ASCVD:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
ASCVD - Pooled Cohort Risk Assessment: N/A
Baseline LDL-C Level to Initiate Therapy (% reduction): N/A
Baseline LDL-C Level to Initiate Therapy (mgdL): N/A
Concomitant therapy required with Bile acid sequestrant or niacin: No
Concomitant therapy required with ezetimibe: No
Concomitant therapy required with maximally tolerated statin: No
Documentation Period of LDL-C Levels: N/A
History of CVD presumed to be of Atherosclerotic origin: No
LDL-C Level for Reauthorization (mgdL): N/A
LDL-C Level for Reauthorization (% reduction): N/A
Lifestyle modifications required: No
Duration of Statin Step Failure: N/A
Duration of Ezetimibe Step Failure: N/A
Ezetimibe Step is Optional: No
LDL-C Goal for Optional Ezetimibe Step (% reduction): N/A
Statin Intolerance Defined: No
PushTronex MUST be used after Syringe or Sureclick: No

HeFH:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Baseline LDL-C Level to Initiate Therapy (% reduction): N/A
Baseline LDL-C Level to Initiate Therapy (mgdL): N/A
Concomitant therapy required with Bile acid sequestrant or niacin: No
Concomitant therapy required with ezetimibe: No
Concomitant therapy required with maximally tolerated statin: No
Documentation Period of LDL-C Levels: N/A
LDL-C Level for Reauthorization (mgdL): N/A
LDL-C Level for Reauthorization (% reduction): N/A
Lifestyle modifications required: No
Diagnosis verbiage includes genetic testing ( LDLR, ApoB, PCSK9 or ARH mutations): No
Diagnosis verbiage includes Simon Broome criteria: No
Diagnosis verbiage includes WHODutch Lipid Network Criteria: No
Diagnosis verbiage includes US MEDPED criteria: No
Duration of Statin Step Failure: N/A
Duration of Ezetimibe Step Failure: N/A
Ezetimibe Step is Optional: No
LDL-C Goal for Optional Ezetimibe Step (% reduction): N/A
Statin Intolerance Defined: No
PushTronex MUST be used after Syringe or Sureclick: No

HoFH:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Diagnosis verbiage includes presence of cutaneous or tendon xanthomas before age 10: No
Diagnosis verbiage includes evidence of HeFH in both parents: No
Baseline LDL-C Level to Initiate Therapy (% reduction): N/A
Baseline LDL-C Level to Initiate Therapy (mgdL): N/A
Concomitant therapy required with Bile acid sequestrant or niacin: No
Concomitant therapy required with ezetimibe: No
Concomitant therapy required with maximally tolerated statin: No
Documentation Period of LDL-C Levels: N/A
LDL-C Level for Reauthorization (mgdL): N/A
LDL-C Level for Reauthorization (% reduction): N/A
Lifestyle modifications required: No
PushTronex MUST be used after Syringe or Sureclick: No