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OKLAHOMA DEPARTMENT OF CORRECTIONS NON-FORMULARY MEDICATION REQUEST FORM (This form must be legibly completed in its entirety) Cost Center #: Name of Facility: Date Requested: / / Return Fax #: Offender
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What is non-formulary medication request form?
A non-formulary medication request form is a document used to request medications that are not included on the approved list of medications covered by a specific health insurance plan or formulary.
Who is required to file non-formulary medication request form?
Patients or their healthcare providers are typically required to file a non-formulary medication request form in order to request coverage for medications that are not on the approved list.
How to fill out non-formulary medication request form?
The non-formulary medication request form usually requires the patient's personal information, the medication details, the reason for the request, and any supporting documentation. It is important to provide accurate and complete information when filling out the form.
What is the purpose of non-formulary medication request form?
The purpose of the non-formulary medication request form is to provide a way for patients to request coverage for medications that are not on the approved list, often due to medical necessity or lack of viable alternatives.
What information must be reported on non-formulary medication request form?
The non-formulary medication request form typically requires information such as patient demographics, medical history, the prescribed medication, dosage, frequency, duration, the reason for the request, and any supporting documentation or medical notes.
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