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Please print, type or write legibly in blue or black ink. If you have an nhs care identity (smartcard) account, you will be able to use this to access the nhsmail portal, your emails, microsoft..

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Below Is A List Of Common Drugs And/Or Therapeutic Categories That Require Prior Authorization:

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Web Prescription Drug Prior Authorization.

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Once Completed, Please Fax This Form To The Designated Fax Number For.

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