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  • Prior Authorization Questionnaire Belatacept Iv Injection

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Date PRIOR AUTHORIZATION QUESTIONNAIRE (belatacept) IV injection M.D. Last Name: Physician Phone: M.D. First Name: Physician Fax: Physician Address: Physician NPI/DEA#: Patient ID# DOB **FAILURE.

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Warnings: This medication may increase the risk for developing serious (even fatal) infections or certain cancers after receiving a kidney transplant. Belatacept may also increase the risk for developing a certain medical condition, post-transplant lymphoproliferative disorder (PTLD), which can become a type of cancer.

The most commonly reported adverse reactions occurring in ≥20% of patients treated with the recommended dose and frequency of were anemia, diarrhea, urinary tract infection, peripheral edema, constipation, hypertension, pyrexia, graft dysfunction, cough, nausea, vomiting, headache, hypokalemia, hyperkalemia, ...

Why is this medication prescribed? Belatacept injection is used in combination with other medications to prevent rejection (attack of a transplanted organ by the immune system of a person receiving the organ) of kidney transplants. Belatacept injection is in a class of medications called immunosuppressants.

Note: (belatacept) has the following black box warnings: Increased risk of developing post-transplant lymphoproliferative disorder (PTLD), predominately involving CNS.

(21) found that belatacept was associated with a 2.36 times increase in adjusted hazard of rejection during a 1-year follow-up, compared with . There was a decrease in risk for new onset diabetes on belatacept (3.8% vs. 2.2%).

Belatacept is a selective T-cell costimulation blocker used in the prophylaxis of organ rejection in adult patients receiving a kidney transplant.

The dose is 10 mg per kg. - Calculated Dose: 64 kg × 10 mg per kg = 640 mg - The closest doses evenly divisible by 12.5 mg below and above 640 mg are 637.5 mg and 650 mg. - The nearest dose to 640 mg is 637.5 mg. - Therefore, the actual prescribed dose for the patient should be 637.5 mg.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232