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Form FA-170 Sunosi Prior Authorization Request Form - Nevada
What Is Form FA-170?
This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form FA-170?A: Form FA-170 is the Sunosi Prior Authorization Request Form.
Q: What is Sunosi?A: Sunosi is a medication used to improve wakefulness in adults with excessive daytime sleepiness.
Q: What is the purpose of Form FA-170?A: The purpose of Form FA-170 is to request prior authorization for Sunosi in Nevada.
Q: Who should use Form FA-170?A: Form FA-170 should be used by healthcare providers who want to prescribe Sunosi to their patients in Nevada.
Form Details:
- Released on August 3, 2020;
- The latest edition provided by the Nevada Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form FA-170 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
Download Form FA-170 Sunosi Prior Authorization Request Form - Nevada
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