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Washington Buprenorphine Transdermal Patch Authorization Request Form

Washington Buprenorphine Transdermal Patch Authorization Request Form

Name: Washington Buprenorphine Transdermal Patch Authorization Request Form
Brand: US Legal Forms
Price: 59.00 USD
Rating: 4.64 (343 reviews)

Category:

Washington Workers Compensation - Official

State:

Washington

Control #:

WA-SKU-3423

Format:

Instant download

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Description

Buprenorphine Transdermal Patch Authorization Request Form The Washington Buprenorphine Transdermal Patch Authorization Request Form is a document provided by the Washington State Health Care Authority (HCA) to authorize the prescribing of buprenorphine transdermal patches to treat opioid addiction in eligible patients in the state of Washington. The form includes information about the patient's medical history, the diagnosis of opioid addiction, and the patient's treatment plan. The form must be completed and signed by the prescribing provider, the patient, and the patient's guardian (if applicable). There are two types of Washington Buprenorphine Transdermal Patch Authorization Request Forms: the short form and the long form. The short form is used to authorize the prescribing of up to a three-month supply of buprenorphine transdermal patches. The long form is used to authorize the prescribing of up to a six-month supply of buprenorphine transdermal patches.

The Washington Buprenorphine Transdermal Patch Authorization Request Form is a document provided by the Washington State Health Care Authority (HCA) to authorize the prescribing of buprenorphine transdermal patches to treat opioid addiction in eligible patients in the state of Washington. The form includes information about the patient's medical history, the diagnosis of opioid addiction, and the patient's treatment plan. The form must be completed and signed by the prescribing provider, the patient, and the patient's guardian (if applicable). There are two types of Washington Buprenorphine Transdermal Patch Authorization Request Forms: the short form and the long form. The short form is used to authorize the prescribing of up to a three-month supply of buprenorphine transdermal patches. The long form is used to authorize the prescribing of up to a six-month supply of buprenorphine transdermal patches.

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How to fill out Washington Buprenorphine Transdermal Patch Authorization Request Form?

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FAQ

You can apply a buprenorphine patch to your upper outer arms, upper chest, upper back, or the side of your chest. Choose an area of skin that is flat and hairless. Do not apply the patch to parts of the body that irritated, broken, cut, damaged, or changed in any way.

Training Video For Application of Transdermal Patches - YouTube YouTube Start of suggested clip End of suggested clip Underneath. You must avoid touching the sticky adhesive surface. With your fingers. Again toMoreUnderneath. You must avoid touching the sticky adhesive surface. With your fingers. Again to reiterate the skin we're applying the patch should not be wet oily.

How to use Buvalor 10mg Transdermal Patch? Buvalor 10mg Transdermal Patch should be applied to a clean, dry, rash-free, hairless, or nearly hairless area of skin on the upper chest, back, or arm, or side of the chest.

Each patch should be worn continuously for 7 days. The new patch should be applied on a different skin area, preferably at the same time of day as the previous patch. Do not apply to the same skin area for the next 3-4 weeks. The patch should not fall off when you bathe or swim.

Choose an area of non-irritated, intact skin on your upper arm, outer arm, upper chest, upper back or side of the chest. Ask for assistance if you cannot apply the patch yourself. The Buprenorphine patch should be applied to a relatively hairless or nearly hairless skin site.

Starting a buprenorphine patch Apply patch; continue the immediate release opioid 4 hourly for the next 12 hours. Apply patch when the last dose of a 12 hourly, modified release opioid is given. Apply the patch and continue the infusion for the next 12 hours, then stop the infusion.

BUTRANS contains buprenorphine, a Schedule III controlled substance. BUTRANS exposes users to the risks of opioid addiction, abuse, and misuse.

More info

Please fax the completed form along with any supportive medical documentation to: 360-902-6315 Attention: Drug Review Program. Buprenorphine Transdermal Patch: learn about side effects, dosage, special precautions, and more on MedlinePlus.Butrans (buprenorphine). Prior Authorization Request Form. Step. 1. Dosage Form(s) Under. Review. Please complete this entire form and fax it to: 866-940-7328. All MCOs and FFS use the same Prior Authorization Request Form. Active Ingredient: buprenorphine. Active Ingredient: buprenorphine. Fax requests: Complete the applicable form below and fax it to 1-855-681-8650.

Washington Buprenorphine Transdermal Patch Authorization Request Form

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How do you administer buprenorphine patches?

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