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MftR12\'19Pfi 201 MISSTATE OF NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEAL TH SER VICES 29 HAVEN DRIVE, CONCORD, NH 03301Jeffrey A. Meyers6032714501CommissionerFax:

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authorize form department of is for obtaining authorization for specific actions or requests.

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Authorize form department of must include details about the action or request requiring authorization, as well as any relevant supporting documentation.

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