 2014-08-07 16:26:15 Pharmacology Anti-diabetic drugs Eli Lilly and Company Pharmacist Metformin Insulin Dapagliflozin Pharmaceutical drug Sulfonylurea Medicine Chemistry Endocrine system		UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Sodium-Glucose Co-transporter 2 (SGLT-2) Inhibitors (canagliflozin, dapagliflozin)) Patient name:_____________________________________Medicaid ID #:__________ Document is deleted from original location. Use the Download Button below to download from the Web Archive. Download Document from Web Archive File Size: 88,00 KB

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