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Does patient require higher dosage (quantity limit exception)? If yes, indicate quantity requested: per 30 days OR quantity The number of doses available under the dose restriction for the prescription drug zolpidem has been ineffective in the treatment of the enrollee’s disease or medical condition .
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(continued on page 2) Fax Confidentiality Notice: The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection under the ambien quantity limits ambien alternatives zolpidem tartrate manufacturers in india zolpidem high law, including the Health Insurance Portability and Accountability Act (HIPAA) .
The message is intended for the sole use zolpidem of the individual or entity to whom it is addressed .
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Additionally, requests that are subject to prior authorization (or any other utilization management requirement), zolpidem may require supporting information .
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