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UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM CONTAINS CONFIDENTIAL PATIENT INFORMATION Complete this form in its entirety and send to Rocky Mountain Health Plans at 8583572538 Initial Request
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Sodium oxybate - rocky is a prescription medication used to treat excessive daytime sleepiness and cataplexy in patients with narcolepsy.
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Healthcare providers are required to file sodium oxybate - rocky for their patients.
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The purpose of sodium oxybate - rocky is to help manage symptoms of narcolepsy such as excessive daytime sleepiness and cataplexy.
What information must be reported on sodium oxybate - rocky?
Information that must be reported on sodium oxybate - rocky includes patient name, dosage instructions, prescribing healthcare provider, and any relevant medical history.
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