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This version of the form is not currently in use and is provided for reference only. Download this version of
Form F-11049
for the current year.
Form F-11049 Prior Authorization / Drug Attachment (Pa / Dga) - Wisconsin
What Is Form F-11049?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form F-11049?
A: Form F-11049 is the Prior Authorization/Drug Attachment (PA/DGA) form used in Wisconsin.
Q: What is a Prior Authorization/Drug Attachment (PA/DGA) form?
A: A Prior Authorization/Drug Attachment (PA/DGA) form is a document used to request coverage or reimbursement for specific prescription drugs.
Q: Who uses Form F-11049?
A: Form F-11049 is used by healthcare providers in Wisconsin to request prior authorization for certain prescription drugs.
Q: Why do healthcare providers need to use this form?
A: Healthcare providers need to use this form to request approval from the insurance company or managed care organization before prescribing certain medications.
Form Details:
- Released on July 1, 2016;
- 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-11049 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-11049 Prior Authorization / Drug Attachment (Pa / Dga) - Wisconsin
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