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SPECIAL AUTHORIZATION REQUEST Dabigatran(), (), () Fax requests to (902) 3684905 OR mail requests to PEI Pharmacies, P.O. Box 2000, Charlottetown, PE, C1A 7N8SECTION 1 PRESCRIBER INFORMATIONSECTION
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Begin by gathering all necessary information and documentation for the special authorization request for dabigatran.
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Ensure that you have the appropriate forms or templates for the request.
03
Fill out the forms or templates with the required information, including the patient's details, medical history, reason for the request, and any supporting documentation.
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Submit the special authorization request for dabigatran to the designated authority or department.
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Await the decision on the special authorization request for dabigatran, which may involve approval, denial, or request for additional information.
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Who needs special authorization request dabigatran?

01
Patients who require dabigatran but do not meet the standard eligibility criteria may need to submit a special authorization request. This may apply to individuals who have specific medical conditions, such as certain heart conditions or renal impairment, or those who require a higher dosage than typically prescribed. The exact criteria for needing a special authorization request may vary depending on local guidelines and regulations.
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Special authorization request dabigatran is a request for approval to use the medication dabigatran in certain cases that may require additional review or justification.
Healthcare providers or patients may be required to file a special authorization request for dabigatran, depending on the specific circumstances and guidelines set by the insurance provider or health authority.
Special authorization request form for dabigatran typically requires information such as patient's medical history, previous treatments, reason for prescribing dabigatran, and supporting documentation as deemed necessary.
The purpose of special authorization request for dabigatran is to ensure that the medication is prescribed appropriately and used in cases where standard treatment options may not be suitable or effective.
Information to be reported on special authorization request for dabigatran may include patient's medical history, previous treatments, reason for prescribing dabigatran, and any relevant supporting documentation.
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