Hydrocodone-homatropine, Hydromet, Tussigon . Prior Authorization Request Form (Page 1 of 2) DO NOT COPY FOR FUTURE USE. FORMS ARE UPDATED FREQUENTLY AND MAY BE BARCODED ... specifications. Please complete the following questions and then fax this form to the toll free number listed below. Upon receipt of the completed form,
Hydrocodone, sold under brand names such as Vicodin and Norco among many others, is a semisynthetic opioid derived from codeine, one of the opioid alkaloids found in the opium poppy. It is a narcotic analgesic used orally for relief of moderate to severe pain, but also commonly taken in liquid form as an antitussive/cough suppressant.
NORCO® (Hydrocodone bitartrate and acetaminophen) is supplied in tablet form for oral administration. Hydrocodone bitartrate is an opioid analgesic and antitussive and occurs as fine, white crystals or as a crystalline powder. It is affected by light. The chemical name is 4,5α-Epoxy-3-methoxy-17 ...
specifications. Please complete the following questions and then fax this form to the toll free number listed below. Upon receipt of the completed form, ... (Hydrocodone-acetaminophen 10mg-325mg) Prior Authorization Request Form (Page 2 of 2) DO NOT COPY FOR FUTURE USE. FORMS ARE UPDATED FREQUENTLY AND MAY BE BARCODED