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Prior authorization
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#	Item
421	SAMARITAN HEALTH PLAN OPERATIONS • INTERCOMMUNITY HEALTH PLANS • 815 NW NINTH STREET • CORVALLIS OR[removed]PRIOR AUTHORIZATION REQUEST IMPORTANT! Illegible/Incomplete requests will be sent back for clarification an Add to Reading List Source URL: www.samhealth.org Language: English - Date: 2014-08-20 14:18:01 Technology Fax Office equipment
422	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: ahca.myflorida.com - Date: 2013-10-08 13:22:21
423	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: ahca.myflorida.com Language: English - Date: 2012-06-25 14:41:56 Chemistry Alcohols Organochlorides Acetamides Drug rehabilitation
424	Print Form Reset Form CHILDREN’S MEDICAL SERVICES NETWORK Prior Authorization Add to Reading List Source URL: ahca.myflorida.com Language: English - Date: 2014-07-24 07:31:39 Technology Clinical pharmacology Medical prescription Patient safety Gonadotropin-releasing hormone Leuprorelin Fax Precocious puberty Medicine Health Pharmacology
425	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: ahca.myflorida.com - Date: 2012-06-25 14:07:32
426	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: ahca.myflorida.com - Date: 2012-06-25 14:42:30
427	Prior Authorization Criteria PA_GroupNm: Covered Uses for this Drug Coverage Excluded Reasons Information Required Age Restrictions Add to Reading List Source URL: www.upmchealthplan.com Language: English - Date: 2010-09-07 14:21:17 Myelodysplastic syndrome Food and Drug Administration Methadone Pharmaceutical drug Antipsychotic Rheumatoid arthritis Kidney transplantation Major depressive disorder Alternative medicine Medicine Health Pharmacology
428	CHILDREN’S SPECIAL HEALTH CARE SERVICES (CSHCS) REQUEST FOR PRIOR AUTHORIZATION OF "OUT OF STATE SERVICES" (Note: Print or Write legibly.) Add to Reading List Source URL: michigan.gov Language: English - Date: 2014-04-02 13:54:45 Medicine Health care Primary care Health
429	Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date: Add to Reading List Source URL: ahca.myflorida.com Language: English - Date: 2013-08-21 11:12:29 Biology Eli Lilly and Company Peptide hormones Saizen Growth hormone treatment Growth hormone deficiency Growth hormone Humatrope Insulin-like growth factor 1 Growth hormones Medicine Endocrine system
430	105 Heth Hall \| PO Box 6904 \| Radford, VA 24142 \| Telephone: [removed] \| Fax: [removed]Authorization to Cancel Registration To be used prior to the start of class(es) within the given semester. Please complete an Add to Reading List Source URL: www.radford.edu Language: English - Date: 2014-06-10 19:32:16 Radford Virginia Education Academia Virginia American Association of State Colleges and Universities Radford University Registrar

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