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Gov. WEBPBSC-0260-17 January 2017 SC Medicaid Aptensio XR PAB Fax Form 01. 22. 17. docx PATIENT NAME PATIENT ID 9. PAGE 1 OF 2 CONTINUED ON PAGE 2 www. BlueChoiceSCMedicaid.com BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. BlueChoice HealthPlan has contracted with Amerigroup Partnership Plan LLC an independent company for services to support administration of Healthy Connections. CONTAINS CONFIDENTIAL PATIENT INFORMATION Aptensio XR Complete...
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