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UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM (sulfate) Patient name: Medicaid ID #: Prescriber Name: Prescriber NPI#: Contact person: Prescriber Phone#: Extension/Option: Fax#: Pharmacy:

How to fill out quinine form

How to fill out quinine:

1. Start by carefully reading the instructions provided with the quinine medication.
2. Typically, quinine comes in the form of tablets or capsules. Take the prescribed dose as directed by your healthcare professional.
3. It is important to take quinine with a full glass of water, unless otherwise instructed by your doctor.
4. Quinine is usually taken with food to prevent stomach upset. Follow the specific instructions given by your healthcare provider.
5. Do not crush, chew, or break the tablets or capsules unless instructed to do so. Swallow them whole.
6. If you forget to take a dose, take it as soon as you remember. However, if it is close to your next scheduled dose, skip the missed dose and continue with your regular dosing schedule.
7. Keep track of your quinine usage and make sure to finish the complete course as prescribed, even if you start feeling better.
8. If you have any questions or concerns about how to fill out quinine, consult your doctor or pharmacist for clarification.

Who needs quinine:

1. Quinine is primarily used for the treatment of malaria, a mosquito-borne infectious disease.
2. It is also occasionally prescribed to manage muscle cramps or spasms, especially those related to conditions like nocturnal leg cramps or restless leg syndrome.
3. Quinine can only be obtained with a prescription from a qualified healthcare professional. They will assess your condition and determine if quinine is appropriate for your specific needs.

Note: The use of quinine should always be based on the recommendations and guidance of a healthcare professional, as they will consider factors such as your medical history, drug interactions, and potential side effects.

For pdfFiller’s FAQs

What is quinine?

Quinine is a medication used to treat malaria and babesiosis.

Who is required to file quinine?

Chemical manufacturers and importers are required to file quinine.

How to fill out quinine?

Quinine can be filled out online or through paper forms provided by the regulatory agency.

What is the purpose of quinine?

The purpose of quinine is to monitor the production and importation of chemicals for safety and regulatory compliance.

What information must be reported on quinine?

Information such as chemical name, quantity produced/imported, intended use, and safety data must be reported on quinine.

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