This document contains official instructions for Form F-01749 , Prior Authorization Drug Attachment for Hypoglycemics, Insulin - Long-Acting - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-01749 is available for download through this link.
Q: What is Form F-01749?
A: Form F-01749 is a prior authorization drug attachment for hypoglycemics, specifically insulin - long-acting.
Q: Who needs to fill out Form F-01749?
A: Form F-01749 needs to be filled out by individuals in Wisconsin who require prior authorization for long-acting insulin.
Q: What is the purpose of Form F-01749?
A: The purpose of Form F-01749 is to request prior authorization for the use of long-acting insulin for the treatment of diabetes.
Instruction Details:
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Wisconsin Department of Health Services.