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PA12 SOLAR NOT required for recipients less than 21 years of age. Executive Office of Health & Human Services PRIOR AUTHORIZATION REQUEST FORM for RI MEDICAID FEE FOR SERVICE (FFS) Gain well Technologies
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The purpose of the form is to track and monitor the use of CNS stimulants.
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The form must include details of the prescribed CNS stimulants, patient information, and prescriber details.
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