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*Please ll out all sec ONS of forms, if not applicable write N/A Dr. Was will review all new pa ENT paperwork to determine if he can assume your care at this me. If so, we will contact you for scheduling.

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How to fill out medical use of cocaine

01

Obtain a prescription from a licensed healthcare provider.

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Take the medication as directed by your healthcare provider.

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Report any side effects or concerns to your healthcare provider.

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Store the medication properly and out of reach of children or pets.

Who needs medical use of cocaine?

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Individuals with certain medical conditions such as chronic pain or nasal surgery may be prescribed cocaine for medical use.

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Medical professionals should determine if the benefits of using cocaine outweigh the risks for each individual patient.

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What is medical use of cocaine?

Medical use of cocaine is limited to certain medical procedures, such as nasal surgery, due to its ability to act as a local anesthetic and vasoconstrictor.

Who is required to file medical use of cocaine?

Medical professionals who prescribe and administer cocaine for medical purposes are required to file the necessary documentation.

How to fill out medical use of cocaine?

Medical professionals must accurately document the medical necessity and dosage of cocaine administered, along with the patient's information.

What is the purpose of medical use of cocaine?

The purpose of medical use of cocaine is to provide anesthesia and vasoconstriction during specific medical procedures.

What information must be reported on medical use of cocaine?

Information such as the patient's name, medical history, dosage administered, date of administration, and medical necessity must be reported.

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