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D. /D. O. Specialty SECTION C - MEDICAL INFORMATION Directions for use Diagnosis Please be specific provide as much information as possible ICD-10 CODE INITIAL AUTHORIZATION Does the patient have hypersensitivity to natural or recombinant beta human albumin albumin-containing formulations only or any other component of the formulation YES NO Is the prescriber a neurologist YES NO RE- AUTHORIZATION Has ANY of the following occurred YES NO Symptomatic hepatotoxicity e.g. jaundice Anaphylaxis or...
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What is unitedhealthcare community plan?
UnitedHealthcare Community Plan is a health insurance program for individuals and families who meet certain income and eligibility requirements.
Who is required to file unitedhealthcare community plan?
Individuals and families who qualify for the program are required to file for UnitedHealthcare Community Plan.
How to fill out unitedhealthcare community plan?
To fill out UnitedHealthcare Community Plan, individuals can contact their local service center or visit the official website for guidance on application process.
What is the purpose of unitedhealthcare community plan?
The purpose of UnitedHealthcare Community Plan is to provide healthcare coverage and services to those in need who meet the eligibility criteria.
What information must be reported on unitedhealthcare community plan?
Information such as income, household size, and other eligibility requirements must be reported on UnitedHealthcare Community Plan.
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