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CONTAINS CONFIDENTIAL PATIENT INFORMATIONOzurdex (intravitreal implant) Prior Authorization of Benefits (PAB) Form Complete form in its entirety and fax to: Prior Authorization of Benefits Center
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How to fill out intravitreal implant
How to fill out intravitreal implant
01
To fill out an intravitreal implant, follow these steps:
02
Wash your hands thoroughly with soap and water.
03
Prepare all the necessary materials such as the implant, syringe, and accessories.
04
Clean the injection site with an antiseptic solution.
05
Use a sterile drape to cover the surrounding area.
06
Attach the correct needle to the syringe and draw up the prescribed amount of medication.
07
Remove any air bubbles from the syringe by tapping it lightly and pushing out the excess medication.
08
Hold the syringe like a pencil with your dominant hand.
09
With your non-dominant hand, stabilize the eyelid and ask the patient to look in a specific direction.
10
Slowly insert the needle into the eye at the recommended injection site.
11
Inject the medication slowly and steadily.
12
Once the medication is fully injected, withdraw the needle gently.
13
Apply gentle pressure to the injection site with a sterile cotton swab to prevent any medication leakage.
14
Dispose of the used syringe, needle, and other medical waste properly.
15
Document the procedure in the patient's medical records.
16
Provide post-injection instructions and schedule a follow-up appointment.
17
Always follow the specific instructions provided by the healthcare professional administering the intravitreal implant.
Who needs intravitreal implant?
01
Intravitreal implants are typically used for individuals who have certain eye conditions or diseases that require targeted medication delivery to the retina or the back of the eye.
02
The following individuals may need an intravitreal implant:
03
- Patients with age-related macular degeneration (AMD)
04
- Patients with diabetic retinopathy
05
- Patients with retinal vein occlusion
06
- Patients with uveitis
07
- Patients with certain infections or inflammations of the eye
08
It is important to consult with an ophthalmologist or retina specialist to determine if an intravitreal implant is the appropriate treatment option for your specific eye condition.
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What is intravitreal implant?
Intravitreal implant is a small device inserted into the eye to deliver medication for treatment of various eye conditions.
Who is required to file intravitreal implant?
Healthcare professionals, such as ophthalmologists, are required to file intravitreal implant for their patients.
How to fill out intravitreal implant?
The intravitreal implant form must be completed with patient information, implant details, and treatment plan by the healthcare provider.
What is the purpose of intravitreal implant?
The purpose of intravitreal implant is to deliver medication directly to the eye to treat conditions such as macular degeneration and diabetic eye disease.
What information must be reported on intravitreal implant?
The intravitreal implant form must include patient demographics, implant type, dosage, administration date, and adverse reactions.
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