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Get LA AmeriHealth Caritas / Pharmacy Prior Authorization Form 2012-2024

Tom of page 2). Documentation of ongoing behavioral health care for co-existing behavioral health disorders. / Pharmacy Prior Authorization Form Page 1 Rationale and/or additional information, which may be relevant to the review of this prior authorization request (if criteria listed above are not met, address those issues and explain why is still felt to be medically indicated): Patient has consistently been on for extended period of time.

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