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Rozlytrek (entreating)Fax completed form to: (855) 8401678 If this is an URGENT request, please call (800) 8824462 (800.88.CHINA)PHYSICIAN INFORMATIONPATIENT INFORMATION* Physician Name: Specialty:*Due
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To fill out the duration of therapy form, follow these steps:
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Start by providing the start date of the therapy.
03
Indicate the end date of the therapy.
04
Calculate the duration of the therapy by subtracting the start date from the end date.
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Specify the duration in the appropriate format (e.g., days, weeks, months, years).
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The duration of therapy form is needed by medical professionals, such as doctors, therapists, and counselors. It is also required by healthcare institutions, insurance companies, and research organizations.
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