Norditropin smn 2026

1. Click ‘Get Form’ to open the norditropin smn document in the editor.
2. Begin by filling in the patient’s name, date of birth, and address in the first section. Note that only the patient’s name is required if a demographic sheet is submitted.
3. In the insurance section, provide details about primary and secondary insurance, including subscriber names and member IDs. Attach copies of both sides of the insurance cards as needed.
4. Complete the diagnosis section by selecting the appropriate ICD-9 codes for conditions such as GHD or Turner syndrome. Ensure accuracy for proper treatment authorization.
5. Fill out physician information, including name, license number, and contact details. This section certifies that the therapy is medically necessary.
6. Finally, ensure that all signatures are obtained where required, especially from the patient’s legal guardian on the Patient Authorization form.

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