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Form FA-184 Evenity (Romosozumab-Aqqg) Prior Authorization Request Form - Nevada
What Is Form FA-184?
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-184 Evenity?
A: Form FA-184 Evenity is a Prior Authorization Request Form for the medication Romosozumab-Aqqg, also known as Evenity.
Q: What is Romosozumab-Aqqg?
A: Romosozumab-Aqqg is a medication used to treat osteoporosis in postmenopausal women at high risk for fracture.
Q: Why is Form FA-184 Evenity used?
A: Form FA-184 is used to request prior authorization for Romosozumab-Aqqg in the state of Nevada.
Q: How can I obtain Form FA-184 Evenity?
A: You can obtain Form FA-184 Evenity from your healthcare provider or the Nevada Prior Authorization Program.
Q: What information is required on Form FA-184 Evenity?
A: Form FA-184 Evenity requires information such as patient details, medical history, prescriber information, and supporting documentation.
Form Details:
- Released on April 6, 2021;
- 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-184 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
