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Iowa Department of Human Services FAX Completed Form To (866) 9407328Request for Prior AuthorizationProvider Help Desk (800) 3106826Buprenorphine/Naloxone (PLEASE PRINT ACCURACY IS IMPORTANT) IA Medicaid
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How to fill out naloxone pa form npi

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How to fill out naloxone pa form npi

01
To fill out the naloxone PA form NPI, follow these steps:
02
Obtain the NPI (National Provider Identifier) for the prescriber of naloxone.
03
Fill in the prescriber's NPI in the designated field on the form.
04
Provide the patient's personal information, such as name and date of birth.
05
Indicate the reason for prescribing naloxone, such as a history of opioid use, opioid overdose risk, or being a caregiver.
06
Include any additional relevant information, like the quantity of naloxone being prescribed.
07
Review the completed form for accuracy and make sure all required fields are filled.
08
Submit the form to the appropriate authority or organization as instructed.

Who needs naloxone pa form npi?

01
Individuals who are at risk of opioid overdose or are in a position to assist someone experiencing an opioid overdose may need the naloxone PA form NPI.
02
This includes medical professionals, caregivers, family members, or friends of individuals with a history of opioid use, individuals with chronic pain who are prescribed opioids, or individuals who are at risk of accidental opioid overdose.
03
It is recommended to consult with a healthcare provider or local authorities to determine the specific eligibility requirements for obtaining naloxone and filling out the form.
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Naloxone PA form NPI is a form used to report naloxone dispensing information in Pennsylvania.
Pharmacies and healthcare facilities that dispense naloxone in Pennsylvania are required to file naloxone PA form NPI.
Naloxone PA form NPI can be filled out online through the Pennsylvania Department of Health's website or submitted via mail.
The purpose of naloxone PA form NPI is to track naloxone dispensing data to help combat opioid overdose deaths.
Information such as the quantity of naloxone dispensed, patient demographics, prescriber information, and dispenser information must be reported on naloxone PA form NPI.
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