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FLORIDA MEDICAID Prior AuthorizationProvigil () (12 Month Approval)Note: Form must be completed in full. An incomplete form may be returned. Recipients Medicaid ID×Date of Birth (MM/DD/YYY)/Recipients

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Requests to access a certain webpage or resource will be redirected to another URL.

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Requests to be redirected must include the original URL, the new URL for redirection, and any relevant details.

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