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Ora lair (allergen extract mixed grass pollen) Medication Request Form (MRF) for Healthy Indiana Plan (HIP) and Hoosier Care Connect (HCC) FAX TO: (858) 7907100 c/o Impact Healthcare Systems, Inc.

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What is mdwise oralairmrfdoc?

It is a form used by MDwise for reporting allergy medication.

Who is required to file mdwise oralairmrfdoc?

Healthcare providers prescribing allergy medication.

How to fill out mdwise oralairmrfdoc?

Fill out the form with the required patient and medication information.

What is the purpose of mdwise oralairmrfdoc?

To track and monitor the use of allergy medication for patients.

What information must be reported on mdwise oralairmrfdoc?

Patient name, medication details, prescribing healthcare provider.

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