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PREFERRED GLUCOSE TEST STRIPS/DISKS AND METERS
PRIOR AUTHORIZATION REQUEST
PRESCRIBER FAX FORM
ONLY the prescriber may complete this form. This form is for prospective, concurrent, and retrospective
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How to fill out non-preferred glucose test stripsdisks

How to fill out non-preferred glucose test stripsdisks
01
To fill out non-preferred glucose test strips/disks, follow these steps:
02
Wash your hands with soap and warm water, and dry them thoroughly.
03
Take a non-preferred glucose test strip/disk out of its packaging.
04
Insert the test strip/disk into your glucose meter according to the manufacturer's instructions.
05
Use a lancet device to prick your finger and obtain a small drop of blood.
06
Touch the tip of the test strip/disk to the blood drop, making sure it fully absorbs the blood.
07
Wait for the glucose meter to display your blood glucose level.
08
Record the result and dispose of the used test strip/disk properly.
09
Repeat the process as needed or as recommended by your healthcare provider.
Who needs non-preferred glucose test stripsdisks?
01
Non-preferred glucose test strips/disks are typically used by individuals with diabetes or other conditions that require monitoring blood glucose levels.
02
These individuals may have specific preferences for certain test strip brands or may have insurance plans that only cover non-preferred test strips.
03
It is important to consult with a healthcare provider to determine if non-preferred test strips/disks are suitable for your specific needs.
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What is non-preferred glucose test stripsdisks?
Non-preferred glucose test strips/disks are specialized medical devices used to measure blood glucose levels, which are not covered under the standard insurance plan.
Who is required to file non-preferred glucose test stripsdisks?
Individuals using non-preferred glucose test strips/disks typically need to file claims with their insurance provider to seek reimbursement for the costs incurred.
How to fill out non-preferred glucose test stripsdisks?
To fill out the necessary claims for non-preferred glucose test strips/disks, individuals should provide personal information, details about the product, purchase date, and any required medical documentation.
What is the purpose of non-preferred glucose test stripsdisks?
The purpose of non-preferred glucose test strips/disks is to allow diabetic patients to monitor their blood sugar levels accurately, aiding in the management of their condition when alternatives are unavailable or unsuitable.
What information must be reported on non-preferred glucose test stripsdisks?
Information that must be reported includes the type of glucose test strips, purchase date, quantity, cost, the prescribing physician's details, and any relevant insurance information.
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