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HEALTH PARTNERS PLANS 2023 PRIOR AUTHORIZATION REQUEST FORMCamzyos (mavacamten) Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient. Certain
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01
Start by gathering important information such as medical history, family history of heart diseases, lifestyle factors, and any existing health conditions.
02
Use a standardized risk assessment tool such as the Framingham Heart Study checklist to calculate the risk score.
03
Record key measurements including blood pressure, cholesterol levels, and body mass index (BMI).
04
Evaluate the risk factors such as age, gender, smoking status, diabetes, and high blood pressure.
05
Consider additional tests such as an electrocardiogram (ECG) or echocardiogram for further assessment if necessary.
06
Discuss the findings with a healthcare provider to develop a personalized plan for managing heart failure risk.

Who needs risk of heart failure?

01
Individuals with a family history of heart diseases
02
Individuals with existing health conditions such as diabetes, high blood pressure, or obesity
03
Individuals with lifestyle factors such as smoking, poor diet, or lack of exercise
04
Individuals over the age of 40
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Risk of heart failure is the likelihood of experiencing a heart condition where the heart is unable to pump blood effectively.
Patients who are diagnosed or at risk of heart failure are required to report their condition to their healthcare providers.
To fill out risk of heart failure, individuals should provide detailed information about their medical history, symptoms, and any relevant test results.
The purpose of risk of heart failure reporting is to monitor and manage the condition, guide treatment decisions, and improve patient outcomes.
Information such as symptoms, medical history, test results, medications, and lifestyle factors should be reported on risk of heart failure.
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