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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. Gov. WEBPBSC-0192-16 December 2016 SC Medicaid PAB Fax Form 11. 01. 16. doc 9. PHYSICIAN SIGNATURE Prescriber or authorized signature Date medications are appropriate for a patient. CONTAINS CONFIDENTIAL PATIENT...
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Hydrochloride is a chemical compound formed when hydrochloric acid is combined with another substance.
Any organization or individual that produces, imports, or sells products containing hydrochloride may be required to file hydrochloride.
To fill out a hydrochloride form, you will need to provide information about the quantity of hydrochloride used, the source of the hydrochloride, and the intended use of the hydrochloride.
The purpose of hydrochloride is to track the use of this chemical compound and ensure it is being used in a safe and responsible manner.
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