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The document is a patient transition enrollment form for VIVITROL, a medication used to treat alcohol and opioid dependence. It outlines the necessary information required from prescribers, patients, and insurance details to facilitate the prescription and delivery of VIVITROL. The form emphasizes the importance of completing all fields to avoid processing delays and includes sections for patient diagnosis, insurance information, and authorization for health information disclosure. Additionally, it provides important safety information regarding VIVITROL's use, contraindications, warnings, and potential adverse reactions.

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