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The document is a Custom Compounding Fax Form used for prescribing various compounded medications, including treatments for dermatological conditions, acne, nail care, and scalp issues. It requires patient information, prescription details, and provider contact information. The form also includes options for different ingredients and formulations, along with pricing information and authorization for handling insurance communications.

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Versions	Form popularity	Fillable & printable
2016	4.4 Satisfied (22 Votes)

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