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Prior Authorization Request Form for Opioid Barbiturate Analgesic Combinations FAX this completed form to (844) 2053386 OR Mail requests to: Pharmacy Department | 5 River Park Place East, Suite 210

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How to fill out analgesics non-opioid barbiturate combinations

01

Obtain a prescription from a licensed healthcare provider

02

Read the instructions on the medication label carefully

03

Take the medication as directed by your healthcare provider

04

Do not exceed the recommended dosage

05

Monitor for any potential side effects and contact your healthcare provider if you experience any

Who needs analgesics non-opioid barbiturate combinations?

01

Individuals experiencing moderate to severe pain that is not adequately managed with other pain relief medications

02

Patients with conditions such as migraines, neuropathic pain, or postoperative pain

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What is analgesics non-opioid barbiturate combinations?

Analgesics non-opioid barbiturate combinations are combinations of pain relievers that do not contain opioids but include barbiturates.

Who is required to file analgesics non-opioid barbiturate combinations?

Healthcare providers or facilities that prescribe or administer analgesics non-opioid barbiturate combinations are required to file.

How to fill out analgesics non-opioid barbiturate combinations?

The forms for filing analgesics non-opioid barbiturate combinations can typically be completed online or submitted through a designated reporting system.

What is the purpose of analgesics non-opioid barbiturate combinations?

The purpose of these combinations is to provide non-opioid pain relief while also incorporating barbiturates for their sedative properties.

What information must be reported on analgesics non-opioid barbiturate combinations?

The information typically required includes the type and dosage of the analgesics and barbiturates used, the patient's information, and the healthcare provider's details.

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