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SPECIAL AUTHORIZATION REQUEST Dabigatran(), (), () Fax requests to (902) 3684905 OR mail requests to PEI Pharmacies, P.O. Box 2000, Charlottetown, PE, C1A 7N8SECTION 1 PRESCRIBER INFORMATIONSECTION
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How to fill out dabigatran special authorization request
How to fill out dabigatran special authorization request
01
To fill out the dabigatran special authorization request, follow these steps:
02
Obtain the special authorization form from the appropriate authority.
03
Fill in the patient's personal information, including name, date of birth, and contact details.
04
Provide the relevant medical history of the patient, including any pre-existing conditions or allergies.
05
Specify the reason for requesting dabigatran special authorization, such as a medical necessity or contraindication to other anticoagulants.
06
Attach supporting documents or medical reports that substantiate the need for dabigatran.
07
Submit the completed form along with any additional required documentation to the designated authority.
08
Await the decision on the special authorization request, which will be communicated to you or the patient.
Who needs dabigatran special authorization request?
01
The dabigatran special authorization request is required for individuals who meet certain criteria and require dabigatran but do not meet the standard coverage criteria.
02
Typically, this request is needed for patients who have specific medical conditions or contraindications to other anticoagulants, as determined by the treating healthcare professional.
03
The final decision on the need for dabigatran special authorization is made by the appropriate authority responsible for approving such requests.
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What is dabigatran special authorization request?
Dabigatran special authorization request is a form that needs to be submitted in order to request approval for the use of dabigatran outside of its approved indications.
Who is required to file dabigatran special authorization request?
Healthcare providers or pharmacists are typically required to file dabigatran special authorization requests on behalf of their patients.
How to fill out dabigatran special authorization request?
Dabigatran special authorization request forms can be obtained from the drug manufacturer or the relevant healthcare authority. The form must be completed with all necessary patient and prescribing information.
What is the purpose of dabigatran special authorization request?
The purpose of dabigatran special authorization request is to ensure the safe and appropriate use of dabigatran in patients who do not meet the standard criteria for its use.
What information must be reported on dabigatran special authorization request?
The dabigatran special authorization request typically requires information about the patient's medical history, the reason for requesting dabigatran, and any relevant lab results.
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