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Androgenic Agents Replacement Therapy (TRT) Washington Prior Authorization Request Form Please complete this entire form and fax it to: 8669407328. If you have questions, please call 8003106826. This
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What is androgenic agents?
Androgenic agents are substances that promote the development of male characteristics in the body.
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Any individual or organization involved in the production, distribution, or use of androgenic agents may be required to file.
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Androgenic agents can be filled out by providing information on the type of agent, quantity used, intended use, and any potential risks.
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The purpose of androgenic agents is to stimulate the development and maintenance of male characteristics, such as facial hair and muscle growth.
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Information that must be reported on androgenic agents includes the name of the agent, quantity used, purpose of use, and any relevant safety information.
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