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Get OPTUMRx & Prior Authorization Request Form 2014

Ation request, please answer the following questions:  Yes  No While using the requested medication, is the patient experiencing relief of excessive sleepiness or insomnia associated with a work period that occurs during the habitual sleep phase?  Yes  No Does the patient’s sleep disturbance continue to cause clinically significant distress or significant impairment in occupational functioning?  Yes  No Does the patient still require treatment for SWSD? Select the medications.

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