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PHYSICIAN PRIOR AUTHORIZATION REQUEST FORM BlueChoice Healthily Patient Information Name: Insurance ID #: Address: Birthdate: Provider Information Physicians Name: Physician DEA #: Phone: Fax: Office
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What is 8888360730?
8888360730 is a form used for reporting information about certain transactions.
Who is required to file 8888360730?
Entities engaged in specified transactions are required to file 8888360730.
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You can fill out 8888360730 by providing the required information on the form.
What is the purpose of 8888360730?
The purpose of 8888360730 is to report information about certain transactions to the relevant authorities.
What information must be reported on 8888360730?
Information about specified transactions must be reported on 8888360730.
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