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County (secukinumab) Medication Request Form (MRF) for Healthy Indiana Plan (HIP) and Hoosier Care Connect (HCC) FAX TO: (858) 7907100 c/o Impact Healthcare Systems, Inc. Attn: Prior Authorization

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1. Start by gathering all the necessary documents that you want to send via fax. These could include contracts, forms, letters, or any other important paperwork.
2. Once you have your documents ready, make sure they are organized in the correct order that you want them to be transmitted. This will ensure that the recipient receives the fax in the intended sequence.
3. Next, prepare a cover page for your fax. Include your name, contact information, and any additional details that are required by the recipient. This will help the recipient identify who the fax is from and what it pertains to.
4. On the cover page, include the recipient's information, including their name, company, and fax number (in this case, 858 790-7100). Double-check the fax number to make sure it is correct.
5. If there are any specific instructions or additional information that you want to convey to the recipient, include it on the cover page or as a separate document. This will ensure that the recipient understands any additional context or requirements.
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What is fax to 858 790-7100?

The fax to 858 790-7100 is used for submitting documents or information.

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Any individual or entity required to submit specific documents or information to the recipient of the fax.

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Fill out the required fields with accurate information and ensure all necessary documents are attached before sending.

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The purpose of faxing to 858 790-7100 is to provide requested information or documents in a timely manner.

What information must be reported on fax to 858 790-7100?

The specific information or documents requested by the recipient should be reported on the fax.

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