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Medication Prior Authorization Form (OnabotulinumtoxinA) () (rimabotulinumtoxinB) (incobotulinumtoxinA) Policy Number:1042Policy History Approve Date:12/11/2015Revise Dates:Next Review:12/11/2016Review
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Revised dates refer to updated or corrected dates in a document or file.
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The purpose of revise dates is to ensure that accurate and up-to-date information is provided.
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The information that must be reported on revise dates includes the corrected dates and the reasons for the changes.
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