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Prior Authorization (PA) Form for Pulmonary Arterial Hypertension (PAH) Agents. Prior Authorization (PA) Form for Pulmonary Arterial Hypertension (PAH) Agents

Prior Authorization (PA) Form for Pulmonary Arterial Hypertension (PAH) Agents. Prior Authorization (PA) Form for Pulmonary Arterial Hypertension (PAH) Agents 2025

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4.8 out of 5

54 votes

The document is a Prior Authorization Form used by Kaiser Permanente Health Plan of Mid-Atlantic States for the coverage of Pulmonary Arterial Hypertension (PAH) agents. It outlines the necessary patient and provider information, drug therapy requested, diagnosis confirmation, clinical criteria, and provider sign-off requirements. The form must be completed and faxed back within 24 hours for authorization requests to be considered.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (54 Votes)
2018	3.9 Satisfied (28 Votes)

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