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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 actemra tocilizumab iv mcrr

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How to fill out Actemra Tocilizumab IV MCRR:

01
Gather all necessary supplies: Actemra Tocilizumab IV MCRR medication, sterile injection equipment, and alcohol swabs.
02
Wash your hands thoroughly with soap and water before handling any of the supplies.
03
Check the expiration date on the Actemra Tocilizumab IV MCRR medication. Do not use if expired.
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Inspect the medication for any signs of damage or discoloration. If it appears abnormal, do not use it and contact a healthcare professional.
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Prepare the injection site by cleaning it with an alcohol swab and allowing it to dry completely.
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Use aseptic technique when handling the Actemra Tocilizumab IV MCRR medication. This means avoiding contact with non-sterile surfaces or substances.
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Ensure the appropriate dosage and volume of Actemra Tocilizumab IV MCRR medication is prescribed and ordered by a healthcare professional.
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If necessary, reconstitute the powdered medication with the appropriate diluent as instructed by a healthcare professional.
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Draw up the correct amount of Actemra Tocilizumab IV MCRR medication into a syringe. Remove any air bubbles from the syringe.
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Administer the medication intravenously as directed by a healthcare professional. Follow the recommended injection technique and guidelines.
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Dispose of all used supplies properly, following the appropriate local regulations.

Who needs Actemra Tocilizumab IV MCRR:

01
Individuals diagnosed with rheumatoid arthritis (RA) may be prescribed Actemra Tocilizumab IV MCRR as a treatment option. RA is a chronic autoimmune disease that affects the joints, causing pain, inflammation, and stiffness.
02
Some patients with giant cell arteritis (GCA), a condition characterized by inflammation of the blood vessels, may also benefit from Actemra Tocilizumab IV MCRR therapy.
03
Actemra Tocilizumab IV MCRR may be used in combination with other medications to treat systemic juvenile idiopathic arthritis (SJIA) in children aged 2 years and older. SJIA is a rare form of arthritis that affects multiple joints and can cause various systemic symptoms.
04
In some cases, Actemra Tocilizumab IV MCRR may be used off-label for other conditions or in clinical trials. This decision should be made by a healthcare professional based on the individual's specific medical needs and circumstances.
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It is crucial to consult with a healthcare professional to determine if Actemra Tocilizumab IV MCRR is suitable and necessary for an individual's medical condition. Only a qualified healthcare professional can determine the appropriate treatment options.
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