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Prior authorization
Results: 1240

#	Item
241	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Non-Preferred Authorization Request Patient name:___________________________________Medicaid ID #:________________________________ Prescriber Name:____________ Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:36:41 Pharmaceutical sciences Pharmaceutical drug Pharmacy Medical necessity Medical terms Healthcare Ohio Automated Rx Reporting System Electronic prescribing Pharmacology Medicine Health
242	BUREAU FOR MEDICAL SERVICES WEST VIRGINIA MEDICAID PREFERRED DRUG LIST WITH PRIOR AUTHORIZATION CRITERIA This is not an all-inclusive list of available covered drugs and includes only managed categories. Refer to cover p Add to Reading List Source URL: www.dhhr.wv.gov Language: English - Date: 2013-01-03 13:03:32 Morphinans Phenols Alcohols Ketones Tramadol Benzoyl peroxide Clindamycin Sulfacetamide/sulfur Codeine Chemistry Organic chemistry Anti-acne preparations
243	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM ARANESP (darbepoetin alfa) Patient name:___________________________________Medicaid ID #:________________________________ Prescriber Name:_________________Presc Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:15 Amgen Erythropoietin Fax Anemia Hematocrit Hemoglobin Nephrology Dialysis Medicine Hematology Blood tests
244	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FOR INJECTABLE ANTIBIOTICS For Non-Traditional Clients Patient name:___________________________________Medicaid ID #:________________________________ Prescriber Name Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:15 Bacterial diseases Osteomyelitis Osteopathies
245	Microsoft PowerPoint - Personal Care Prior Authorization-What You Need to Know - Kay Ewalt.pptx Add to Reading List Source URL: www.armits.org Language: English - Date: 2014-08-28 15:40:35 Presidency of Lyndon B. Johnson Authorization Hygiene Health Federal assistance in the United States Healthcare reform in the United States Medicaid
246	Standard Request Form For Prior Authorization of Medical Care or Health Care Services Advisory Committee Purpose: To advise the Commissioner on the technical, operational, and practical aspects of developing the single, Add to Reading List Source URL: www.tdi.texas.gov Language: English - Date: 2014-10-24 12:18:17 Primary care Health insurance Healthcare Health economics Texas E-Health Alliance John O. Agwunobi Health Medicine Health care
247	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Sodium-Glucose Co-transporter 2 (SGLT-2) Inhibitors (canagliflozin, dapagliflozin)) Patient name:_____________________________________Medicaid ID #:__________ Add to Reading List Source URL: medicaid.utah.gov Language: English - 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
248	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM AGE and/or QUANTITY OVERRIDE Patient name:______________________________________Medicaid ID #:________________________________ Prescriber Name:________________ Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:15 Fax Drug Technology Medicinal chemistry Pharmacy
249	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM CYTOGAM (cytomeglavirus immune globulin) Patient name:___________________________________Medicaid ID #:________________________________ Prescriber Name:________ Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:16
250	UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Thiazolidinediones (TZDs) (pioglitazone, rosiglitazone and combination products) Patient name:_____________________________________Medicaid ID #:_____________ Add to Reading List Source URL: medicaid.utah.gov Language: English - Date: 2014-08-07 16:26:15 Chemistry Medicine Endocrine system Pioglitazone Rosiglitazone Pharmacist Metformin Insulin Diabetes mellitus type 2 Eli Lilly and Company Pyridines Thiazolidinediones

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