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DuPont
Prior Authorization Request
Send completed form to: Case Review Unit CVS Earmark Prior Authorization Fax: 18662496155
CVS Earmark administers the prescription benefit plan for the patient identified.
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How to fill out moderate-to-severe atopic dermatitis

How to fill out moderate-to-severe atopic dermatitis
01
To fill out moderate-to-severe atopic dermatitis, follow these steps:
02
Start by gathering all the necessary information about the patient's medical history, including previous treatments, allergies, and underlying conditions.
03
Assess the severity of the atopic dermatitis using a standardized scoring system, such as the EASI (Eczema Area and Severity Index) or SCORAD (SCORing Atopic Dermatitis). This will help in determining the appropriate treatment options.
04
Evaluate the patient's quality of life and the impact of atopic dermatitis on their daily activities. This can be done through questionnaires and interviews.
05
Determine the treatment goals in collaboration with the patient, considering factors such as symptom relief, improvement in skin appearance, and prevention of flares.
06
Discuss the available treatment options, both topical and systemic. Topical treatments include moisturizers, corticosteroids, calcineurin inhibitors, and PDE4 inhibitors. Systemic treatments may include oral immunosuppressants or biologic agents.
07
Educate the patient about proper skincare practices, including gentle cleansing, moisturizing, and avoiding triggers that worsen symptoms.
08
Develop an individualized treatment plan considering the patient's preferences, treatment goals, and potential side effects.
09
Regularly monitor the patient's progress and adjust the treatment plan if needed. Follow-up visits should be scheduled to assess the response to treatment and make any necessary modifications.
Who needs moderate-to-severe atopic dermatitis?
01
Moderate-to-severe atopic dermatitis is a condition that requires treatment and care for individuals who experience more significant symptoms and impacts on their daily life. This includes people who:
02
- Have persistent or recurrent skin inflammation and redness despite using over-the-counter treatments.
03
- Exhibit intense itching, skin dryness, and scaling that affect sleep and quality of life.
04
- Have frequent flares or worsening of symptoms, which may lead to skin infections.
05
- Experience limited physical activities or require time off work or school due to atopic dermatitis.
06
It's important for individuals with moderate-to-severe atopic dermatitis to seek medical attention and discuss their symptoms with a healthcare professional, as appropriate management can help alleviate symptoms and improve their overall quality of life.
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What is moderate-to-severe atopic dermatitis?
Moderate-to-severe atopic dermatitis is a chronic inflammatory skin condition that causes red, itchy, and inflamed skin.
Who is required to file moderate-to-severe atopic dermatitis?
Patients who have been diagnosed with moderate-to-severe atopic dermatitis are required to file.
How to fill out moderate-to-severe atopic dermatitis?
Patients can fill out the necessary forms provided by their healthcare provider or dermatologist.
What is the purpose of moderate-to-severe atopic dermatitis?
The purpose of moderate-to-severe atopic dermatitis reporting is to track and monitor the condition of patients for treatment and research purposes.
What information must be reported on moderate-to-severe atopic dermatitis?
Information such as medical history, symptoms, treatment plan, and any other relevant details about the condition must be reported.
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