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D. /D. O. Specialty Section C - Medical Information Treatment Regimen include strength directions for use and duration of therapy Epclusa Daklinza product Harvoni Technivie Other Zepatier Olysio Sovaldi Viekira Pak or XR This section MUST be completed for ALL patients with Hepatitis C ALL supporting labs and chart documentation is required for medical review of this request Genotype MUST submit supporting lab documentation Genotype 1 Prescriber Specialty Hepatologist Gastroenterologist...
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