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HEALTH PARTNERS PLANS PRIOR AUTHORIZATION REQUEST Formative Hypnotics Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient. Certain requests

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What is is this a request?

This is a request for information or action.

Who is required to file is this a request?

Any individual or entity that needs to obtain specific information or seek approval.

How to fill out is this a request?

To fill out a request, you will need to provide all necessary details and submit it to the appropriate authority or department.

What is the purpose of is this a request?

The purpose of a request is to formally ask for information, assistance, or approval.

What information must be reported on is this a request?

The required information to be reported on a request may vary depending on the specific nature of the request.

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