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MEDICARE PRIOR AUTHORIZATION REQUEST FORM All REQUIRE MEDICAL RECORDS TO BE ATTACHED Phone: 8559695884 Fax: 8135137304 FOR BEHAVIORAL HEALTH CALL 8445409595 This form is for prior authorization requests
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How to fill out phone 855-969-5884 fax 813-513-7304
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The phone number is 855-969-5884 and the fax number is 813-513-7304.
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