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UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION (ORAL DOSAGE FORMS ONLY) Patient name: Medicaid ID #: Prescriber Name: Prescriber NPI#: Contact person: Prescriber Phone#: Extension/Option: Fax#: Pharmacy:
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Obtain the necessary forms from the Utah Department of Health's website or local office.
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The Utah Department of Health is a state government agency responsible for promoting and protecting the health of the residents of Utah.
Certain healthcare facilities and providers in Utah are required to file necessary health information with the Utah Department of Health.
To fill out the Utah Department of Health forms, healthcare facilities and providers can visit the official website of the department or contact them directly for guidance.
The purpose of the Utah Department of Health is to monitor, assess, protect, and promote the health and wellbeing of the residents of Utah.
Healthcare facilities and providers are required to report various health data such as infectious diseases, vital statistics, and other important public health information.
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