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PRIOR AUTHORIZATION REQUEST FORM
Well Sense 9.002 Mandatory Generic Substitution
BM CHP Mandatory Generic Substitution Program
Version 11.0
Effective Date 3/1/16
Phone: 8779571300
Fax back to: 8663055739
ENVISION
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How to fill out 002 mandatory generic substitution
01
To fill out 002 mandatory generic substitution form, follow these steps:
02
Start by providing your personal information, such as name, address, phone number, and date of birth.
03
Next, specify the medication details, including the name of the prescribed drug, the dosage, and the reason for the prescription.
04
Indicate whether you agree to receive a generic substitute for your medication if available.
05
If you have any specific preferences or concerns regarding generic substitution, mention them in the designated section.
06
Finally, sign and date the form to confirm your understanding and agreement with the mandatory generic substitution policy.
Who needs 002 mandatory generic substitution?
01
The 002 mandatory generic substitution form is needed by individuals who are prescribed medication and have the option for generic substitution.
02
It is a legal requirement in some jurisdictions for pharmacies to offer generic versions of prescribed drugs if available.
03
Therefore, patients who want to give consent or express their preferences regarding generic substitution need to fill out this form.
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What is 002 mandatory generic substitution?
002 mandatory generic substitution is a policy that requires pharmacists to substitute a generic drug for a brand-name drug when it is available.
Who is required to file 002 mandatory generic substitution?
Pharmacists are required to file 002 mandatory generic substitution.
How to fill out 002 mandatory generic substitution?
To fill out 002 mandatory generic substitution, pharmacists must track the substitution process and report it accordingly.
What is the purpose of 002 mandatory generic substitution?
The purpose of 002 mandatory generic substitution is to promote the use of cost-effective generic drugs.
What information must be reported on 002 mandatory generic substitution?
The information that must be reported on 002 mandatory generic substitution includes the brand-name drug, the generic drug substituted, and the patient's information.
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