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Form F-00841 HMO Referral for Pharmacy Services Lock-In of HMO Member - Pharmacy Services Lock-In Program - Wisconsin
What Is Form F-00841?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form F-00841?
A: Form F-00841 is a referral form for HMO members in Wisconsin who need lock-in services for pharmacy services.
Q: What is the purpose of HMO Referral for Pharmacy Services Lock-In?
A: The purpose is to enroll HMO members in the Pharmacy Services Lock-In Program in Wisconsin.
Q: What is the Pharmacy Services Lock-In Program?
A: The Pharmacy Services Lock-In Program is a program that limits HMO members to using one specific pharmacy for their prescription drug needs.
Q: Who is eligible for the Pharmacy Services Lock-In Program?
A: HMO members who have exhibited excessive utilization of pharmacy services and meet certain criteria are eligible for the program.
Q: What are the benefits of the Pharmacy Services Lock-In Program?
A: The program helps to ensure appropriate use of pharmacy services, prevent drug abuse, and control prescription drug costs.
Q: How can a member be referred to the Pharmacy Services Lock-In Program?
A: A member can be referred by the HMO or by a healthcare professional.
Q: Is the Pharmacy Services Lock-In Program mandatory?
A: Yes, once a member is enrolled in the program, it is mandatory for them to use the designated pharmacy for their prescription needs.
Form Details:
- Released on May 1, 2015;
- The latest edition provided by the Wisconsin Department of Health 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 fillable version of Form F-00841 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-00841 HMO Referral for Pharmacy Services Lock-In of HMO Member - Pharmacy Services Lock-In Program - Wisconsin
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