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Washington Buprenorphine Transdermal Patch Authorization Request Form

Can You Put Butrans Patch On Thigh

Name: Washington Buprenorphine Transdermal Patch Authorization Request Form
Brand: US Legal Forms
Price: 59.00 USD
Rating: 4.77 (345 reviews)

Category:

Washington Workers Compensation - Official - Claims

State:

Washington

Control #:

WA-SKU-3076

Format:

Instant download

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Description

Buprenorphine Transdermal Patch Authorization Request Form Washington Buprenorphine Transdermal Patch Authorization Request Form is a document used in the state of Washington to request authorization for the use of buprenorphine transdermal patch systems for the treatment of opioid use disorder. The form is completed by a qualified healthcare provider and submitted to the Washington State Department of Health for review and approval. The form includes information on the patient, the prescribing provider, the medication to be prescribed, and the clinical rationale for the request. There are two types of Washington Buprenorphine Transdermal Patch Authorization Request Forms: one for new patients and one for existing patients. Both forms must be completed and submitted to the Washington State Department of Health for review and approval.

Washington Buprenorphine Transdermal Patch Authorization Request Form is a document used in the state of Washington to request authorization for the use of buprenorphine transdermal patch systems for the treatment of opioid use disorder. The form is completed by a qualified healthcare provider and submitted to the Washington State Department of Health for review and approval. The form includes information on the patient, the prescribing provider, the medication to be prescribed, and the clinical rationale for the request. There are two types of Washington Buprenorphine Transdermal Patch Authorization Request Forms: one for new patients and one for existing patients. Both forms must be completed and submitted to the Washington State Department of Health for review and approval.

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

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FAQ

DIRECTIONS FOR USE Wash and dry the area where the transdermal patch must be placed. Choose a non-irritated, intact skin, relatively hairless or nearly hairless skin area on your upper arm, outer arm, upper chest, upper back, or side of the chest to apply the patch.

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

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.

Apply the patch to a clean, dry area. You can choose any area on your stomach, hip, thigh, shoulder, upper arm or flank (side of the body between the ribs and pelvis). Make sure that the area of skin is not oily, cut, blistered or irritated.

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.

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.

The transdermal buprenorphine patch should be applied to intact skin on the flat surfaces of the upper outer arm, upper chest, upper back, or the side of the chest.

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.

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.

Can You Put Butrans Patch On Thigh

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