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South Carolina Pharmacy Services

Physician/Prescriber • Documents

Physician/Prescriber Documents

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Educational Tools
Title
Title
Medication Assisted Treatment Coverage Guidelines

Forms
Title
Title
Prior Authorization Request Form: Medications
Antipsychotic - Children ≤ 6 Years of Age PA Request Form
Growth Hormone PA Request Form - Adult Treatment
Growth Hormone PA Request Form - Pediatric Treatment
Health Insurance Referral Form
Hepatitis C PA Request Form
Medwatch Form
Universal Synagis Authorization Form