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STATEMENT OF MEDICAL NECESSITY RESPIRATORY SYNOVIAL VIRUS (RSV) PROPHYLAXIS Complete form in its entirety and fax to number listed below PRIMARY DIAGNOSIS Patients Gestational Age: Coventry Health
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Who needs 1synagisrsvdoc:
01
Infants and children at high risk of severe respiratory syncytial virus (RSV) infections.
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Those with specific medical conditions, such as prematurity, congenital heart disease, or chronic lung disease.
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Pediatricians or healthcare providers who administer Synagis®, a medication used for preventing RSV infections in high-risk individuals.
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What is 1synagisrsvdoc?
1synagisrsvdoc is a form used for reporting information related to Synagis usage for Respiratory Syncytial Virus (RSV) prevention.
Who is required to file 1synagisrsvdoc?
Healthcare providers who administer Synagis to patients for RSV prevention are required to file 1synagisrsvdoc.
How to fill out 1synagisrsvdoc?
1synagisrsvdoc can be filled out electronically or manually, with all relevant information about Synagis administrations and patients provided accurately.
What is the purpose of 1synagisrsvdoc?
The purpose of 1synagisrsvdoc is to track and report the usage of Synagis for RSV prevention, ensuring proper monitoring and documentation of treatments.
What information must be reported on 1synagisrsvdoc?
Information such as patient details, Synagis dosage, administration dates, healthcare provider information, and any adverse reactions must be reported on 1synagisrsvdoc.
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