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Date PRIOR AUTHORIZATION QUESTIONNAIREStelara () in. M.D. Last Name: Physician Phone: M.D. First Name: Physician Fax: Patient ID# DOB **FAILURE TO COMPLETE THE FORM MAY RESULT IN A DELAY OR AN AUTOMATIC
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Medical professionals or healthcare providers are required to administer and file the information for us tekinumab inj.
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The purpose of us tekinumab inj is to provide targeted treatment for autoimmune conditions and to help manage symptoms.
Information regarding the dosage, patient's name, date of administration, any side effects, and the healthcare provider administering the medication must be reported.
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