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Prescriber Criteria Form Marigold Aurelio 2022 PA Fax 3152A v2 010122.docx Aurelio (pexidartinib) Coverage Determination This fax machine is located in a secure location as required by HIPAA regulations.

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How to fill out turalio pexidartinib- prior authorizationnotification

01

Step 1: Obtain the turalio pexidartinib- prior authorizationnotification form from the relevant healthcare provider or insurance company.

02

Step 2: Fill out the patient's demographic information, including their name, date of birth, and contact information.

03

Step 3: Provide the patient's medical history, including any relevant diagnoses and current medications.

04

Step 4: Include detailed clinical documentation supporting the need for turalio pexidartinib treatment, such as pathology reports or imaging results.

05

Step 5: Attach any required supporting documents, such as laboratory test results or previous treatment records.

06

Step 6: Submit the completed turalio pexidartinib- prior authorizationnotification form to the appropriate healthcare provider or insurance company through the designated channels.

07

Step 7: Await a decision from the healthcare provider or insurance company regarding the prior authorizationnotification.

Who needs turalio pexidartinib- prior authorizationnotification?

01

Patients who are prescribed turalio pexidartinib by their healthcare provider.

02

Patients whose insurance policy requires prior authorizationnotification for turalio pexidartinib coverage.

03

Healthcare providers who need to submit a prior authorizationnotification for turalio pexidartinib on behalf of their patients.

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What is turalio pexidartinib- prior authorizationnotification?

Turalio pexidartinib-prior authorization notification is a form that needs to be submitted before receiving approval for the medication Turalio (pexidartinib).

Who is required to file turalio pexidartinib- prior authorizationnotification?

Healthcare providers and facilities are required to file the turalio pexidartinib-prior authorization notification.

How to fill out turalio pexidartinib- prior authorizationnotification?

The turalio pexidartinib-prior authorization notification form must be completed with all relevant patient information and submitted to the appropriate insurance or healthcare organization for approval.

What is the purpose of turalio pexidartinib- prior authorizationnotification?

The purpose of the turalio pexidartinib-prior authorization notification is to obtain approval for the medication Turalio (pexidartinib) from insurance providers or healthcare organizations.

What information must be reported on turalio pexidartinib- prior authorizationnotification?

The turalio pexidartinib-prior authorization notification must include patient demographics, diagnosis, medication dosage, prescribing provider information, and any relevant medical history.

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