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04/13/2016 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. 2. Does the patient have one of the following diagnoses Chronic myeloid leukemia CML Aggressive systemic mastocytosis ASM Hypereosinophilic syndrome HES and/or chronic eosinophilic leukemia CEL Gastrointestinal stromal tumors GIST. Complete/review information sign and date. Fax signed forms to Mercy Maricopa Integrated...
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When conditions are considered met when all specified criteria or requirements are fulfilled.
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