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US Family Health Plan Prior Authorization Request Form for Continuous Glucose Monitoring (CGM) Systems (Deacon G6, Freestyle Libra 2, Freestyle Libra 3) To be completed and signed by the prescriber.
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How to fill out continuous glucose monitoring cgm

01
Wash your hands with soap and water before handling the CGM device.
02
Remove the protective covering from the sensor applicator.
03
Insert the sensor applicator into the skin according to the instructions provided.
04
Wait for the sensor to calibrate and start measuring your glucose levels.
05
Use the receiver or smartphone app to monitor your glucose levels and trends throughout the day.
06
Follow the guidelines provided by your healthcare provider for interpreting the readings and adjusting your treatment plan.

Who needs continuous glucose monitoring cgm?

01
People with diabetes who need to closely monitor their blood glucose levels throughout the day.
02
People with diabetes who experience frequent fluctuations in blood sugar levels.
03
People with diabetes who have difficulty managing their blood sugar levels with traditional blood glucose monitoring methods.
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Continuous Glucose Monitoring (CGM) is a system that tracks glucose levels throughout the day and night.
Individuals with diabetes or other conditions that require monitoring of glucose levels are required to use CGM.
CGM devices are typically worn on the body and automatically record glucose levels at regular intervals.
The purpose of CGM is to provide real-time information about glucose levels to help individuals manage their condition more effectively.
CGM reports typically include glucose levels over a period of time, trends, and potential alerts for high or low levels.
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