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RSV Season 20122013 Complete form in its entirety and fax to number listed belowPATIENT INFORMATION1 Last Names Allergies:Gestational Age: weeks: Diagnosis:First Name Date of BirthPRIOR AUTHORIZATION
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How to fill out rsv prophylaxis

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To fill out RSV prophylaxis, follow these steps: 1. Consult with a healthcare professional to determine if RSV prophylaxis is necessary.
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Obtain the appropriate RSV prophylaxis medication prescribed by the healthcare professional.
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Read the instructions and dosage recommendations provided with the medication carefully.
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Prepare the medication according to the instructions, which may involve measuring and mixing the medication as required.
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Administer the medication as directed by the healthcare professional, ensuring the correct dosage and method of administration.
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Complete the full course of RSV prophylaxis as prescribed, even if symptoms improve or disappear.
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Who needs rsv prophylaxis?

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RSV prophylaxis is typically recommended for certain high-risk groups, including:
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- Premature infants born before 29 weeks of gestation
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- Infants with chronic lung disease
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It is important to consult with a healthcare professional to determine if an individual falls into any of these high-risk groups and requires RSV prophylaxis.
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RSV prophylaxis is a treatment given to certain high-risk individuals to prevent respiratory syncytial virus infection.
Healthcare providers and facilities may be required to administer and report RSV prophylaxis.
RSV prophylaxis is typically administered as injections or infusions according to specific guidelines set by healthcare professionals.
The purpose of RSV prophylaxis is to prevent severe respiratory infections in high-risk individuals.
Information such as type of prophylaxis administered, dosage, frequency, and patient demographics may need to be reported.
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