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Get and Sign Prior Authorization PA Informationpharmacy Medicaid Ohio Gov

Get and Sign Prior Authorization PA Informationpharmacy Medicaid Ohio Gov

Use a ky medicaid prior authorization template to make your document workflow more streamlined.

At least 6 months apart to demonstrate a chronic HCV infection. Date Result Diagnosis Criteria and Simplified Treatment Eligibility Repeat DAA Therapy Questions complete only if requesting repeated DAA therapy Which of the following applies to this patient a. Previously treated for Hepatitis C If so provide details below. Prior HCV treatment experience medication/dates if applicable c. Prescriber specialty check all that apply Gastroenterology Hepatology Infectious Disease HIV Specialist AAHIVS...
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