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Ns issued to RPAs by the Department of Health must contain the imprinted names of both the RPA and his or her supervising physician, pursuant to Section 94.2 of Title 10. Please complete and enclose this form with your registration form for the Official Prescription Program. I. To Be Completed by Supervising Physician I hereby authorize (Name of RPA) to order official New York State prescriptions from the New York State Department of Health impr.

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