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Sedative Hypnotics PRIOR AUTHORIZATION REQUEST FORM24 HOUR URGENTComplete ENTIRE form and Fax to: 8669407328SECTION A PATIENT INFORMATIONTodays Date: First Name: Last Name: Member ID #: Address: City:
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How to fill out sedative hypnotics edular crintermezzo
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Read the medication guide provided by your pharmacist before you start taking this medication.
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Take this medication by mouth as directed by your doctor, usually 1 to 2 hours before bed.
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Place the tablet under your tongue and allow it to dissolve completely.
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Do not swallow the tablet whole or chew it.
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Do not eat or drink anything until the tablet has completely dissolved.
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If needed, you may drink water to help with swallowing once the tablet has dissolved.
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This medication is usually taken as needed for sleep. Do not take it more often than prescribed.
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Do not take a dose of this medication unless you have time for a full night's sleep of at least 7 to 8 hours.
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If you wake up before this, you may have some memory loss and may have trouble safely doing any activity that requires alertness, such as driving or operating machinery.
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Do not take a dose of this medication unless you have at least 4 hours of sleep time left before being active again.
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If you have liver problems, the recommended dose is 5 mg under the tongue once per day at bedtime.
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If you are older than 65 years, the recommended dose is 5 mg under the tongue once per day at bedtime.
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Follow your doctor's instructions carefully.
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However, it is important to note that the use of sedative hypnotics should be determined by a healthcare professional and should only be used as prescribed.
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