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MedicationPriorAuthorizationForm Locate recombinantantihemophilicfactor, Fcfusionprotein(revivify) PolicyNumber:1045PolicyHistory Approve Date:12/11/2015 Reiterates:NextReview: 12/11/2016 Revalidates:Preauthorization
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Individualhaslessthanorequalto1internationalunitperdeciliteriudllessthanorequalto1 refers to an individual whose blood contains less than or equal to 1 international unit per deciliter.
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Individuals or healthcare providers may be required to file information on an individual who has less than or equal to 1 international unit per deciliter in their blood.
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To fill out information about an individual who has less than or equal to 1 international unit per deciliter, you may need to provide details about their medical condition, test results, and any relevant treatment.
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The purpose of reporting on an individual who has less than or equal to 1 international unit per deciliter may be for medical monitoring, research, or treatment purposes.
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