Form F-00142 Prior Authorization Drug Attachment for Synagis - Wisconsin

Form F-00142 Prior Authorization Drug Attachment for Synagis - Wisconsin

What Is Form F-00142?

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-00142?
A: Form F-00142 is the Prior Authorization Drug Attachment specifically for Synagis in Wisconsin.

Q: What is Synagis?
A: Synagis is a medication used to prevent serious lung infections in high-risk infants, such as those born prematurely.

Q: What is the purpose of the Prior Authorization Drug Attachment?
A: The purpose of the Prior Authorization Drug Attachment is to request approval from the insurance company for coverage of Synagis.

Q: Who needs to submit Form F-00142?
A: Healthcare providers who are prescribing Synagis for their patients in Wisconsin need to submit Form F-00142.

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Form Details:

  • Released on October 1, 2021;
  • 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;

Download a fillable version of Form F-00142 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.

Download Form F-00142 Prior Authorization Drug Attachment for Synagis - Wisconsin

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