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Granite Alliance Insurance Company (PDP) P.O. Box 899 SLC, UT 84110 Fax: 8015033880 Phone: 18555862573, TTY 711 MEDICARE PART D PRIOR AUTHORIZATION REQUEST () URGENT REQUEST (Life Threatening) MONUMENT
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Criteria form is a standardized document used to evaluate a certain set of criteria.
Certain individuals or entities designated by the governing body are required to file the criteria form.
Criteria form can be filled out electronically or manually, following the instructions provided in the form.
The purpose of criteria form is to assess and document compliance with specific criteria set forth by the governing body.
The criteria form requires reporting of relevant data and information related to the specified criteria.
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