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UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM CONTAINS CONFIDENTIAL PATIENT INFORMATION Complete this form in its entirety and send to Rocky Mountain Health Plans at 8583572538 Urgent 1 Monument
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Hyaluronic acid derivatives are compounds derived from hyaluronic acid, a substance naturally found in the human body.
Manufacturers and suppliers of products containing hyaluronic acid derivatives are required to file.
To fill out hyaluronic acid derivatives, companies must provide information on the composition, usage, and safety of the products containing the derivatives.
Hyaluronic acid derivatives are used in various cosmetic and medical products for their moisturizing and anti-aging properties.
Information such as the concentration of the derivatives, any potential side effects, and usage instructions must be reported.
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