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HEALTH PARTNERS PLANS PRIOR AUTHORIZATION REQUEST FORMHematopoietic Mixtures Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient. Certain
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01
Prepare the necessary equipment including syringes, needles, vials of hematopoietic mixture, alcohol wipes, and gloves.
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Who needs hematopoietic mixtures?
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Patients with certain blood disorders such as anemia, leukemia, or other types of blood cancers may require hematopoietic mixtures to stimulate the production of blood cells.
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Individuals undergoing chemotherapy or radiation therapy that may damage the bone marrow and affect blood cell production may also benefit from hematopoietic mixtures.
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What is hematopoietic mixtures?
Hematopoietic mixtures are a combination of different types of blood cells.
Who is required to file hematopoietic mixtures?
Hematopoietic mixtures are typically filed by medical professionals or healthcare facilities.
How to fill out hematopoietic mixtures?
Hematopoietic mixtures can be filled out by providing detailed information about the types and quantities of blood cells in the mixture.
What is the purpose of hematopoietic mixtures?
The purpose of hematopoietic mixtures is to provide a treatment option for patients with certain blood disorders or conditions.
What information must be reported on hematopoietic mixtures?
Information such as the composition of different blood cells, quantity of each type, and any additives used in the mixture must be reported.
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