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OPTIMA HEALTH COMMUNITY CARE
AND
OPTIMA FAMILY CARE
(MEDICAID)
PHARMACY PRIOR AUTHORIZATION/STEPPED REQUEST*
Directions: The prescribing physician must sign and clearly print name (preprinted stamps
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What is form to be completed?
The form to be completed is the IRS Form 1040, which is the standard individual income tax return form used in the United States.
Who is required to file form to be completed?
Any individual who earns income above a certain threshold is required to file Form 1040, including U.S. citizens and resident aliens.
How to fill out form to be completed?
To fill out Form 1040, you need to provide personal information, report your income, claim deductions and credits, and calculate your tax liability on the form.
What is the purpose of form to be completed?
The purpose of Form 1040 is to report an individual's annual income, calculate taxes owed, and determine eligibility for refunds or credits.
What information must be reported on form to be completed?
The information that must be reported includes personal details, wages, interest, dividends, capital gains, deductions, credits, and other income sources.
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