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Form FA-152 Epidiolex (Cannabidiol) Prior Authorization Request Form - Nevada
What Is Form FA-152?
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-152?
A: Form FA-152 is the Epidiolex (Cannabidiol) Prior Authorization Request Form used in Nevada.
Q: What is Epidiolex?
A: Epidiolex is a medication that contains the active ingredient Cannabidiol (CBD). It is used to treat certain types of seizures.
Q: What is the purpose of Form FA-152?
A: Form FA-152 is used to request prior authorization for the medication Epidiolex in Nevada.
Q: Who can use Form FA-152?
A: Form FA-152 is used by healthcare providers or their designated representatives.
Q: What information is required on Form FA-152?
A: Form FA-152 requires information such as the patient's personal and insurance details, medical diagnosis, and prescribing healthcare provider.
Q: What should I do if I have questions about Form FA-152?
A: If you have questions about Form FA-152, you should contact your healthcare provider or the Nevada Medicaid program for assistance.
Form Details:
- 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 printable version of Form FA-152 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
