Stony Brook University Non-Formulary Medication Request free printable template

NON-FORMULARY MEDICATION. REQUEST FORM. Please paste patient information label in this area. This form must be completed before the pharmacy can ...

How to fill out brook non formulary

How to fill out Stony Brook University Non-Formulary Medication Request Form

1. Obtain the Stony Brook University Non-Formulary Medication Request Form from the pharmacy or online.
2. Fill in the patient’s information, including name, date of birth, and student ID.
3. Specify the medication requested, including the name, dosage, and frequency.
4. Provide the reason for the request, detailing why the non-formulary medication is needed.
5. List any previous medications tried and the outcomes.
6. Obtain the prescribing physician's signature and any necessary supporting documentation.
7. Submit the completed form to the appropriate pharmacy department for review.

Who needs Stony Brook University Non-Formulary Medication Request Form?

1. Students at Stony Brook University who require medications not included in the standard formulary list.
2. Healthcare providers looking to obtain approval for non-formulary medications on behalf of their patients.

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What is Stony Brook University Non-Formulary Medication Request Form?

The Stony Brook University Non-Formulary Medication Request Form is a document used by healthcare providers to request the approval of medications that are not included in the university's standard formulary.

Who is required to file Stony Brook University Non-Formulary Medication Request Form?

Any healthcare provider or clinician prescribing a medication that is not part of Stony Brook University's formulary is required to file the Non-Formulary Medication Request Form.

How to fill out Stony Brook University Non-Formulary Medication Request Form?

To fill out the Stony Brook University Non-Formulary Medication Request Form, a healthcare provider must provide patient information, details about the requested medication, justification for its use, and any relevant clinical information.

What is the purpose of Stony Brook University Non-Formulary Medication Request Form?

The purpose of the Stony Brook University Non-Formulary Medication Request Form is to evaluate the necessity and appropriateness of using non-formulary medications for patient care, ensuring safe and effective treatment options are provided.

What information must be reported on Stony Brook University Non-Formulary Medication Request Form?

The information that must be reported on the Stony Brook University Non-Formulary Medication Request Form includes the patient's name, medical record number, medication name, dosage, frequency, reason for the request, and supporting clinical information.