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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.
02
Wash hands thoroughly with soap and water before handling the hematopoietic mixtures.
03
Check the expiration date on the vials and make sure they are not expired.
04
Clean the rubber stopper of the vial with an alcohol wipe and let it dry before inserting the needle.
05
Draw the appropriate amount of hematopoietic mixture into the syringe according to the prescribed dosage.
06
Remove any air bubbles from the syringe by gently tapping on it and pushing the plunger slightly.
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Choose an injection site such as the upper arm or thigh and clean the area with an alcohol wipe.
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Inject the hematopoietic mixture into the chosen site at a 90-degree angle and slowly push the plunger to administer the medication.
09
Dispose of the used needles and syringes in a proper container and wash hands again after completing the procedure.

Who needs hematopoietic mixtures?

01
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.
02
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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Hematopoietic mixtures are a combination of different types of blood cells.
Hematopoietic mixtures are typically filed by medical professionals or healthcare facilities.
Hematopoietic mixtures can be filled out by providing detailed information about the types and quantities of blood cells in the mixture.
The purpose of hematopoietic mixtures is to provide a treatment option for patients with certain blood disorders or conditions.
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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