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PRIOR APPROVAL/NON-FORMULARY MEDICATION REQUEST FORM FAX (716) 887-8981 or TOLL FREE FAX 1-866-221-5784 TOLL FREE TELEPHONE 1-800-716-3230 Date: / / Patient Name: ID#: DOB: / / Diagnosis: Medication
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What is 716 887 8981?
716 887 8981 is a form used for reporting income.
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Form 716 887 8981 must be filled out accurately, including all relevant income information and personal details.
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The purpose of form 716 887 8981 is to report income to the appropriate tax authorities.
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Form 716 887 8981 requires information such as income earned, deductions, and personal details.
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