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HEALTH PARTNERS PLANS PRIOR AUTHORIZATION REQUEST FORMProgestational Agents Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient. Certain
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How to fill out progestational agents

01
Consult with your healthcare provider to determine if progestational agents are necessary for your specific condition.
02
Follow the instructions provided by your healthcare provider for dosing and timing of administration.
03
Take the progestational agent consistently and as directed.
04
Keep track of any side effects or changes in your symptoms and report them to your healthcare provider.
05
Follow up with your healthcare provider regularly to monitor the effectiveness of the progestational agent.

Who needs progestational agents?

01
Progestational agents are commonly prescribed for individuals with hormone imbalances, irregular menstrual cycles, endometriosis, or as part of hormone replacement therapy for menopausal symptoms.
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Progestational agents are synthetic hormones that mimic the function of progesterone in the body.
Healthcare providers or facilities that prescribe or administer progestational agents are required to file them.
Progestational agents can be filled out on a form provided by the regulatory agency overseeing their use.
The purpose of progestational agents is to regulate the menstrual cycle, support pregnancy, or treat certain medical conditions.
The information that must be reported on progestational agents includes the dosage, frequency of administration, and any side effects experienced by the patient.
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