UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Dipeptidyl Peptidase IV (DPP-4) Inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin and combination products) Patient name:_________________________ - Dipeptidyl peptidase - Document - PDFSEARCH.IO

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	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Dipeptidyl Peptidase IV (DPP-4) Inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin and combination products) Patient name:_________________________ Add to Reading List Document Date: 2014-08-07 16:26:15 Open Document File Size: 87,76 KB Share Result on Facebook Facility Pharmacy Phone# / IndustryTerm combination products / / MedicalCondition diabetes mellitus / pancreatitis / / Organization DEPARTMENT OF HEALTH / / / Position pharmacist / / Product Requested Medication / / SocialTag Amides Anti-diabetic drugs Alcohols Nitriles Sitagliptin Saxagliptin Metformin Pharmacist Dipeptidyl peptidase Chemistry

UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Dipeptidyl Peptidase IV (DPP-4) Inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin and combination products) Patient name:_________________________Add to Reading List