Chronic Opioid Request Form

Chronic Opioid Request Form - (Forms/Publications)
Document Information
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Title Chronic Opioid Request Form (A fillable form - 169 KB PDF)
Description

Use this form to request opioid coverage beyond 12 weeks from the date of injury or surgery, or every 90 days for chronic opioid therapy.

Detail
Form number F252-091-000
Availability
Order it
Keywords chronic noncancer pain, opioids, pain management, preauthorization, request
Languages English
Valid dates 07-2013
Contact information   - 360-902-5762 -
Office of the Medical Director

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