PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form 1356
for the current year.
Form 1356 Xyrem Standard Pa Addendum (Medicaid) - Texas
What Is Form 1356?
This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 1356 Xyrem Standard Pa Addendum?
A: Form 1356 Xyrem Standard Pa Addendum is a Medicaid form specifically for the state of Texas.
Q: What is Xyrem?
A: Xyrem is a medication used to treat narcolepsy, a sleep disorder.
Q: What is the purpose of Form 1356 Xyrem Standard Pa Addendum?
A: The purpose of this form is to request prior authorization for Xyrem under Medicaid in Texas.
Q: Who needs to fill out this form?
A: This form needs to be filled out by healthcare providers requesting Medicaid coverage for Xyrem on behalf of their patients.
Q: Is Form 1356 Xyrem Standard Pa Addendum specific to Texas Medicaid?
A: Yes, this form is specific to the Medicaid program in the state of Texas.
Form Details:
- Released on May 1, 2018;
- The latest edition provided by the Texas 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 1356 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
