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We are now using the 17-P Authorization Form for ordering progesterone. Women eligible for progesterone have a history of a previous singleton birth between 20 and 36 weeks (spontaneous) and have a current singleton pregnancy.
The 17-P Authorization Form should be used when the injections will be given in the office. This form should be completed, signed by the authorizing physician and faxed to the Select Health Prenatal Department at 866.368.4562.
Incomplete forms will not be reviewed. The progesterone prescription should be faxed to Boothwyn Pharmacy at 610.485.9223.
Once approved and filled, the medication will be shipped next day to the physician’s office or to the member, depending on the office preference. If you have any questions, please call Prenatal Outreach at 888.559.1010. The form is available on our website at http://www.selecthealthofsc.com/firstchoice/pdf/provider/communication/forms/17p-authorization.pdf
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