Get Wisconsin Forward Health Prior Auth F 00556

Filling out the Wisconsin Forward Health Prior Authorization Drug Attachment for Antipsychotic Drugs for Children 7 Years of Age and Younger (F 00556) can be straightforward with the right guidance. This guide will provide you with step-by-step instructions to ensure that you complete the form accurately and efficiently online.

Follow the steps to accurately complete the Prior Auth F 00556 form.

1. Press the ‘Get Form’ button to access the online version of the F 00556 form. This will allow you to start filling out the required fields directly in your web browser.
2. Begin by entering the member information in Section I. Provide the member's last name, first name, middle initial, member identification number, and date of birth.
3. In Section II, fill in the prescription information including the drug name, drug strength, National Drug Code (NDC), date the prescription was written, directions for use, requested start date, prescriber's name, National Provider Identifier (NPI), address, and telephone number.
4. For Section III, enter the diagnosis code and its corresponding description to specify the medical condition being treated.
5. In Section IV, indicate the target symptoms by selecting the appropriate checkbox that applies to the child. Ensure that you only check one target symptom.
6. In Section V, answer whether the child is currently taking a stimulant medication and provide relevant information as required.
7. Calculate and enter the body mass index (BMI) in Section VI. Provide the child's height in inches, weight in pounds, the date of the weight measurement, and the BMI percentile.
8. Complete Section VII by listing recent medical information pertaining to the child’s lipid panel and fasting glucose, if applicable.
9. In Section VIII, state whether the child is currently taking any psychoactive medication aside from the drug being requested, and detail the medication categories and total daily doses.
10. Proceed to Section IX to provide information on any past medications the child has taken within the last 12 months.
11. Indicate the prescriber’s specialty in Section X, choosing the appropriate option from the list provided.
12. If applicable, complete Section XI regarding any previous child psychiatry consultations that the child may have received.
13. In Section XII, if requesting a non-preferred antipsychotic drug, provide required information on past trials of preferred drugs and justify the request.
14. Fill out Section XIII if you are a pharmacy provider using STAT-PA, providing the necessary NDC, days’ supply requested, and associated service details.
15. In the authorized signature section, ensure the prescriber signs and dates the form.
16. Review all entered information for accuracy and completeness. Once satisfied, you can save your changes, download, print, or share the completed form as needed.

Complete your Wisconsin Forward Health Prior Auth F 00556 online with confidence by following these steps.