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COAGULATION FACTOR VIIaPRIOR AUTHORIZATION REQUEST PRESCRIBER FAX FORM Only the prescriber may complete this form. This form is for prospective, concurrent, and retrospective reviews. The following

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How to fill out coagulation factor viia prior

01

Verify the prescription from your healthcare provider for the correct dose and route of administration.

02

Wash your hands thoroughly with soap and water before handling the medication.

03

Gather all necessary supplies including the vial of coagulation factor VIIa, syringe, alcohol swab, and sterile needle.

04

Clean the vial rubber stopper with an alcohol swab and let it dry.

05

Draw up the prescribed amount of medication into the syringe according to the instructions provided.

06

Administer the medication as directed by your healthcare provider, either intravenously or subcutaneously.

Who needs coagulation factor viia prior?

01

Individuals with inherited or acquired hemophilia A or B with inhibitors to factor VIII or IX may need coagulation factor VIIa prior to surgical or invasive procedures.

02

Patients with congenital factor VII deficiency or other rare bleeding disorders may also require coagulation factor VIIa prior to treatments.

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What is coagulation factor viia prior?

Coagulation factor VIIa prior is a form that needs to be submitted before administering the medication to patients.

Who is required to file coagulation factor viia prior?

Healthcare providers or facilities that are responsible for administering coagulation factor VIIa are required to file the prior authorization form.

How to fill out coagulation factor viia prior?

The form can be filled out electronically or manually by providing all necessary patient and treatment information.

What is the purpose of coagulation factor viia prior?

The purpose of the prior authorization is to ensure that the medication is being used appropriately and for the right patients.

What information must be reported on coagulation factor viia prior?

Information such as patient details, medical history, dosage, frequency of administration, and prescribing physician must be reported on the form.

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