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PO Box 45018 Fresno, CA 93718 Utilization Management Phone: 559.499.2450 or 1.800.755.7247 Confidential Fax: 559. 243.7012 Patients Name: Date of Birth: Subscriber Name: Address: Patient/Guardian
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Completed by direct phone is a form of communication where the information is conveyed directly through a phone call.
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