Form preview

Get the free Braftovi (encorafenib) and Mektovi (binimetinib)

Get Form
UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORMBraftovi (encorafenib) and Mentor (binimetinib) Member and Medication Information (required) Member ID:Member Name:DOB:Weight:Medication
We are not affiliated with any brand or entity on this form
4,4
98,753 Reviews
4,5
11,210 Reviews
4,6
715 Reviews
4,6
789 Reviews

Get, Create, Make and Sign braftovi encorafenib and mektovi

Edit
Edit your braftovi encorafenib and mektovi form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your braftovi encorafenib and mektovi form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit braftovi encorafenib and mektovi online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Use the instructions below to start using our professional PDF editor:
1
Log in. Click Start Free Trial and create a profile if necessary.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit braftovi encorafenib and mektovi. Rearrange and rotate pages, insert new and alter existing texts, add new objects, and take advantage of other helpful tools. Click Done to apply changes and return to your Dashboard. Go to the Documents tab to access merging, splitting, locking, or unlocking functions.
4
Save your file. Select it from your list of records. Then, move your cursor to the right toolbar and choose one of the exporting options. You can save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud, among other things.
It's easier to work with documents with pdfFiller than you can have believed. You can sign up for an account to see for yourself.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
Learn more about security & compliance
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out braftovi encorafenib and mektovi

Illustration

How to fill out braftovi encorafenib and mektovi

01
To fill out Braftovi Encorafenib and Mektovi, follow the instructions provided by your healthcare provider.
02
Take the prescribed dosage as directed by your doctor.
03
Braftovi and Encorafenib are usually taken together with Mektovi.
04
Follow the specific instructions regarding the timing and frequency of doses.
05
Take the medication with or without food, as instructed.
06
Swallow the tablets whole with a glass of water - do not crush, chew, or break them.
07
If you miss a dose, take it as soon as you remember.
08
Do not double the dose to make up for a missed one.
09
Continue taking Braftovi Encorafenib and Mektovi for the prescribed duration, even if you start feeling better.
10
If you have any questions or concerns regarding the medication, consult your healthcare provider.

Who needs braftovi encorafenib and mektovi?

01
Braftovi Encorafenib and Mektovi are medications used in combination to treat certain types of cancer, specifically melanoma.
02
These medications are typically prescribed to adults who have a specific genetic mutation called BRAF V600E or BRAF V600K positive advanced melanoma.
03
It is important to note that Braftovi Encorafenib and Mektovi should only be used under the supervision and prescription of a healthcare professional.
04
The eligibility for these medications may vary depending on individual circumstances, so it is best to consult with a healthcare provider to determine if you are a suitable candidate.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.8
Satisfied
43 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

When you're ready to share your braftovi encorafenib and mektovi, you can swiftly email it to others and receive the eSigned document back. You may send your PDF through email, fax, text message, or USPS mail, or you can notarize it online. All of this may be done without ever leaving your account.
With pdfFiller, you may easily complete and sign braftovi encorafenib and mektovi online. It lets you modify original PDF material, highlight, blackout, erase, and write text anywhere on a page, legally eSign your document, and do a lot more. Create a free account to handle professional papers online.
Install the pdfFiller iOS app. Log in or create an account to access the solution's editing features. Open your braftovi encorafenib and mektovi by uploading it from your device or online storage. After filling in all relevant fields and eSigning if required, you may save or distribute the document.
Braftovi encorafenib and Mektovi are medications used to treat certain types of cancer.
Healthcare providers and facilities are required to file braftovi encorafenib and Mektovi.
Braftovi encorafenib and Mektovi should be filled out according to the guidelines provided by the medication manufacturer.
The purpose of braftovi encorafenib and Mektovi is to target specific cancer cells and inhibit their growth.
Information such as patient demographics, prescribed dosage, and treatment duration must be reported on braftovi encorafenib and Mektovi.
Fill out your braftovi encorafenib and mektovi online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview

Braftovi Encorafenib And Mektovi is not the form you're looking for?Search for another form here.

Related Features

Allow Signed Electronically Audit Committee Charter
Allow Signed Electronically Certificate Of Incorporation
Allow Signed Electronically Joint Venture Agreement Template
Allow Signed Electronically Car Sale Agreement Template
Allow Signed Electronically Divorce Settlement Agreement Template

Relevant keywords

2019 utah encorafenib mektovi binimetinib braftovi braf fda prolongation uveitis thromboembolism rhabdomyolysis hepatotoxicity ild toxicities malignancies prescriber prescribers v600k v600e npi unresectable interstitial dob cardiomyopathy metastatic legib

Related Forms

Form preview
TOP END FORCE G HANDCYCLE Trunk Powered Position
Invader top end force g hand cycle price list and order form effective may 15,
Fill Now
Form preview
Top End Eliminator OSR Racing Chair - Invacare
Top end eliminator osr racing chair price list and order form effective january 1, 2006,
Fill Now
Form preview
Top End Excelerator Custom Handcycle - Invacare
Top end accelerator custom hand cycle price list and order form effective january 1, 2006,
Fill Now
Form preview
Top End T-5 7000 Series Tennis Chair - Invacare
Top end t-5 7 series tennis chair price list and order form effective september 30,
Fill Now
Form preview
Top End Schulte 7000 Series BB Chair - Invacare
Top end schultz 7 series bb chair price list and order form effective september 30,
Fill Now
Form preview
Top End OSR Racing Chair Kneel
Top end osr racing chair: kneel suggested canadian price list effective march 2nd, 2009, revised
Fill Now
Form preview
Top End Eliminator OSR Racing Chair Standard
Top end eliminator osr racing chair: standard suggested canadian price list effective march 2nd, 2009,
Fill Now
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.