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I am writing on behalf of my patient, [PATIENT NAME], to [REQUEST PRIOR AUTHORZATION/DOCUMENT MEDICAL NECESSITY] for treatment with [INSERT PRODUCT]. The [PATIENT NAME] has a diagnosis of [DIAGNOSIS] and needs treatment with [INSERT PRODUCT], and that [INSERT PRODUCT] is medically necessary for [him/her] as prescribed. SAMPLE LETTER OF MEDICAL NECESSITY bauschretinarx.com https://.bauschretinarx.com › › pdf bauschretinarx.com https://.bauschretinarx.com › › pdf PDF
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