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Impact HQ Code: PRO03/PRO05 Impact Group: RL001/RL002 DO NOT WRITE IN BLOCKED AREAS FOR INTERNAL USE ONLY Contacted: Physician: Pharmacy: Patient: Instruction: Medication Request Form Attn: Prior
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What is do not write in?
Do not write in is a legal document that prohibits certain actions or specifies restrictions.
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Do not write in can be filled out by clearly stating the restrictions or prohibitions and providing necessary signatures.
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The purpose of do not write in is to establish and enforce certain limitations or restrictions.
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Information regarding the specific restrictions or prohibitions, as well as the parties involved, must be reported on do not write in.
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