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PRIOR AUTHORIZATION PROGRAM REIMBURSEMENT REQUEST FORM For diabetes: Trinity (dulaglutide)Please fax form to: 18668401509Please note that the patient AND physician must complete this form. All fields
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How to fill out diabetes trulicity dulaglutide

01
Step 1: Wash your hands thoroughly with soap and water before handling the Trulicity dulaglutide pen.
02
Step 2: Check the label on the pen to confirm that it is the correct medication and dose prescribed by your healthcare provider.
03
Step 3: Remove the cap from the pen and attach a new needle. Gently rotate the needle to ensure it is securely in place.
04
Step 4: Prime the pen by turning the dose knob in a clockwise direction until the green stripe appears in the dose window. This removes any air bubbles from the pen.
05
Step 5: Select an injection site on your abdomen, thigh, or upper arm. Clean the injection site with an alcohol swab.
06
Step 6: Pinch a fold of skin at the injection site and insert the needle at a 45-degree angle. Press the dose button to inject the medication.
07
Step 7: Hold the pen in place for 10 seconds after the injection to ensure the full dose is delivered.
08
Step 8: Safely dispose of the needle and pen in a sharps container.
09
Step 9: Wash your hands after completing the injection.

Who needs diabetes trulicity dulaglutide?

01
Trulicity dulaglutide is typically prescribed to individuals with type 2 diabetes.
02
It is used to help control blood sugar levels in adults with this condition.
03
Your healthcare provider will determine if Trulicity dulaglutide is appropriate for you based on your specific medical history and treatment goals.
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Diabetes trulicity dulaglutide is a medication used to help control blood sugar levels in adults with type 2 diabetes.
Patients who have been prescribed diabetes trulicity dulaglutide are required to file it as part of their treatment plan.
Diabetes trulicity dulaglutide is typically administered through injection under the skin. Patients should follow the instructions provided by their healthcare provider on how to properly administer the medication.
The purpose of diabetes trulicity dulaglutide is to help improve blood sugar control in adults with type 2 diabetes.
Patients may be required to report their blood sugar levels, any side effects experienced, and any changes in their overall health while taking diabetes trulicity dulaglutide.
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