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PRIOR AUTHORIZATION FORM IntegraNet Health 1900 North Loop West, Suite 400 Houston, TX 77018 Telephone No: 2815915289 or 18882921923 Specialist: Please Fax Request to PCP (Sections A C must be filled.

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  1. Open the form in the full-fledged online editing tool by clicking Get form.
  2. Complete the required fields that are yellow-colored.
  3. Click the arrow with the inscription Next to jump from field to field.
  4. Go to the e-autograph tool to e-sign the form.
  5. Insert the date.
  6. Check the entire e-document to ensure that you haven?t skipped anything.
  7. Press Done and download the resulting document.

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