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Form F-00142 Prior Authorization Drug Attachment for Synagis - Wisconsin
What Is Form F-00142?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form F-00142?
A: Form F-00142 is the Prior Authorization Drug Attachment specifically for Synagis in Wisconsin.
Q: What is Synagis?
A: Synagis is a medication used to prevent serious lung infections in high-risk infants, such as those born prematurely.
Q: What is the purpose of the Prior Authorization Drug Attachment?
A: The purpose of the Prior Authorization Drug Attachment is to request approval from the insurance company for coverage of Synagis.
Q: Who needs to submit Form F-00142?
A: Healthcare providers who are prescribing Synagis for their patients in Wisconsin need to submit Form F-00142.
Form Details:
- Released on October 1, 2021;
- The latest edition provided by the Wisconsin Department of Health 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 F-00142 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-00142 Prior Authorization Drug Attachment for Synagis - Wisconsin
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