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03/16/2016 Prior Authorization MERCY MARICOPA INTEGRATED CARE - TXIX/XXI SMI MEDICAID Omega-3 Carboxylic Acids AZ88 This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information sign and date. Fax signed forms to Mercy Maricopa Integrated Care - TXIX/XXI SMI at 1-855-247-3677. Has the patient experienced an inadequate treatment response to OTC over the counter fish oil and at least ONE other formulary medication such as fenofibric acid or OTC...
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Omega-3 carboxylic acids az88 is a type of omega-3 fatty acid medication used to reduce triglycerides in the blood.
Healthcare providers and pharmacies are required to file omega-3 carboxylic acids az88 to track usage and distribution.
Omega-3 carboxylic acids az88 can be filled out by entering the patient's information, prescribing physician details, and dosage information.
The purpose of omega-3 carboxylic acids az88 is to manage and reduce triglyceride levels in patients.
Information such as patient details, prescription details, and dispensing pharmacy information must be reported on omega-3 carboxylic acids az88.
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