Form ODM10192 Request for Rx Prior Authorization Short-Acting or Long-Acting Opioid Medication - Ohio

What Is Form ODM10192?

This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is ODM10192?
A: ODM10192 is a form used to request prior authorization for short-acting or long-acting opioid medication in Ohio.

Q: What is the purpose of ODM10192?
A: The purpose of ODM10192 is to seek approval from Ohio Department of Medicaid for the use of short-acting or long-acting opioid medication.

Q: Who needs to complete ODM10192?
A: The form needs to be completed by the prescriber or the prescriber's authorized representative.

Q: What information is required on ODM10192?
A: ODM10192 requires information such as patient details, prescribing information, medical history, and reason for the request.

Q: Is ODM10192 specific to Ohio?
A: Yes, ODM10192 is specific to Ohio and is used for requesting prior authorization for opioid medication in the state.

Q: Can ODM10192 be used for all types of opioid medication?
A: Yes, ODM10192 can be used to request prior authorization for both short-acting and long-acting opioid medication.