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STATE OF ALASKA DEPARTMENT OF CORRECTIONS REQUEST TO USE NON-FORMULARY DRUG PROVIDERS: This form should be completed when is appears clinically necessary to prescribe a drug that is not included in

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What is request to use non-formulary?

Request to use non-formulary is a formal request made by an individual or organization to obtain approval for the use of a medication that is not included in the formulary list of approved drugs.

Who is required to file request to use non-formulary?

Any individual or healthcare provider who wishes to prescribe or use a non-formulary medication is required to file a request to use non-formulary.

How to fill out request to use non-formulary?

To fill out a request to use non-formulary, individuals or healthcare providers must provide detailed information about the patient, the medication being requested, the reason for the request, and any supporting documentation or evidence.

What is the purpose of request to use non-formulary?

The purpose of a request to use non-formulary is to seek approval from the relevant authority to prescribe or use a medication that is not included in the formulary. This is typically done when the non-formulary medication is deemed necessary for the individual patient's treatment.

What information must be reported on request to use non-formulary?

A request to use non-formulary typically requires information such as the patient's medical history, diagnosis, current medications, the non-formulary medication being requested, dosage, duration of treatment, and any supporting medical or clinical evidence.

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