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04/21/2015 Prior Authorization Form MARYLAND PHYSICIANS CARE (MEDICAID) Octreotide (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information,
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Octreotide medicaid is a medication used to treat certain conditions such as acromegaly and diarrhea caused by carcinoid syndrome.
Healthcare providers are required to file octreotide medicaid for their patients who are prescribed this medication.
To fill out octreotide medicaid, healthcare providers need to submit the necessary patient and prescription information to the Medicaid program.
The purpose of octreotide medicaid is to ensure that patients who need this medication have access to it through the Medicaid program.
Information such as patient demographics, diagnosis, prescribing provider, dosage, and frequency of administration must be reported on octreotide medicaid.
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