Get the free Continuous Glucose Monitor Prior Authorization Form - WV.gov

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Pharmacy Prior Approval Request for Continuous Glucose Monitors Beneficiary Information 1. Beneficiary Last Name: ___ 2. First Name: ___ 3. Beneficiary ID #: ___ 4. Beneficiary Date of Birth: ___

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How to fill out continuous glucose monitor prior

01

Wash your hands with soap and water before handling the continuous glucose monitor.

02

Insert the sensor according to the instructions given by the manufacturer.

03

Calibrate the monitor as instructed to ensure accurate readings.

04

Check the glucose levels on the monitor regularly and follow any alerts or alarms.

05

Replace the sensor as recommended by the manufacturer.

Who needs continuous glucose monitor prior?

01

People with type 1 diabetes who require frequent monitoring of their glucose levels.

02

Individuals with type 2 diabetes who need to closely monitor their blood sugar throughout the day.

03

Patients with gestational diabetes who need to track their glucose levels during pregnancy.

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What is continuous glucose monitor prior?

Continuous glucose monitor prior is a form that needs to be submitted to a healthcare provider in order to request the coverage for a continuous glucose monitor device.

Who is required to file continuous glucose monitor prior?

Patients with diabetes who wish to have a continuous glucose monitor device covered by their insurance provider are required to file a continuous glucose monitor prior.

How to fill out continuous glucose monitor prior?

Continuous glucose monitor prior can be filled out by providing necessary information such as patient details, healthcare provider information, and justification for needing a continuous glucose monitor device.

What is the purpose of continuous glucose monitor prior?

The purpose of continuous glucose monitor prior is to request coverage for a continuous glucose monitor device from the insurance provider.

What information must be reported on continuous glucose monitor prior?

Information such as patient's medical history, healthcare provider's prescription, and reasons for needing a continuous glucose monitor device must be reported on continuous glucose monitor prior.

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