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05/18/2016 Prior Authorization MERCY MARICOPA INTEGRATED CARE - TXIX/XXI SMI MEDICAID AZ88 This fax machine is located in a secure location as required by HIPAA regulations. Nodosum leprosum subacute cutaneous systemic lupus erythematosus SLE lesions steroids AND at least 2 of the following medications for a minimum duration of 12 weeks each If yes please indicate which medications were tried or Chloroquine 7. Complete/review information sign and date. Fax signed forms to Mercy Maricopa...
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