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Maryland Medicaid Pharmacy ProgramRequest for Rx Prior Authorization Do Not Use for Antipsychotic Requests: (866) 4409345 Phone: (800) 9323918Please check the appropriate box for the Prior Authorization
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Do not use is for indicating items or materials that should not be used.
Anyone responsible for maintaining a list of prohibited items or materials.
Fill out the form by listing the items or materials that should not be used.
The purpose of do not use is to prevent the use of certain items or materials for safety or compliance reasons.
The items or materials that should not be used, along with any relevant details or reasons for the restriction.
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