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LWC FORM 1010 REQUEST OF AUTHORIZATION/CARRIER OR SELF INSURED EMPLOYER RESPONSE PLEASE PRINT OR TYPE SECTION 1. IDENTIFYING INFORMATION To Be Filled Out By Health Care Provider First: Middle: Street.

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Keywords relevant to Form 1010

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  • ICD-9
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  • DRG
  • LWC
  • cpt
  • utilization
  • emailed
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  • certify
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