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pegaptanib sodium Injectable Medication Precertification Request Page 1 of 2 All fields must be completed and return both pages for precertification review Please indicate Start of treatment start date / Phone A. Primary ICD Code Other ICD Code G. CLINICAL INFORMATION -- Required clinical information must be completed for ALL precertification requests. PRESCRIBER INFORMATION Last Name Address ZIP Cell Phone Allergies Current Weight lbs or B. INSURANCE INFORMATION Provider E-mail For Medicare...
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01
Wash your hands thoroughly before handling the Macugen Pegaptanib Sodium Injectable.
02
Check the vial for any signs of damage or particles before use.
03
Remove the protective cap from the vial and wipe the rubber stopper with an alcohol swab.
04
Using a sterile syringe and needle, withdraw the prescribed dose of Macugen from the vial.
05
Inject the solution slowly into the affected eye as directed by your healthcare professional.
06
After injecting, dispose of the syringe and needle in a proper sharps container.
07
Repeat the process for each scheduled dose of Macugen as prescribed.
08
Follow all additional instructions and guidelines provided by your healthcare professional.
09
If you have any questions or concerns, consult your healthcare professional before using Macugen Pegaptanib Sodium Injectable.

Who needs macugen pegaptanib sodium injectable?

01
Macugen Pegaptanib Sodium Injectable is intended for patients with neovascular (wet) age-related macular degeneration (AMD).
02
Patients with the specific diagnosis of neovascular (wet) AMD may require Macugen treatment as determined by their healthcare professional.
03
The decision to use Macugen Pegaptanib Sodium Injectable should be made by a qualified healthcare professional based on the individual patient's condition and medical history.
04
It is important to consult with your healthcare professional to assess if Macugen is suitable and necessary for your specific case.
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Macugen pegaptanib sodium injectable is a prescription medication used to treat age-related macular degeneration (AMD).
Healthcare providers or clinics administering macugen pegaptanib sodium injectable are required to file the necessary paperwork.
Macugen pegaptanib sodium injectable should be filled out with the patient's information, dosage, date of administration, and any relevant medical history.
The purpose of macugen pegaptanib sodium injectable is to slow down the progression of AMD and improve vision in patients.
Information such as patient demographics, dose administered, date of injection, and any adverse reactions must be reported on macugen pegaptanib sodium injectable.
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