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PRIOR AUTHORIZATION PROGRAM REIMBURSEMENT REQUEST FORM For multiple sclerosis therapy: (beta1b)Please fax form to: 18668401509Please note that the patient AND physician must complete this form. All
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Multiple sclerosis formrapy beta-1b is a medication used to treat relapsing forms of multiple sclerosis.
Patients who have been prescribed multiple sclerosis formrapy beta-1b are required to file it.
Multiple sclerosis formrapy beta-1b can be filled out by following the instructions provided by the healthcare provider.
The purpose of multiple sclerosis formrapy beta-1b is to help manage symptoms and reduce the number of relapses in patients with multiple sclerosis.
Information such as the patient's name, dosage, frequency of administration, and any side effects experienced must be reported on multiple sclerosis formrapy beta-1b.
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