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COMPOUND MEDICATION PRIOR AUTHORIZATION REQUEST FORM 24 HOUR URGENT Complete BOTH PAGES of form and Fax to: 866-940-7328 Today s Date: SECTION PATIENT INFORMATION First Name: Last Name: Member ID:

How to fill out compound medication

How to fill out compound medication:

1. Gather all necessary ingredients and materials.
2. Read and follow the instructions provided by the prescribing healthcare professional or pharmacist.
3. Measure or weigh the required amount of each ingredient accurately.
4. Mix the ingredients thoroughly according to the specific instructions provided.
5. Ensure the proper labeling of the compound medication, including the patient's name, the medication name, dosage, and any additional instructions.
6. Store the compound medication in an appropriate container and place, following any storage instructions given.

Who needs compound medication:

1. Patients with unique medication needs: Compound medication may be prescribed for patients with specific requirements that cannot be met by commercially available medications.
2. Allergy sufferers: Compound medication can be useful for patients with allergies to specific ingredients or additives found in commercial medications.
3. Children and infants: Compound medication can be customized to meet dosing needs for young patients who have difficulty swallowing or require different strengths than those available commercially.
4. Geriatric patients: Compound medication can provide personalized dosing adjustments and formulations for elderly patients with varying needs.
5. Pets: Compound medication is often used for veterinary purposes, as it allows for specific dosages and formulations tailored to the needs of animals.

Note: It is important to consult with a healthcare professional or pharmacist to determine the suitability and safety of compound medication for an individual's specific needs.

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What is compound medication?

Compound medication is a customized medication that is made by mixing individual ingredients in the exact strength and dosage required for a specific patient.

Who is required to file compound medication?

Healthcare providers, pharmacists, and pharmacies are required to file compound medication.

How to fill out compound medication?

Compound medication can be filled out by providing the specific ingredients used, strength, dosage, patient information, and the prescribing healthcare provider.

What is the purpose of compound medication?

The purpose of compound medication is to provide personalized medication solutions for patients with unique needs.

What information must be reported on compound medication?

Information such as the ingredients used, strength, dosage, patient information, prescribing healthcare provider, and any potential side effects must be reported on compound medication.