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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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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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- Infants with congenital heart disease
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- Infants with compromised immune systems
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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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What is rsv prophylaxis?
RSV prophylaxis is a treatment given to certain high-risk individuals to prevent respiratory syncytial virus infection.
Who is required to file rsv prophylaxis?
Healthcare providers and facilities may be required to administer and report RSV prophylaxis.
How to fill out rsv prophylaxis?
RSV prophylaxis is typically administered as injections or infusions according to specific guidelines set by healthcare professionals.
What is the purpose of rsv prophylaxis?
The purpose of RSV prophylaxis is to prevent severe respiratory infections in high-risk individuals.
What information must be reported on rsv prophylaxis?
Information such as type of prophylaxis administered, dosage, frequency, and patient demographics may need to be reported.
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