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Get Paragon Healthcare Injection Orders 2014-2024

Patient Name: Allergies: DOB: Patient Phone: J Code: J2315 Diagnosis ICD-9: Alcohol Dependency (303.00-303.01) Opioid Dependency (304.00-304.3) Other: ICD-9: Labs: Required labs to be drawn by: Infusion Clinic Referring Physician ORDERS Dose 380mg IM, given once every month Number of Dos.

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