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Please complete ALL information below and fax your request to 18886715285Cimzia Prior Authorization Request Form (Page 1 of 2) DO NOT COPY FOR FUTURE USE. FORMS ARE UPDATED FREQUENTLY AND MAY BE BARCODEDMember
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Moderately to severely active refers to individuals who engage in physical activity with moderate to high intensity on a regular basis.
Individuals who meet the criteria for being moderately to severely active are required to report their activity levels.
To fill out the moderately to severely active form, individuals need to accurately report their physical activity levels using the provided guidelines.
The purpose of reporting moderately to severely active status is to track individuals' physical activity levels for health and research purposes.
Individuals must report the duration, type, and intensity of physical activities they engage in to determine their activity level.
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