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Form FA-89B Tedizolid (Sivextro) Prior Authorization Request Form - Nevada
What Is Form FA-89B?
This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form FA-89B?
A: Form FA-89B is a Tedizolid (Sivextro) Prior Authorization Request Form.
Q: What is Tedizolid (Sivextro)?
A: Tedizolid (Sivextro) is a medication.
Q: What is a Prior Authorization Request Form?
A: A Prior Authorization Request Form is a form used to request approval for a specific medication.
Q: Who can use Form FA-89B?
A: Form FA-89B can be used by residents of Nevada.
Q: What is the purpose of Form FA-89B?
A: The purpose of Form FA-89B is to request prior authorization for the use of Tedizolid (Sivextro).
Q: What information is required on Form FA-89B?
A: Form FA-89B requires information such as patient details, healthcare provider information, and medical justification for the use of Tedizolid (Sivextro).
Form Details:
- Released on March 22, 2019;
- The latest edition provided by the Nevada Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form FA-89B by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
