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Neutropenia / Filgrastim / Cancer treatments / Absolute neutrophil count / Hematopoietic stem cell transplantation / Chemotherapy / Acute myeloid leukemia / Febrile neutropenia / Medicine / Hematology / Oncology


NEU/LEU.10 Form # 20520 R:05.11 State of Maine Department of Health & Human Services MaineCare/MEDEL Prior Authorization Form
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Document Date: 2012-03-19 13:37:39


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File Size: 36,00 KB

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Currency

RON / /

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MedicalCondition

Cancer / cancer patient Severe Chronic Neutropenia / Severe Chronic Neutropenia- ANC / idiopathic Severe neutropenia / AIDS / myelosuppressive chemotherapy Cancer patients receiving bone marrow transplant Acute Myeloid Leukemia / /

MedicalTreatment

chemotherapy / antiretroviral therapy / bone marrow transplant / /

Organization

Department of Health / /

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Product

NEUPOGEN / NEULASTA / LEUKINE / /

Technology

chemotherapy / /

URL

www.mainecarepdl.org_ / /

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