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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 Urgent 1 Monument
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Patients with chronic lymphocytic leukemia (CLL): Zydelig idelalisib - rocky is indicated for the treatment of CLL, a type of cancer that affects the white blood cells. It is prescribed to patients who have relapsed CLL or have not responded to other treatments.
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What is zydelig idelalisib - rocky?
Zydelig (idelalisib) is a prescription medicine used to treat certain types of leukemia and lymphoma.
Who is required to file zydelig idelalisib - rocky?
Healthcare providers are required to file Zydelig (idelalisib) usage reports for their patients.
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Healthcare providers need to report the patient's information, dosage, treatment duration, and any side effects experienced during the treatment.
What is the purpose of zydelig idelalisib - rocky?
The purpose of Zydelig (idelalisib) is to effectively treat certain types of leukemia and lymphoma in patients.
What information must be reported on zydelig idelalisib - rocky?
The information that must be reported includes patient details, dosage regimen, treatment duration, and any adverse reactions observed.
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