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Unison Health Plan Pharmacy Department Medical Exception Worksheet/Prescription Order Form Injectable Medications Please complete and return fax to 412-457-1328 or 866-639-7785 PATIENT DEMOGRAPHICS
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What is ungeneral injectable med exception?
Ungeneral Injectable Med Exception is a form that must be filed to request an exception for certain injectable medications.
Who is required to file ungeneral injectable med exception?
Healthcare providers and facilities who need to administer injectable medications not covered under the general rule.
How to fill out ungeneral injectable med exception?
The form can be filled out online or submitted through mail with all required information and supporting documents.
What is the purpose of ungeneral injectable med exception?
The purpose is to ensure that patients have access to necessary injectable medications that may not be covered by their insurance.
What information must be reported on ungeneral injectable med exception?
The form requires details about the patient, healthcare provider, specific medication, medical necessity, and supporting documentation.
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