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DME PRIOR AUTHORIZATION FORM 26957 Northwestern Highway, Suite 400 Southfield, MI 48033 18009035253 Fax: 8552259847 Today's Date Patient Name DOB Fax Senders Name ID # Phone Fax Is this a HIPAA secure

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What is 18009035253?

18009035253 is a form used for reporting certain information to the relevant authority.

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