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SPECIAL AUTHORIZATION REQUEST NINTEDANIB/PIRFENIDONE Fax requests to (902) 3684905 OR mail requests to PEI Pharmacies, P.O. Box 2000, Charlottetown, PE, C1A 7N8SECTION 1 PRESCRIBER INFORMATION NAME
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How to fill out special authorization request
How to fill out special authorization request
01
Obtain the special authorization request form from the appropriate authority.
02
Fill in all required fields on the form completely and accurately.
03
Provide any supporting documentation or information as requested.
04
Review the completed form to ensure all information is correct.
05
Submit the form and any supporting documents to the designated agency or individual.
06
Follow up with the agency or individual to confirm receipt and processing of the request.
07
Await a response regarding approval or denial of the special authorization request.
Who needs special authorization request?
01
Individuals or entities who require permission or authorization for a specific action or access to certain resources may need to submit a special authorization request.
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What is special authorization request?
Special authorization request is a formal request made to seek approval for a specific action or exemption that deviates from the standard process or requirements.
Who is required to file special authorization request?
Any individual or organization that needs approval for a special action or exemption is required to file a special authorization request.
How to fill out special authorization request?
To fill out a special authorization request, one must provide detailed information about the specific action or exemption being requested and any supporting documentation.
What is the purpose of special authorization request?
The purpose of a special authorization request is to seek approval for deviations from standard processes or requirements in order to proceed with a specific action.
What information must be reported on special authorization request?
The special authorization request must include detailed information about the specific action or exemption being requested, as well as any supporting documentation or justification.
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