13th Annual CMHC

October 24-27, 2018

Boston, MA

2018 Prior Authorization Patient Case Submission Form

Purpose

Submit a real-world, challenging prior authorization patient case to be discussed by an expert faculty panel during the CME symposium titled, Mastering the Prior Authorization Process to Meet Patient Needs; on Thursday, October 25th from 6:15-7:30 PM at the 13th Annual CMHC meeting.

Live Discussion Format

  • 2 to 3 patient cases will be discussed by a multidisciplinary expert panel
  • Engage in an interactive learning format and find solutions to your prior authorization challenges and questions

Why Should I Submit a Case?

  • Selection of a patient case will result in a COMPLIMENTARY registration to next year's 14th Annual CMHC in Boston, and acknowledgement from the presenting faculty.*

Deadline for Submission:

The deadline to submit a case is Friday, September 28, 2018.

*This discount cannot be applied to previous registrations associated with other pricing discounts.
*Fields in bold are required.

Contact Information

Your Practice

Case Study

For your patient case to be considered, please provide the following details:
Word Count Limit to: 1,000 words
  • Disease state (i.e. hypercholesterolemia, type 2 diabetes, hypertension, etc.)
  • Patient case introduction†:
    • Patient sex, age, race
    • Indication for medication that requires prior authorization
  • Any pertinent information that is necessary for the prior authorization process (i.e. past medical history, physical exam results (i.e. BMI, blood pressure, etc.), laboratory results pertinent to the case, past and current medications)
  • Specific challenges encountered during the prior authorization process for the recommended medication and questions that you would like specifically addressed regarding the prior authorization process
† Please do not include patient name, social security number, medical identification number, or any information specific to the patient's identity.
‡ There is no limit to the number of patient cases you may submit. Submission is free.

Provide the above information as one or multiple files (MS Word or PDF) using the file upload fields below:

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