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Offender Name: DOC #: Date of Birth: REQUEST TO USE FORMULARY DRUG (NFL) Facility: DO NOT THIN PRACTITIONER DIAGNOSIS other than Level I in HP will require CRC approval prior to submission of NFL.
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Begin filling out the form by entering your personal information. This may include your name, address, contact information, and any other details that are required.
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Provide the necessary details about the purpose of the request. Clearly state why you are submitting the doc 13091 request and what specific information or action you are seeking.
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Legal professionals submitting requests on behalf of their clients regarding legal matters.
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Doc 13091 requests to gather information regarding certain financial transactions.
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Information regarding the parties involved in the transaction, the nature of the transaction, and the source of funds must be reported on doc 13091 request.
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Relevant keywords

2010 NFR RCW CFR PLN ADLs CRC OHP THERAPEUTICS Designee formulary KOP benchmark Chairperson algorithms ie applicable therapies pertains prohibit electronically baseline PRACTITIONER unsuccessful disclosure PT insufficient deficit submission attachment Gen

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