Page 1 of 2 PRESCRIPTION DRUG PRIOR AUTHORIZATION REQUEST FORM Plan Medical Group Name: ________________________________ Plan Medical Group Phone - Prior authorization - Document - PDFSEARCH.IO

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	Page 1 of 2 PRESCRIPTION DRUG PRIOR AUTHORIZATION REQUEST FORM Plan/Medical Group Name: ________________________________ Plan/Medical Group Phone#: (_______) Add to Reading List Document Date: 2014-11-20 23:47:32 Open Document File Size: 104,03 KB Share Result on Facebook Company Plan/Medical Group / Health Plan / / IndustryTerm routine audit / / MedicalCondition Allergies / / Person Location / / Position Physician / Representative / / Product Dispensing Information Medication / / SocialTag Patient safety Clinical pharmacology Medical prescription Medical terms Health Insurance Portability and Accountability Act Prescription medication Methadone Electronic prescribing Ohio Automated Rx Reporting System Medicine

Page 1 of 2 PRESCRIPTION DRUG PRIOR AUTHORIZATION REQUEST FORM Plan/Medical Group Name: ________________________________ Plan/Medical Group Phone#: (_______)Add to Reading List