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Get Mercy Care Medication Prior Auth Form

S and date (or submit labs with request): If no, then no further questions. Y N 11. Has the patient had a normal EKG and ophthalmic examination since starting ? Please document date of EKG and eye exam (or submit clinical documentation with request): No further questions. Y N 12. Is the renewal for Lemtrada? If no, skip to question 14. Y N 13. Has the patient received.

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