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事先授权要求您的患者福利计划需要事先授权某些药物。为了做出适当的医疗必需性确定，需要患者的诊断和其他临床信息。请填写以下表格上要求的信息，并传真此表格以及支持优先合作伙伴的临床文件，请致电1-866-212-4756免费收费，以启动审核过程。如果您对先前授权有疑问，请通过888-819-1043与Pirctity Partners联系。选项4。Patient's Name: _____________________________ Date : ________________________________ Patient's ID: _______________________________ Patient's Date of Birth: ________________ Physician's Name: _______________________________________________________________________ Specialty: _________________________________ NPI#: ________________________________ Physician Office Telephone: __________________ Physician Office Fax: ___________________ Referring Provider Info: Same as Requesting Provider Name: ________________________________________ NPI#: ______________________________ Fax: ________________________ Phone: _____________________ Rendering Provider Info: Same as Referring Provider Same as Requesting Provider Name: ________________________________________ NPI#: ______________________________传真：________________________电话：__________________________
Johns Hopkins医院（CCU）的冠状动脉护理部门 心脏概念学院绘制图 - icatibant，firazyr，sajazir D-SNP（HMO）提供者和护理培训模型 药房居住计划受体 JHHP提供商教育（所有计划） Vosevi，Sovaldi的事先授权请求表 2025 Worktite Wellness菜单 无症状的先天性巨细胞病毒感染...
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