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01/04/2016 Prior Authorization MERCY MARICOPA INTEGRATED CARE - TXIX/XXI SMI MEDICAID DPP-4 Inhibitors AZ88 This fax machine is located in a secure location as required by HIPAA regulations. 4mg per dL for females or greater than 1. 5mg per dL for males B Metabolic acidosis C Diabetic ketoacidosis Please list contraindication s If no then no further questions. Complete/review information sign and date. Fax signed forms to Mercy Maricopa Integrated Care - TXIX/XXI SMI at 1-855-247-3677. Please...
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