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State of Oklahoma
SoonerCareBalversa (erdafitinib) Prior Authorization Form
Member Name:___ Date of Birth:___ Member ID#:___Drug Information
Pharmacy Billing (NDC:___) Start Date (or date of next
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Obtain the necessary forms for initial authorization from the appropriate agency or organization.
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Who needs for initial authorization?
01
Individuals or organizations who are seeking permission or approval to begin a certain activity or process may need to apply for initial authorization.
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What is for initial authorization?
Initial authorization is the process of obtaining permission or approval to begin a certain activity or operation.
Who is required to file for initial authorization?
Certain individuals or entities may be required to file for initial authorization depending on the specific regulations or requirements in place.
How to fill out for initial authorization?
To fill out for initial authorization, individuals or entities must typically provide relevant information or documentation as requested by the governing authority.
What is the purpose of for initial authorization?
The purpose of for initial authorization is to ensure that activities or operations comply with regulations, standards, or requirements set by the governing authority.
What information must be reported on for initial authorization?
Information required for initial authorization may include but is not limited to: contact details, purpose of authorization, timeline, supporting documents, and any additional requirements specified by the governing authority.
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