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Replacement Special Form Capsule Order Form Please fill out and submit this form to order replacement Special Form Capsules (SFC's) for the Offsite Source Recovery Program (ORP) at Los Alamos National

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How to fill out replacement special form capsule

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To fill out the replacement special form capsule, follow these steps:

02

Obtain the replacement special form capsule from the authorized provider or pharmacy.

03

Read the instructions on the packaging carefully.

04

Open the packaging and remove the replacement special form capsule.

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Fill out the required information on the form, including your name, contact details, and prescription details.

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Place the replacement special form capsule back into the packaging.

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Seal the packaging securely.

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Submit the filled out replacement special form capsule to the designated authority or healthcare provider.

Who needs replacement special form capsule?

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Anyone who requires a replacement special form capsule needs it. This may include individuals who have lost or damaged their original special form capsule or have been instructed by their healthcare provider to obtain a replacement.

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