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9/01/2013 Prior Authorization AETNA BETTER HEALTH OF ILLINOIS IL88 This fax machine is located in a secure location as required by HIPAA regulations. Does the patient have localized postherpetic neuralgia PHN pain peripheral neuropathy DPN 7. Has the patient had a trial and treatment failure of topical agents such as OTC capsaicin IF YES PLEASE DOCUMENT MEDICATIONS TRIED AND REASON FOR TREATMENT FAILURE medications such as tricyclic antidepressants e.g. or IF YES PLEASE DOCUMENT MEDICATIONS...
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