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Formula samples Submitted justification Referred to Medi-Cal to health plan Referred to WIC Other: Regular Medi-Cal (fee-for-service) If the patient requires a therapeutic formula and does NOT have health insurance, check ALL boxes below that apply: Submitted justification to pharmacist QUESTIONS: Call 1-888-942-9675 or 1-800-852-5770. Health Professionals: Go to www.wicworks.ca.gov; click Health Care Professionals; then click WIC contacts for MDs. The information above is only for use.

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Get Cdph 247a Form

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Questions & Answers

How do I fix underexposed video in DaVinci Resolve?

How do you add a shadow in Premiere Pro?

What is the shortcut for highlight in resolve?

How do I lower saturation in DaVinci Resolve?

How do you fade a clip in resolve?

How do I change shadows in DaVinci Resolve?

How do you fix over exposed footage?

How do I fix a washed video in DaVinci Resolve?

How do you desaturate one color in DaVinci Resolve?

How do I lower resolution in DaVinci Resolve?

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Get Cdph 247a Form

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Questions & Answers

How do I fix underexposed video in DaVinci Resolve?

How do you add a shadow in Premiere Pro?

What is the shortcut for highlight in resolve?

How do I lower saturation in DaVinci Resolve?

How do you fade a clip in resolve?

How do I change shadows in DaVinci Resolve?

How do you fix over exposed footage?

How do I fix a washed video in DaVinci Resolve?

How do you desaturate one color in DaVinci Resolve?

How do I lower resolution in DaVinci Resolve?

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