
Get the free FAX DOCUMENTATION bb - Utah Medicaid
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UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM () Patient name: Medicaid ID #: Prescriber Name: Prescriber NPI#: Contact person: Prescriber Phone#: Extension/Option: Fax#: Pharmacy: Pharmacy
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Fax documentation bb typically requires information such as sender details, recipient details, document type, and any additional notes or attachments.
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