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IntegraReimbursement Services Center (RSC)Benefit Verification/Prior Authorization Form Wound Reconstruction Reverification WoundProduct to be applied:AmnioExcel Amniotic Allograft Membrane or AmnioExcel
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Ensure all necessary materials are prepared such as sterile gloves, syringe, vials, and labeling stickers.
02
Thaw the amniotic or placental-derived product following the manufacturer's instructions.
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Use aseptic technique to transfer the product to the desired vial or syringe.
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Label the vial or syringe with the appropriate information including patient name, date, and product name.
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Store the filled vial or syringe in the recommended storage conditions until ready for use.

Who needs amniotic and placental-derived product?

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Individuals with injuries or conditions such as osteoarthritis, tendinitis, and wound healing issues may benefit from amniotic and placental-derived products.
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These products are often used in regenerative medicine treatments to promote tissue repair and reduce inflammation.
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Amniotic and placental-derived products are biologically derived materials sourced from amniotic fluid or placental tissues, commonly used in medical treatments and regenerative medicine.
Entities or individuals involved in the collection, manufacturing, or distribution of amniotic and placental-derived products are typically required to file.
Filling out the documentation for amniotic and placental-derived products involves providing accurate information related to sourcing, processing, and intended use, following regulatory guidelines.
The purpose of amniotic and placental-derived products includes promoting healing, reducing inflammation, and facilitating tissue regeneration in various medical applications.
Information that must be reported includes product sourcing details, processing methods, safety data, labeling information, and intended uses.
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