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Prior authorization
Results: 1240

#	Item
781	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: www.fdhc.state.fl.us Language: English - Date: 2012-06-25 14:33:13 Chemistry Pharmacology Dibenzazepines Prodrugs Carbamazepine Epilepsy Bipolar disorder Lamotrigine Primidone Anticonvulsants Medicine Mood stabilizers
782	NEU/LEU.10 Form # 20520 R:05.11 State of Maine Department of Health & Human Services MaineCare/MEDEL Prior Authorization Form Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2012-03-19 13:37:39 Neutropenia Filgrastim Cancer treatments Absolute neutrophil count Hematopoietic stem cell transplantation Chemotherapy Acute myeloid leukemia Febrile neutropenia Medicine Hematology Oncology
783	BYETTA.5 Form # 10230 R: 07.13 State of Maine Department of Health &Human Services MaineCare/MEDEL Prior Authorization Form Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2013-07-23 11:32:16 Thiazolidinediones Pyridines Diabetes Organic chemistry Endocrine system Exenatide Rosiglitazone Pioglitazone Sulfonylurea Anti-diabetic drugs Chemistry Eli Lilly and Company
784	OKLAHOMA STATE UNIVERSITY University Health Services Authorization Form for Hepatitis B Vaccination Please fill out the following information prior to receiving the hepatitis B vaccination. Bring the COMPLETED form with Add to Reading List Source URL: ehs.okstate.edu - Date: 2008-02-01 11:29:42
785	SYN.23 Form # 30120 R: 10.13 State of Maine Department of Health & Human Services MaineCare/MEDEL Prior Authorization Form Add to Reading List Source URL: mainecarepdl.org Language: English - Date: 2013-10-25 11:54:56 Human respiratory syncytial virus Medicine Bronchopulmonary dysplasia Gestational age MedImmune Biology Health AstraZeneca Palivizumab Viral diseases
786	Indiana Health Coverage Programs Quick Reference Guide ADVANTAGE Health SolutionsSM Prior Authorization – Medical FFS P.O. Box[removed]Indianapolis, IN[removed]5720 Add to Reading List Source URL: provider.indianamedicaid.com Language: English - Date: 2014-10-23 11:16:13 Office equipment Pharmacy Emdeon Indianapolis Geography of the United States Geography of Indiana Technology Fax
787	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: www.fdhc.state.fl.us - Date: 2012-06-25 14:08:02
788	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: www.fdhc.state.fl.us Language: English - Date: 2012-10-08 11:24:29 Ketones Imidazoles GlaxoSmithKline Alcohols 5-HT3 antagonist Ondansetron Apomorphine Buprenorphine Chemistry Organic chemistry Antiemetics
789	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: www.fdhc.state.fl.us - Date: 2012-10-08 11:23:32
790	‘ Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Add to Reading List Source URL: www.fdhc.state.fl.us Language: English - Date: 2013-04-29 15:46:20 Multiple sclerosis Prednisone Prodrugs Health West syndrome Dexamethasone Glucocorticoids Medicine Pharmacology

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