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Pharmacy Prior Authorization MERCY MARICOPA INTEGRATED CARE - GMHSA MEDICAID Ingrezza AZ88 This fax machine is located in a secure location as required by HIPAA regulations. Does the patient have a diagnosis of moderate to severe tardive dyskinesia AIMS score greater than or equal to 10 Please provide AIMS score Note Documented baseline evaluation of the patient s condition using the AIMS scoring tool is required. 6. Complete/review information sign and date. Fax signed forms to Mercy...
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