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PRIOR AUTHORIZATION REQUEST FORM BM CHP 9.072 Duchess Muscular Dystrophy Agents 1 Exodus 51 Version 2.0 Effective Date 11/9/2017Phone: 8885660008Fax back to: 8663055739ENVISION RX OPTIONS manages

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Individuals who have been diagnosed or suspected to have Duchenne muscular dystrophy (DMD) are the ones who need 072 Duchenne muscular dystrophy form. This form helps in gathering necessary information about the individual's medical history, symptoms, and the need for appropriate medical treatment and support.

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What is 072 duchene muscular dystrophy?

072 Duchene muscular dystrophy, or DMD, is a genetic disorder characterized by progressive muscle degeneration and weakness.

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Medical professionals or healthcare providers who diagnose or treat patients with Duchene muscular dystrophy are required to file 072 Duchene muscular dystrophy.

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Information such as patient demographics, genetic testing results, symptoms, treatment history, and outcomes must be reported on 072 Duchene muscular dystrophy.

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