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145 The West Mall, P.O. Box 110 U Toronto, ON M8Z 5M4 PRIOR AUTHORIZATION PROGRAM FORM Goalie () Instructions: 1. Section 1 to be completed by Plan Member / Patient 2. Section 2 to be completed by
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Start by gathering the necessary information: Before filling out the form for Toronto ON M8Z 5M4, you will need to have the required details at hand. This includes your full name, complete address including street name and number, city, province (in this case, Ontario), and the postal code for Toronto which is M8Z 5M4.
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This is a postal code in Toronto, Ontario.
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