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Drug Utilization Assessment(DUA) / Pharmacy Peer to Peer(P2P)

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  • *This referral is for:

Requestor Information
Employee/ Claimant Information and Case Details
Case Type
Payor or Adjuster Information
  • Same as Requestor

     

Physician Information
Defense Attorney Information
  • Is there a Defense Attorney


Claimant Attorney Information
  • Is Claimant represented by an Attorney


  • What are the accepted body parts/conditions?

  • Are any body parts/conditions denied?


  • Are there specific medications that need to be addressed?

  • Are there any co-morbidities or other pertinent medical details?

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