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CONTAINS CONFIDENTIAL PATIENT INFORMATIONTOPICAL ACNE AND ROSACEA PRODUCTS Prior Authorization of Benefits (PAB) FormComplete form in its entirety and fax to: Prior Authorization of Benefits Center

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How to fill out topical acne and rosacea

01

Cleanse your face with a gentle cleanser

02

Apply a thin layer of topical acne and rosacea medication to affected areas

03

Allow the medication to absorb into your skin for a few minutes

04

Apply moisturizer to keep your skin hydrated

05

Repeat this process twice a day, or as directed by your dermatologist

Who needs topical acne and rosacea?

01

Individuals suffering from acne and rosacea

02

People with persistent breakouts or redness on their skin

03

Anyone looking to reduce the appearance of acne and rosacea

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What is topical acne and rosacea?

Topical acne and rosacea refers to the reporting of acne and rosacea treatments that are applied directly to the skin.

Who is required to file topical acne and rosacea?

Healthcare providers and dermatologists who prescribe or administer treatments for acne and rosacea are required to file topical acne and rosacea.

How to fill out topical acne and rosacea?

To fill out topical acne and rosacea, healthcare providers must report the details of the treatments prescribed or administered to patients with acne and rosacea.

What is the purpose of topical acne and rosacea?

The purpose of topical acne and rosacea reporting is to track the usage of acne and rosacea treatments and ensure the safety and efficacy of these treatments.

What information must be reported on topical acne and rosacea?

Information such as the type of treatment, dosage, frequency of application, and any side effects must be reported on topical acne and rosacea.

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