UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION BUTRANS (buprenorphine) Patient name:___________________________________Medicaid ID - Kappa Opioid receptor - Document - PDFSEARCH.IO

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	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION BUTRANS (buprenorphine) Patient name:___________________________________Medicaid ID #:________________________________ Prescriber Name:_________________Prescriber NPI#:_____ Add to Reading List Document Date: 2014-08-07 16:26:15 Open Document File Size: 96,26 KB Share Result on Facebook Facility Pharmacy Phone# / / MedicalCondition severe chronic pain requiring / / Organization DEPARTMENT OF HEALTH / / / Product Requested Medication / / SocialTag Anesthesia Drug rehabilitation Ethers Buprenorphine Pain management Opioid Analgesic Kappa Opioid receptor Medicine Pain

UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION BUTRANS (buprenorphine) Patient name:___________________________________Medicaid ID #:________________________________ Prescriber Name:_________________Prescriber NPI#:_____Add to Reading List