Instructions for Form F-01952 Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (Cam) Antagonist Drugs for Deficiency of Interleukin-1 Receptor Antagonist (Dira), Giant Cell Arteritis, Neonatal Onset Multisystem Inflammatory Disease (Nomid), and Non-radiographic Axial Spondyloarthritis (Nr-Axspa) - Wisconsin
This document contains official instructions for Form F-01952 , Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (Cam) Antagonist Drugs for Deficiency of Interleukin-1 Receptor Antagonist (Dira), Giant Cell Arteritis, Neonatal Onset Multisystem Inflammatory Disease (Nomid), and Non-radiographic Axial Spondyloarthritis (Nr-Axspa) - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-01952 is available for download through this link.
FAQ
Q: What is Form F-01952?A: Form F-01952 is a prior authorization drug attachment for certain conditions.
Q: What is the purpose of Form F-01952?A: The purpose of Form F-01952 is to request prior authorization for cytokine and cell adhesion molecule (CAM) antagonist drugs for specific conditions.
Q: Which conditions are covered by Form F-01952?A: Form F-01952 covers deficiency of interleukin-1 receptor antagonist (DIRA), giant cell arteritis, neonatal onset multisystem inflammatory disease (NOMID), and non-radiographic axial spondyloarthritis (NR-axSpA).
Q: What types of drugs are covered by Form F-01952?A: Form F-01952 covers cytokine and cell adhesion molecule (CAM) antagonist drugs.
Q: Who should use Form F-01952?A: Form F-01952 should be used by healthcare providers who are requesting prior authorization for cytokine and CAM antagonist drugs for the specified conditions.
Instruction Details:
- This 3-page document is available for download in PDF;
- Actual and applicable for the current year;
- Complete, printable, and free.
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Wisconsin Department of Health Services.
Download Instructions for Form F-01952 Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (Cam) Antagonist Drugs for Deficiency of Interleukin-1 Receptor Antagonist (Dira), Giant Cell Arteritis, Neonatal Onset Multisystem Inflammatory Disease (Nomid), and Non-radiographic Axial Spondyloarthritis (Nr-Axspa) - Wisconsin
1
2
3
