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Get Attestation To Administer Alpha Hydroxyprogesterone Caproate (17p) Compound Injections And
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How to fill out the attestation to administer alpha hydroxyprogesterone caproate (17P) compound injections online
Completing the attestation to administer alpha hydroxyprogesterone caproate (17P) compound injections is essential for medical professionals providing this treatment. This guide offers clear, step-by-step instructions for filling out the form accurately and efficiently online.
Follow the steps to complete the form correctly.
- Click ‘Get Form’ button to obtain the form and open it in your editor.
- In Section I, enter the member's information. Fill in their name (last, first, middle initial), member identification number, and date of birth clearly.
- Move to Section II. Here, provide the prescriber's information. This includes the prescriber's name, national provider identifier, address (street, city, state, ZIP+4 code), and telephone number.
- Proceed to Section III. You will need to fill in the diagnosis code and description for the member's condition.
- In Section IV, document the prescriber attestation. Sign to confirm that clinical criteria are met, including a current singleton pregnancy and a history of prior spontaneous pre-term birth with normal cervical length in the current pregnancy.
- Finally, record the prescriber's signature and the date signed. Ensure all information is accurate before proceeding.
- Once completed, you can save your changes, download, print, or share the form as necessary.
Complete your documents online today for a seamless experience.
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