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Referral and Pharmacy Guidelines
 
REFERRAL GUIDELINES | PHARMACY GUIDELINES
 
Referral Guidelines
Allergy Consultations
Ambulance-Air Ambulance
Arava - Leflunomide - Pharmacy guideline
Audiology
Behavioral Health referrals
Blepharoplasty
Breast Pump
Cardiac Rehab
Case Management and Patient Referal Form
Chiropractic Care
Chronic Catheterization, Mgmt of Patients on
Chronic Pain Management of Patients
COX-2 Inhibitor - Celebrex - Pharmacy guideline
Criteria for BH Emergency Ambulance Transport_ attachment
Depo-Provera - Pharmacy guideline
Diabetes, Foot Care
Diabetic Blood Glucose Monitoring Supplies - Pharmacy guideline
Diabetic Education
Diabetic Education_Contracted Providers
Digestive Enzymes - Pharmacy guideline
DME - Apnea
DME - Nebulizers
DME - Purchase vs. Rental
DME - Supportive Devices for Feet
DME - Therapeutic Shoes
DME CPAP-BIPAP
Duragesic (Fentanyl) Patches - Pharmacy guideline
EEG Electroencephalographic Monitoring
Electrical Bone Growth Stimulation
FORM - Pharmacy PA Form - 6-06
FORM_ Pharmacy GI Med prior auth
Formulary Overrides
Gastroesophageal Reflux - Pharmacy guideline
GERD_Gastroesophageal Reflux Disease
Glucometers
Growth Hormone Therapy for Children - Pharmacy guideline
Hammertoe Syndrome
Heel Spur Syndrome
Hepatitis A
Hepatitis C in Adults - Pharmacy guideline
Home Health
Hysterectomy
Infusion Therapy
Ingrown Toenails
Inhaled Steroids - Pharmacy guideline
Intermetatarsal Neuroma
Intradiscal Electrothermal Therapy
Lamisil (Terbinafine) - Pharmacy guideline
Montelukast (Singulair) - Pharmacy guideline
MRI of Breast
Neupogen - Pharmacy guideline
Neurology-EMG-NCV Consults
Neurontin (Gabapentin) - Pharmacy guideline
Neuropsychological Evals
Occupational-Hand Therapy
Orthopedic Referrals
Ostomy Supplies
Oxygen Therapy
PET Scan
Physical Therapy
Plavix (Clopidogrel) - Pharmcy guideline
Polysomnography - Sleep Disorder
Psychotropic Medication - Pharmacy guideline
Pulmonary Rehabilitation
Rehabilitation Admissions
Rheumatology
Second-Generation Antihistamines - Pharmcy guideline
Synagis (Palivizumab) - Pharmacy guideline
Table of Contents for Pharmacy Guidelines
Table of Contents for Referral Guidelines
TENS Unit - Supplies
Thiazolidinediones - Pharmacy guideline
Total Body Photography
Tubal Ligations
Vasectomies
Viscosupplementationfor Osteoarthritis
Pharmacy Guidelines
Disclaimer
P.G. 1 DIGESTIVE ENZYMES
P.G. 3 LAMISIL® (TERBINAFINE)
P.G. 4 GROWTH HORMONE THERAPY FOR CHILDREN
P.G. 5 DURAGESIC® (FENTANYL) PATCHES
P.G. 7 COX-2 INHIBITOR – Celebrex
P.G. 8 ARAVA® (LEFLUNOMIDE)
P.G. 9 PROTON PUMP INHIBITORS FOR GASTROESOPHAGEAL REFLUX DISEASE (GERD)
P.G. 10 SECOND-GENERATION ANTIHISTAMINES
P.G. 11 SYNAGIS® (Palivizumab) ADMINISTRATION
P.G. 12 PSYCHOTROPIC MEDICATION REFERRAL AUTHORIZATION
P.G. 15 PLAVIX® (Clopidogrel)
P.G. 16 NEUPOGEN®
P.G. 17 BLOOD GLUCOSE MONITORING SUPPLIES
P.G. 18 THIAZOLIDINEDIONES (PIOGLITAZONE - ACTOS®, ROSIGLITAZONE - AVANDIA®)
P.G. 19 HEPATITIS C: TREATMENT IN ADULTS
P.G. 20 INHALED STEROIDS
P.G. 21 LEUKOTRIENE INHIBITORS
P.G. 22 TOPAMAX® (TOPIRIMATE) FOR MIGRAINE PROPHYLAXIS
P.G. 23 JANUVIA® (SITAGLIPTIN)
P.G. 24 LYRICA® (PREGABALIN)
P.G. 25 TOBACCO CESSATION
Important Phone Numbers
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