Form 1033 Texas Vendor Drug Program Synagis Authorization Request (Medicaid) - Texas

Form 1033 Texas Vendor Drug Program Synagis Authorization Request (Medicaid) - Texas

What Is Form 1033?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 1033?
A: Form 1033 is the Texas Vendor Drug Program Synagis Authorization Request (Medicaid) form.

Q: What is the purpose of Form 1033?
A: Form 1033 is used to request authorization for the use of Synagis, a medication, under the Texas Medicaid program.

Q: Who can use Form 1033?
A: Form 1033 is used by healthcare providers participating in the Texas Medicaid program.

Q: What is Synagis?
A: Synagis is a medication used to prevent serious lower respiratory tract infection caused by a respiratory syncytial virus (RSV) in high-risk pediatric patients.

Q: How do I fill out Form 1033?
A: The form requires the healthcare provider to provide patient information, medical history, and justification for the use of Synagis.

Q: Is Form 1033 specific to Texas?
A: Yes, Form 1033 is specific to the Texas Medicaid program.

Q: Is there a fee for submitting Form 1033?
A: No, there is no fee for submitting Form 1033.

Q: How long does it take to receive a decision on Form 1033?
A: The processing time for Form 1033 may vary, but typically a decision is made within a few business days.

Q: Are there any alternative medications to Synagis?
A: There are alternative medications available, but the use of Synagis should be determined based on the patient's specific needs and clinical guidelines.

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Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Texas Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 1033 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.

Download Form 1033 Texas Vendor Drug Program Synagis Authorization Request (Medicaid) - Texas

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