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Fda.gov/downloads/Safety/MedWatch/HowToReport/DownloadForms/ucm082725. pdf or 1-800FDA-1088 Comments I affirm that the information given on this form is true and accurate as of this date. 12/22/2015 Service Authorization Mercy Maricopa Integrated Care - Integrated Brand Name Physical Health Drugs AZ88 This fax machine is located in a secure location as required by HIPAA regulations. Did the patient experience an adverse reaction to the generic equivalent question 3. of the generic equivalent...

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