IR PROCEDURE REFERENCE GUIDE
|
|
- Letitia Reeves
- 6 years ago
- Views:
Transcription
1 IR PROCEDURE REFERENCE GUIDE Procedure Scan Involvement Preparation Length For Procedure CT CT BIOPSIES/ DRAINS Done per Radiologist in CT (Must be pre-approved by Radiologist) NPO after midnight or 6 hours to May take am meds EXCEPT diabetic/ anticoagulants/ antiplatelets PT/INR/Platelets Off anticoagulants /antiplatelets 3-5 days BX Takes 1 hour to complete/ Drains take 1+ hours to complete Pt. will get sedation- Must have driver post 2-4 hours recovery CARDIAC CTA Used to evaluate Cardiac anatomy NPO 6 hours No caffeine 12 hrs May take am meds, EXCEPT diabetic or ED meds Do not take Excedrin 12 hrs Do not exercise to test IODINE Allergies? Need premedicated Must have Creatinine level drawn within 30 days of exam, if needed. (over 65,diabetic,kidney disease or multiple myeloma) Pt will receive Valium Takes at least 2 hours to complete Must not drive post - bring driver Hospital Departments/Imaging Page 1 Rev 1/2017
2 MRI MRI SEDATION ANY NPO for 6 Hours Prior to Exam Adult patients will receive Valium Takes at least 2 hours to complete depending on scan Pt. will get sedation- Must not drive post Must be scheduled with Radiology RN Hospital Departments/Imaging Page 2 Rev 1/2017
3 Procedure Purpose Preparation Length For Procedure ULTRA SOUND LIVER BIOPSY Obtain liver tissue for needed diagnosis NPO 6hours Off anticoagulants/ antiplatelets for 3-5 days PT/ INR/Platelets to BX May take am meds EXCEPT diabetic/ anticoagulants/ antiplatelets Takes minutes to complete PT will get sedationmust have driver PT must stay 2-4 hours post BX for recovery PARACENTESIS Drainage of Fluid from Abdomen May have light meal PT/ INR/Platelets Off anticoagulants/ antiplatelets for 3-5 days Takes 60 minutes to complete THORACENTESIS Drainage of Fluid from Chest THYROID/SOFT TISSUE BIOPSY Obtain thyroid tissue for needed diagnosis May have light meal Off anticoagulants / antiplatelets for 3-5 days PT/INR/Platelets May have light meal Off anticoagulants/ antiplatelets 3-5 days PT/INR/Platelets for all except Thyroid Takes 60 minutes to complete Takes 60 min to complete Hospital Departments/Imaging Page 3 Rev 1/2017
4 XRAY LUMBAR PUNTCURE Obtain spinal fluid for analysis May have light meal PT/ INR/Platelets Off anticoagulants/ antiplatelets for 3-5 days Takes minutes to complete 2-4 hours for recovery Patient will need a driver PERCUTANEOUS BIOPSY/ IR PROCEDURES REQUIRING SEDATION NPO 6 hours Antibiotics? PT/INR and Platelets Off anticoagulants/ antiplatelets 3-5 days Takes 60 minutes -2 hours to complete Patient will need a driver 2-4 hours for recovery Hospital Departments/Imaging Page 4 Rev 1/2017
5 Myelogram Examination of structures within spinal column May have light meal This test involves *Iodine* Premedicate if Iodine allergy No caffeine after 7pm the night before Drink 2-3 large glasses of water night before and morning of Patient will receive Valium See list of medications to HOLD below Off anticoagulants/ antiplatelets for 3-5 days PT/ INR, if on coumadin Takes 30 min to complete, CT scan after. 2-4 hours for recovery Pt needs a driver Hospital Departments/Imaging Page 5 Rev 1/2017
6 Myelogram Medications These medications should not be taken 48 hours and 24 hours after Myelography. Phenothiazines Antidepressants MAO Inhibitors CNS Stimulants Antipsychotic/ Tranquilizers Compazine Chlorpromazine Etrafon Fluphenazine Mellaril Navane Permitil Perphenazine Phenergan Pherazine Prochlorperazine Procomp Prolixin Promapar Prometh fortis Promethazine Sonazine Stelazine Thioridazine Thiothixene Thorazine Triavil Trifluoperazine Trilafon Amitid Amitril Amitriptyline Amoxapine Anafranil Aventyl Bupropion Clomipramine Cymbalta Desipramine Desvenlafaxine Doxepin Duloxetine Effexor Elavil Etrafon Fluoxetine Imipramine Limbitrol Maprotiline Nopramin Nortriptyline Pamelor Pertofrane Pramine Pristiq Protriptyline Prozac Sarafem Silenor Sinequan Surmontil Symbyax Tofranil Trimipramine Venlafaxine Vivactil Wellbutrin Zonalon Zyban Azilect Atapryl Carbex Eldepryl Emsam Isocarboxazid Isoniazid Linezolid Marplan Nardil Parnate Phenelzine Rasagililne Rifamate Rifater Selegiline Tranylcypromine Zelapar Zyvox Adderall Adipex All caffeine Containing Products Amphetamines Aminophylline Anoquan Armodafinil Awake Benzedrine Benzphetamine Biphetamine Bontril Cafcit Cafergot Concerta Daytrana Delcobese Desoxyephedrine Desoxyn Dexampex Dexedrine Dexmethylphenidate Dextroamphetamine Dextrostat Didrex Diethylpropion Dopram Doxapram Esgic Excedrin Fastin Femcet Fioricet Fiorinal Focalin Invagesic Ionamin Lanorinal Lisdexamfetamine Medigesic Plus Metadate Methampex Methamphetamine Methylin Methylphenidate Migergot Modafinil Abilify Aripiprazole Asenapine Clozapine Droperidol Eskalith Fanapt Fazaclo ODT Geodon Haldol Haloperidol Iloperidone Inapsine Invega Latuda Lithane Lithium Lithobid Lithotabs Loxapine Loxitane Lurasidone Mellaril Navane Olanzapine Orap Paliperidone Pimozide Quetiapine Relprevv Risperdal Risperidone Saphris Seroquel Symbyax Thiothixene Ziprasidone Zydis Zyprexa Hospital Departments/Imaging Page 6 Rev 1/2017
7 Nodoz Norgesic Nuvigil Orphengesic Paredrine Phentermine Phendimetrazine Pre-Sate Provigil Qsymia Ritalin Suprenza Synalgos-DC Theo-24 Theo-Dur Theophylline Tenuate Vivarin MISCELLANEOUS Buspar Rybix Ultracet Buspirone Ryzolt Ultram Conzip Tramadol These Anticoagulant medications should not be taken 3-5 days and 24 hours after Myelography. Anticoagulants Aspirin Coumadin/Warfarin Heparin Lovenox Plavix/Clopidogrel Pradaxa/Dabigatran Effient/Prasugrel Brilinta/Ticagrelor Xarelto/Rivaroxaban *any other medication containing Aspirin Hospital Departments/Imaging Page 7 Rev 1/2017
Medications and Children Disorders
Mental Health Comprehensive Services Providing Family Stability and Developing Life Coping Skills Medications and Children Disorders Psychiatric medications can be an effective part of the treatment for
More informationAppendix: Psychotropic Medication Reference Tables
Appendix: Psychotropic Medication Reference Tables How to Use these Tables These reference tables are designed to provide clinic staff with specific medication related criteria for the Polypharmacy, Cardiometabolic
More informationDealing with a Mental Health Crisis
Dealing with a Mental Health Crisis Information and Resources for First Responders P... PROFESSIONAL WHAT NAMI DOES NAMI Minnesota is a statewide 501(c)(3) grassroots nonprofit organization dedicated to
More informationIMPORTANT NOTICE. Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members
IMPORTANT NOTICE Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members These changes apply only to members covered under the DC Healthcare Alliance program Alliance
More informationMO Medicaid Foster Care Drugs FY10-FY14
MO Medicaid Foster Care Drugs FY10-FY14 Medicaid (MO HealthNet) Cost of Drugs given to Missouri Foster Care Children by combinations of Age, Gender, Drug Class and Fiscal Year [Raw Data Provided by Missouri
More informationU T I L I Z A T I O N E D I T S
I N D I A N A H E A L T H C O V E R A G E P R O G R A M S U T I L I Z A T I O N E D I T S A P R I L 1 9, 2 0 1 2 s for s Refer to Provider Bulletin BT200709 for additional information regarding the Mental
More informationUSF Health Psychiatry Clinic. New Patient Questionnaire Adult
USF Health Psychiatry Clinic New Patient Questionnaire Adult Please mail or fax the completed forms to the address/fax number on the bottom of this page. Completed forms must be received five (5) days
More informationJudges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children
Judges Reference Table for the Psychotropic Medication Utilization Parameters for Foster Children Stimulants for treatment of ADHD Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages 13-17
More informationHCA BHS Prescribing Guidelines Committee - Approved Medications 2012
Amitriptyline/Perphenazine Triavil MAJOR TRANQUILIZERS Beneficiaries 10/2, 10/4, 25/2, 25/4, 50/4 Aripiprazole Abilify 2mg, 5mg, 10mg, 15mg, 20mg, 30mg Quantity Limit 31 / mo for Asenapine Saphris 5mg,
More informationGuide to Psychiatric Medications for Children and Adolescents
Guide to Psychiatric Medications for Children and Adolescents by Glenn S. Hirsch, M.D. The following guide includes most of the medications used to treat child and adolescent mental disorders. It lists
More informationReview of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)
Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder
More informationPATIENT FACE SHEET PATIENT NAME: PATIENT DOB: PATIENT PHONE #: INSURANCE: MEMBER ID: GROUP NUMBER: PATIENT ADDRESS
1 P a g e PATIENT FACE SHEET PATIENT NAME: PATIENT DOB: PATIENT PHONE #: INSURANCE: MEMBER ID: GROUP NUMBER: PATIENT ADDRESS PRIOR AUTHORIZATION #: (for office use only) INS. CONTACT NAME/ DIRECT NUMBER:
More informationOverview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials
SPEAKER NOTES Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials Summarized by Thomas T. Thomas New psychotropic medications are coming on the
More informationMental Health Medications. National Institute of Mental Health. U.S. Department of HealtH and HUman ServiceS National Institutes of Health
Mental Health Medications National Institute of Mental Health U.S. Department of HealtH and HUman ServiceS National Institutes of Health Contents Mental Health Medications...1 What are psychiatric medications?...1
More informationA Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer
A Brief Overview of Psychiatric Pharmacotherapy Joel V. Oberstar, M.D. Chief Executive Officer Disclosures Some medications discussed are not approved by the FDA for use in the population discussed/described.
More informationPharmacy Benefit Management (PBM) Program FORMULARY/PRODUCT RESTRICTIONS
Workforce Safety & Insurance Revised Document Date: 07/21/2015 1600 E Century Ave Ste 1 PO Box 5585 Bismarck, ND 58506-5585 701.328.3800 1.800.777.5033 www.workforcesafety.com Pharmacy Benefit Management
More informationSupplement: Tables and Figures
Supplement: Tables and Figures Supplement Table 1. Baseline Characteristics by Study and Efavirenz Assignment Supplement Table 2. Baseline Psychoactive Medications by Efavirenz Assignment* Supplement Table
More informationCENPATICO INTEGRATED CARE BEHAVIORAL HEALTH DRUG LIST BY DRUG NAME. Use Brand Only
ACAMPROSATE TABLET DELAYED RELEASE ALPHA-TOCOPHEROL CAPSULES ALPRAZOLAM CONCENTRATE 1 MG/ML ALPRAZOLAM ODT TABLET 0.25MG, 0.5MG, 1MG ALPRAZOLAM ODT TABLET 2MG ALPRAZOLAM SR TABLET 24-HOUR ALPRAZOLAM TABLET
More informationMay 22, DAL: DAL SUBJECT: Hot Weather Advisory. Dear Administrator/Operator:
May 22, 2013 DAL: DAL 13-11 SUBJECT: Hot Weather Advisory Dear Administrator/Operator: The New York State Department of Health would like to remind you of our expectations regarding the protection of Adult
More informationHOSPITAL BASED INPATIENT PSYCHIATRIC SERVICES (HBIPS) MEASURE SET
HOSPITAL BASED INPATIENT PSYCHIATRIC SERVICES (HBIPS) MEASURE SET Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: February, 2013 Most recently revised: December 2018 The Psychiatric Measure Set CMS
More informationSchedule FDA & literature based indications
Psychotropic Medication List Recommended dosages are intended to serve only as a guide for children. Recommended doses are literature based. Clinicians should consult package insert of medications for
More informationPsychiatric Intake Form (Please note: if you are not comfortable answering any of the following questions, feel free to leave the space blank)
Past Psychiatric History: What issues or symptoms bring you to this practice? When did these symptoms start? Are the symptoms constant or intermittent? List any previous psychiatric conditions you have
More informationAttention: Behavioral Health Providers, Pharmacists and Prescribers N.C. Medicaid and N.C. Health Choice Preferred Drug List Changes - UPDATE
Attention: Behavioral Health Providers, Pharmacists and Prescribers N.C. Medicaid and N.C. Health Choice Drug List Changes - UPDATE Note: This article was previously published in the December 2014 Medicaid
More information90 dosage units per 90 days OR. Extended-release Formulations Ultram ER 90 dosage units per 90 days OR
Pre - PA Allowance 12 years of age or older Quantity Immediate-release Formulation Ultracet 720 dosage units per 90 days OR Ultram 720 dosage units per 90 days Extended-release Formulations Ultram ER 90
More informationPsychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA
Psychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA Goals of Medications Use least number at lowest dose to get
More information1911 Keller Andrews Road Sanford, NC
1911 Keller Andrews Road Sanford, NC 27330 919.777.9355 www.wellcenteredcounseling.com Well CENTERED Today's date: Patient Information: Individual Name: Date of Birth: Age: (first) (last) Gender M/F Ethnicity
More informationThank you for choosing Pine Rest Christian Mental Health Services. We look forward to providing services to you.
Thank you for choosing Pine Rest Christian Mental Health Services. We look forward to providing services to you. In order to make the most of your first appointment, please come at least 30 minutes prior
More informationUse Brand Only. Preferred Drug Status PRIOR AUTHORIZATION REQUIRED
Generic Drugs Are Over Brand Drugs Unless Specified As Brand ANTIDEPRESSANTS ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS MIRTAZAPINE REMERON 30 30 MIRTAZAPINE REMERON SOLTAB 30 30 ISOCARBOXAZID TABLETS
More informationPROBE INITIAL ZERO/ DK: Please include any prescription medicines, even if you took them only once.
04/18/01 PHARMACOEPIDEMIOLOGY (PH) *PH1. The next questions are about your use of medicines. First, how many different kinds of prescription medicine have you taken during the past seven days? (IF NEC:
More informationIowa Medicaid Mental Health Advisory Group Meeting February 13, Tentative Agenda
CHESTER J. CULVER, GOVERNOR PATTY JUDGE, LT. GOVERNOR DEPARTMENT OF HUMAN SERVICES EUGENE I. GESSOW, DIRECTOR Iowa Medicaid Mental Health Advisory Group Meeting February 13, 2009 Location: Iowa Medicaid
More informationYouth Indicator Set. Technical Specifications. July NYS Office of Mental Health
Youth Indicator Set July 2010 Technical Specifications NYS Office of Mental Health Youth Indicators Documentation 2 The PSYCKES Youth Indicators Technical Specifications Youth Psychotropic Prescribing
More informationABILIFY INJ. Products Affected Step 2: ABILIFY MAINTENA PREFILLED SYRINGE 300 MG INTRAMUSCULAR ABILIFY MAINTENA PREFILLED SYRINGE 400 MG INTRAMUSCULAR
ABILIFY INJ ABILIFY MAINTENA PREFILLED SYRINGE 300 MG ABILIFY MAINTENA PREFILLED SYRINGE 400 MG ABILIFY MAINTENA SUSPENSION RECONSTITUTED ER 300 MG Claim will pay automatically for ABILIFY MAINTENA if
More informationTRANSCRANIAL MAGNETIC STIMULATION & BRAIN MUSIC THERAPY
TMS - DEPRESSION HISTORY Date: Patient Name: DOB: How did you hear about TMS? What do you know about TMS? Referring Physician? Name of Practice: Name of Inpatient Treatment for Depression: Name of Inpatient
More informationStudy Guidelines for Quiz #1
Annex to Section J Page 1 Study Guidelines for Quiz #1 Theory and Principles of Psychopharmacology, Classifications and Neurotransmitters, Anxiolytics/Antianxiety/Minor Tranquilizers, Stimulants, Nursing
More informationPsychiatric Evaluation Intake Form
Psychiatric Evaluation Intake Form 1. Patient Contact Information Patient Name Preferred Name Last First MI Address Best contact phone number: Email address: Primary Care Physician Tel Fax Pharmacy Phone
More informationAHCCCS BEHAVIORAL HEALTH DRUG LIST EFFECTIVE OCTOBER 1, 2016
Generic Drugs Are Preferred Over Brand Name Drugs Unless Specified As Brand Only Federally Reimbursable Drugs Not Listed On The AHCCCS Drug List Are Available Through Prior Authorization Effective Date
More informationPsychiatric Evaluation Intake Form
Psychiatric Evaluation Intake Form 1. Patient Contact Information Date Patient Name Address Best contact phone number Email address Emergency contact Relationship Phone No Primary Care Physician Tel Fax
More informationNew Patient Information - Adolescent
Scanned Ages 12-17 Dear Parent: To help your clinician understand and help your child, please answer the questions on this form and bring it with you to your child s first appointment. Please print using
More informationPHARMACOGENETICS TESTING MENU
PHARMACOGENETICS TESTING MENU Pharmacogenetics and the Patient Seeking Recovery Pharmacogenetics, as the name suggests, refers to the combined study of medications and inherited genetic traits. The manner
More informationSteps for Initiating Electroconvulsive Therapy Treatment
Steps for Initiating Electroconvulsive Therapy Treatment PSYCHIATRISTS CAN REFER PATIENTS FOR ECT TREATMENT AT EL CAMINO HOSPITAL BY CALLING THE ECT NURSE COORDINATOR AT 650-962-5795. Once the referral
More informationCHILD/ADOLESCENT INTAKE FORM
CHILD/ADOLESCENT INTAKE FORM Today's date: 703-437-6311 www.centerforlifestrategies.com Patient Information: Individual Name: Date of Birth: Age: (fi rst) ( la st) Gender M/F Ethnicity (optional): Name
More informationPharmacy Benefit Management (PBM) Program FORMULARY/PRODUCT RESTRICTIONS
Workforce Safety & Insurance Revised Document Date: 07/23/2015 1600 E Century Ave Ste 1 PO Box 5585 Bismarck, ND 58506-5585 701.328.3800 1.800.777.5033 www.workforcesafety.com Pharmacy Benefit Management
More informationCENPATICO INTEGRATED CARE BEHAVIORAL HEALTH DRUG LIST BY DRUG CLASS
ANTIDEPRESSANTS ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS MIRTAZAPINE ODT TABLETS 15 MG REMERON SOL 90 30 MIRTAZAPINE ODT TABLETS 30 MG REMERON SOL 45 30 MIRTAZAPINE ODT TABLETS 45 MG REMERON SOL 30
More informationPHYSICIAN REFERENCE ANTIDEPRESSANT DOSING GUIDELINES
PHYSICIAN REFERENCE ANTIDEPRESSANT DOSING GUIDELINES Table of Contents Print TABLE OF CONTENTS Drug Page Number Anafranil... 2 Asendin... 4 Celexa... 4 Cymbalta... 6 Desyrel... 8 Effexor...10 Elavil...14
More informationDuragesic Patch (fentanyl patch) Prior authorization is not required if prescribed by an oncologist
Pre - PA Allowance Quantity 30 patches every 90 days Prior-Approval Requirements Prior authorization is not required if prescribed by an oncologist Age 2 years of age or older Diagnosis Patient must have
More informationAPPENDIX E COMMONLY PRESCRIBED MEDICATIONS BY CATEGORY BY BRAND (GENERIC)
APPENDIX E COMMONLY PRESCRIBED MEDICATIONS BY CATEGORY BY BRAND (GENERIC) Revised June 2005 Page E-1 Prescribed Medications by Category by Brand This is not an all-inclusive list ANTIPSYCHOTICS ANTIDEPRESSANTS
More informationADHD Medications Table
Stimulants are the first line treatment of choice for ADHD followed by Non-Stimulants, then off-label medications. We are providing this list of medications so that you can be familiar with the common
More informationHEDIS BEHAVIORAL HEALTH RESOURCE GUIDE
HEDIS BEHAVIORAL HEALTH RESOURCE GUIDE What is HEDIS? 3 HEDIS Reference Guide for Behavioral Health 4 Behavioral Health HEDIS Measures 13 WHAT IS HEDIS? HEDIS (Healthcare Effectiveness Data and Information
More informationOBJECTIVES PSYCHOTROPIC MEDICATIONS WHAT IS PSYCHOTROPIC MEDICATION?
PSYCHOTROPIC MEDICATIONS Sally Davies, Ph.D., HSPP Licensed Psychologist OBJECTIVES 1. Identify psychotropic medications and the typical usages 2. Identify effective methods for the practical application
More informationHappy Daisy Ltd. New Client intake Form. What are the issues for which you are seeking care?
Happy Daisy Ltd. New Client intake Form Name Date Preferred name Pronouns Referred by Date of birth Age Race What are the issues for which you are seeking care? 1. 2. 3. Please check of any of the symptoms
More informationNew Patient Questionnaire
4 Embarcadero Center, Suite 1400, San Francisco, CA 94111 (415) 926-7774 phone; (415) 591-7760 office@sanfranciscopsych.com New Patient Questionnaire Thank you for trusting San Francisco Psychiatry with
More informationAntidepressant Medication Strategies We ve Come a Long Way or Have We? Who Writes Prescriptions for Psychotropic Medications. Biological Psychiatry
Antidepressant Medication Strategies We ve Come a Long Way or Have We? Joe Wegmann, PD, LCSW The PharmaTherapist Joe@ThePharmaTherapist.com 504.587.9798 www.pharmatherapist.com Are you receiving our free
More informationBriefly state the reason for this evaluation: Patient s Name: Sex: Male/Female (circle one) Date of Birth: Age: Patient s Social Security #
Psychiatric Evaluation Form After Hours Psychiatry, PLLC Aaron Alaniz, M.D. 25722 Kingsland Blvd, Suite 202 Katy, TX 77494 T: 281-978-2515 F: 281-978-2895 Briefly state the reason for this evaluation:
More informationALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES MEDICATION FORMULARY
ANTIDEPRESSANTS Serotonin Selective Reuptake Inhibitors citalopram 10, 20, 40 mg, 10 mg/5cc $ 0.40 No escitalopram 10, 20 mg $ 2.60 Yes fluoxetine 10, 20 mg, 20 mg/5 ml $ 0.40 Yes fluvoxamine 25, 50, 100
More informationHYSINGLA ER (hydrocodone bitartrate) Prior authorization is not required if prescribed by an oncologist.
Pre - PA Allowance None Prior authorization is not required if prescribed by an oncologist. Prior-Approval Requirements Age 18 years of age or older Diagnosis Patient must have the following: 1. Pain,
More informationWelcome and thank you for choosing University of Florida Physicians!
DEPARTMENT OF PSYCHIATRY Tuesday, Division of March Child and 14, Adolescent 2017 Psychiatry 8491 NW 39 th Ave. Gainesville, FL 32606 Phone: 352-265-4357 Fax: 352-627-4163 Welcome and thank you for choosing
More informationPre - PA Allowance. Prior-Approval Requirements LEVORPHANOL TARTRATE. None
Pre - PA Allowance None Prior-Approval Requirements Prior authorization is not required if prescribed by an oncologist and/or the member has paid pharmacy claims for an oncology medication(s) in the past
More informationMORPHINE IR DRUG CLASS Morphine IR, Dilaudid IR (hydromorphone), Opana IR (oxymorphone)
Pre - PA Allowance Tablets & Suppositories Morphine sulfate tablets Morphine sulfate suppositories Oxymorphone tablets Hydromorphone tablets Hydromorphone suppositories 360 tablets per 90 days OR 360 suppositories
More informationCONTRAINDICATIONS TABLE
CONTRAINDICATIONS TABLE Generic Name Brand Name Contraindications Amphetamine Salts Adderall, Adderall XR Hypersensitivity to amphetamine, dextroamphetamine, or other sympathomimetic amines Advanced arteriosclerosis
More informationPatient History Form
Patient History Form Date: / / NAME: Last First Middle Birthdate: / / Age: Sex: F M Please read the following questions and answer to the best of your ability by placing a check mark in the appropriate
More informationPSYCHIATRIC HISTORY 6. Are you currently seeing a therapist? (Name & contact phone#)
Cool Springs Psychiatric Group PATIENT HISTORY Patient Name Date of Birth Date form completed: *Please arrive on time and bring this form completed to your appointment to avoid any delay in seeing the
More informationCommissioner for the Department for Medicaid Services Selections for Preferred Products
Commissioner for the Department for Medicaid Services Selections for Preferred Products This is a summary of the final Preferred Drug List (PDL) selections made by the Commissioner for the Department for
More informationAll formulary medications available in generic form are supplied in generic form. Requests for brand name preparations must get prior authorization.
Title 19/21 GMH/SA & Non-Title 19/21 SMI Behavioral Health Drug List Updated 10/01/2018 About the Behavioral Health Drug List The Mercy Care behavioral health drug list includes all of the behavioral health
More informationAntipsychotics Prior Authorization Criteria for Louisiana Fee for Service and MCO Medicaid Recipients
Antipsychotics Prior Authorization Criteria for Louisiana Fee for Service and MCO Medicaid Recipients Preferred Agents (Oral) a Amitriptyline/Perphenazine (Generic) Aripiprazole Tablet (Generic) b Chlorpromazine
More informationMedically Accepted Indications for Pediatric Use of Psychotropic Medications by
Key: White Background: Medically Accepted Indication Yellow Backgroun: Medically Accepted Indication Status Not Ascertained Orange Background: Pediatric Indication cited, but not supported Red Background:
More informationTitle 19/21 GMH/SA & Non-Title 19/21 SMI Behavioral Health Drug List Updated 05/01/2015
Title 19/21 GMH/SA & Non-Title 19/21 SMI Behavioral Health Drug List Updated 05/01/2015 Effective April 1, 2014, Mercy Maricopa Integrated Care began operations as the Regional Behavioral Health Authority
More informationClinical Policy: Olanzapine Long-Acting Injection (Zyprexa Relprevv) Reference Number: CP.PHAR.292 Effective Date: Last Review Date: 08.
Clinical Policy: (Zyprexa Relprevv) Reference Number: CP.PHAR.292 Effective Date: 12.01.16 Last Review Date: 08.18 Line of Business: Medicaid See Important Reminder at the end of this policy for important
More informationRATIONALE FOR INCLUSION IN PA PROGRAM
RATIONALE FOR INCLUSION IN PA PROGRAM Background Tramadol is a centrally acting synthetic opioid analgesic used to treat moderate to moderately severe chronic pain in adults. Along from analgesia, tramadol
More informationChild/Adolescent Intake Form
Child/Adolescent Intake Form Today's date: Patient Information: Individual Name: Date of Birth: / / Age: (First) (Last) Gender: Male Female Ethnicity (optional): Name of Person completing this form: Relationship
More informationCHILD/ADOLESCENT INTAKE FORM
Place demographic label here Today's date: Behavioral Health 131 N Allumbaugh St, Boise, ID 83704 (208) 367-2175 CHILD/ADOLESCENT INTAKE FORM Patient Information: Individual Name: Date of Birth: Age: (first)
More informationPatient Registration Form. Patient Name: Social Security #: Billing Address: City: State: Zip Code: Home Address. Home Phone#: Cell #: Work #:
1 Patient Registration Form Date: Patient Name: Social Security #: Date of Birth: Age: Billing Address: City: State: Zip Code: Home Address City: State: Zip Code: Home Phone#: Cell #: Work #: Email Address:
More informationMajor Depressive Disorder
Major Depressive Disorder HEDIS Measures And Clinical Practice Guidelines Jennifer Highley, PMHNP-BC Behavioral Health West Point Healthcare Effectiveness Data and Information Set (HEDIS) Performance measures
More informationOXYCODONE IR (oxycodone)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Oxycodone hydrochloride, a pure opioid agonist, is used in the treatment of moderate to severe pain (1-2). The precise mechanism of action is unknown; however,
More informationTitle 19/21 GMH/SA & Non-Title 19/21 SMI Behavioral Health Drug List Updated 01/01/2017
Title 19/21 GMH/SA & Non-Title 19/21 SMI Behavioral Health Drug List Updated 01/01/2017 Effective April 1, 2014, Mercy Maricopa Integrated Care began operations as the Regional Behavioral Health Authority
More informationHow did we get here? 1876 Methylene Blue. Insecticide 1935 Du Pont Anthelmintic. Garrett McCann, RPh
Polypharmacy, Adverse Effects, and the Importance of Tapering Medications for People with Intellectual and Developmental Disabilities Garrett McCann, RPh How did we get here? 1876 Methylene Blue Insecticide
More informationTitle 19/21 GMH/SA & Non-Title 19/21 SMI Behavioral Health Drug List Updated 4/01/2018
Title 19/21 GMH/SA & Non-Title 19/21 SMI Behavioral Health Drug List Updated 4/01/2018 Effective April 1, 2014, Mercy Maricopa Integrated Care began operations as the Regional Behavioral Health Authority
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Invega Sustenna, Invega Trinza) Reference Number: CP.PHAR.291 Effective Date: 12.01.16 Last Review Date: 08.18 Line of Business: Medicaid See Important Reminder at the end of this policy
More informationBELBUCA (buprenorphine buccal film)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Belbuca is indicated for the management of chronic pain severe enough to require daily, aroundthe-clock, long-acting opioid treatment for which alternative
More informationWhat s New in Psychopharmacology? Principles of Psychopharmacology. Neuron 8/25/2016. Rochelle Kepes, MSN, PMHNP, BC. What is Neurotransmission?
What s New in Psychopharmacology? Rochelle Kepes, MSN, PMHNP, BC Principles of Psychopharmacology What is Neurotransmission? Anatomical Neuron, Synapses Chemical 6 Neurotransmitters, Communication Electrical
More information#55 PRESCRIBING AND MONITORING PSYCHI RIC MEDICATIONS
- '_ ADMINISTRA TIVE/FISCAUCLINICAL/PHF POLICY AND PROCEDURES COUNTY OF SANTA BARBARA ALCOHOL, DRUG AND MENTAL HEAL TH SERVICES Section - QUALITY ASSURANCE Effective: 12/1/09 Policy- Director's Approval
More informationNEW PATIENT INTAKE FORM
NEW PATIENT INTAKE FORM Please fill out the following form to the best of your ability. Some sections may not apply to you. We will discuss your responses in greater detail during your first appointment.
More informationAntipsychotics and stroke risk
Integrating Sentinel into Routine Regulatory Drug Review: A Snapshot of the First Year Antipsychotics and stroke risk Lockwood G. Taylor, PhD, MPH Division of Epidemiology II Office of Pharmacovigilance
More informationAntipsychotic Medications Age and Step Therapy
Market DC *- Florida Healthy Kids Antipsychotic Medications Age and Step Therapy Override(s) Approval Duration Prior Authorization 1 year Quantity Limit *Virginia Medicaid See State Specific Mandates *Indiana
More informationRAI-MDS 2.0 ASSESSMENT GUIDE FOR USE BY CANADIAN SQLI NURSING HOMES AND NEWFOUNDLAND AND LABRADOR HOMES
RAI-MDS 2.0 ASSESSMENT GUIDE FOR USE BY CANADIAN SQLI NURSING HOMES AND NEWFOUNDLAND AND LABRADOR HOMES HOW TO USE THIS GUIDE: Use this guide alongside the RAI-MDS 2.0 Tracking Tool to track your target
More informationXartemis XR (oxycodone / acetaminophen extended release)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Xartemis XR is a combination of oxycodone and acetaminophen in a dosage formulation to deliver both immediate pain relief, in less than an hour, and extended-release
More informationDosing and Monitoring: Children and Adolescents. By Glenn S. Hirsch
Educational Review Psychopharmacol Bull. 2018;48(2):34 92. Introduction Dosing and Monitoring: Children and Adolescents By Glenn S. Hirsch American culture places a great value on our children. In accordance
More informationCONCEPTS IN PHARMACOLOGICAL MANAGEMENT
CHAPTER 7 PHARMACOLOGICAL PRINCIPLES Psychopharmacology, one of the most active and developing areas of psychiatric research, is the use of psychotropic medication to treat psychiatric disorders. Psychiatric
More informationPOSITIVE YOUTH CONCEPTS Child and Adolescent Therapy 24 Front Street, Suite 302 Exeter, NH
Date: / / NEW CLIENT FORM Client s Name: Address: City State Zip D.O.B.: / / Age: Sex: ================================================================================== Guardian s Name: Custody: Physical
More informationAdult Initial Assessment / Patient Questionnaire Page 1
Page 1 Patient Name: Date: Age: Date of Birth: / / Please read the following questions and answer to the best of your ability by placing a checkmark in the appropriate boxes or filling in the blank as
More informationLevorphanol. Levorphanol Tartrate. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.59 Subject: Levorphanol Page: 1 of 8 Last Review Date: March 16, 2018 Levorphanol Description Levorphanol
More informationLifePath Systems Medication and Laboratory Formulary
Building stronger communities, person by person LifePath Systems Medication and Laboratory Formulary Last update: 12/04/2018 1 Table of Contents Introduction/Contact Information 3 PAP Medications Overview
More informationDual Diagnosis: Substance Abuse and Mental Illness
Dual Diagnosis: Substance Abuse and Mental Illness and a review of the major PSYCHIATRIC MEDICINES Mark Stanford, Ph.D. Santa Clara Valley Health & Hospital System Department of Alcohol & Drug Services
More informationChild & Adolescent Patient History Questionnaire
Child & Adolescent Patient History Questionnaire Child s Name: Nickname? Date of Birth: you When? Additional Concerns: Past Psychiatric History Has your child ever seen a psychiatrist? If so, please provide
More informationDisclosures. What to Tell Your Patient about their Psychiatric Medications. Mr T continued. Mr T. Kattura 04/13/2014
Disclosures What to Tell Your Patient about their Psychiatric Medications None to report Rania Kattura, PharmD, MS, BCPP Clinical Assistant Professor UT College of Pharmacy Austin, TX Objectives for Pharmacist
More informationLevorphanol. Levorphanol Tartrate. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.59 Subject: Levorphanol Page: 1 of 8 Last Review Date: March 17, 2017 Levorphanol Description Levorphanol
More informationTexas Prior Authorization Program Clinical Edit Criteria
Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Drugs requiring prior authorization: the list of drugs requiring prior authorization
More informationNucynta IR. Nucynta IR (tapentadol immediate-release) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Nucynta IR Page: 1 of 9 Last Review Date: December 8, 2017 Nucynta IR Description Nucynta IR (tapentadol
More information