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UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM CONTAINS CONFIDENTIAL PATIENT INFORMATION Complete this form in its entirety and send to Rocky Mountain Health Plans at 8583572538 Initial Request
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How to fill out c1 esterase inhibitor:

01
Make sure that you have received proper training and guidance from a healthcare professional on how to administer the medication.
02
Wash your hands thoroughly with soap and water before preparing the c1 esterase inhibitor. This helps maintain proper hygiene and minimizes the risk of infection.
03
Check the expiration date and color of the medication. If it is expired or the color has changed, do not use it and consult with a healthcare professional.
04
Ensure that you have the necessary equipment, such as syringes, vials, or infusion pumps, as recommended by your healthcare provider.
05
Follow the instructions provided by your healthcare provider for reconstituting or preparing the medication. This may involve mixing the contents of the vial with a diluent or sterile solution.
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Use aseptic techniques while handling the medication to prevent contamination. This may include disinfecting the vial top with an alcohol swab and using sterile needles or syringes.
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Calculate the appropriate dosage of the c1 esterase inhibitor based on the instructions provided by your healthcare provider. This may be determined by factors such as your weight, medical condition, and severity of symptoms.
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Administer the medication as instructed by your healthcare provider. This may involve injecting it subcutaneously (under the skin) or intravenously (into a vein). Follow the recommended injection site and technique.
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Dispose of any unused medication or equipment in an appropriate manner, as instructed by your healthcare provider or local regulations.

Who needs c1 esterase inhibitor:

01
Individuals with hereditary angioedema (HAE) may require c1 esterase inhibitor therapy. HAE is a rare genetic disorder characterized by recurrent episodes of swelling, typically involving the face, limbs, intestinal tract, or airway.
02
Some individuals with acquired angioedema (AAE), which is a non-hereditary form of angioedema, may also benefit from c1 esterase inhibitor treatment. AAE can be associated with underlying conditions such as autoimmune disorders or certain types of cancer.
03
C1 esterase inhibitor therapy may also be recommended for individuals undergoing certain medical procedures, such as cardiac surgery or organ transplantation, to prevent or manage angioedema attacks that can occur due to the release of inflammatory mediators.
It is important to note that the specific indications for c1 esterase inhibitor therapy may vary based on individual patient characteristics and healthcare provider recommendations. Therefore, it is crucial to consult with a healthcare professional for personalized advice and treatment decisions.
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C1 esterase inhibitor is a protein in the blood that helps control inflammation and swelling.
Patients with hereditary angioedema may need to receive c1 esterase inhibitor treatment and their healthcare providers may need to file it.
C1 esterase inhibitor can be administered via intravenous infusion or subcutaneous injection by a healthcare professional.
The purpose of c1 esterase inhibitor is to prevent or reduce swelling attacks in patients with hereditary angioedema.
The dose administered, route of administration, and any side effects experienced must be reported on c1 esterase inhibitor.
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