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UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM CONTAINS CONFIDENTIAL PATIENT INFORMATION Complete this form in its entirety and send to Rocky Mountain Health Plans at 8583572538 Initial Request
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Sapropterin - rocky mountain is a medication used to treat certain genetic disorders that affect the levels of certain chemicals in the body.
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The purpose of sapropterin - rocky mountain is to help manage and alleviate symptoms of certain genetic disorders by restoring or maintaining proper levels of certain chemicals in the body.
Information such as patient demographics, treatment details, adverse reactions, and any other relevant data must be reported on sapropterin - rocky mountain.
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