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UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM CONTAINS CONFIDENTIAL PATIENT INFORMATION Complete this form in its entirety and send to Rocky Mountain Health Plans at 858-357-2538 Initial Request
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What is imbruvica ibrutinib mc?
Imbruvica ibrutinib mc is a prescription medication used to treat certain types of cancer.
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Healthcare providers are required to file imbruvica ibrutinib mc for their patients.
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Information such as the patient's name, dosage of the medication, treatment duration, and any side effects must be reported on imbruvica ibrutinib mc.
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