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Receptor Selective NSAIDs or NSAIDs Combination Medications New Hampshire AIDS Drug Assistance Program Prior Authorization Request Form Fax: 18004247984 Phone: 18004247901 Date of Medication Request:
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Who needs receptorselectivensaidfaxformnhaids1013doc:
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Individuals who have been prescribed or are seeking to be prescribed receptor-selective NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) may need to fill out this form. This could apply to patients with specific medical conditions or those undergoing certain treatments.
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