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The document is a Prior Authorization Request Form for biologic therapy treatments for inflammatory arthritis, including medications such as Enbrel, Humira, and Remicade. It includes sections for provider and member information, drug requests, therapy details, and required documentation for both initial and continuation of therapy requests. The form emphasizes the need for accurate information and supporting medical records to process the request.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (55 Votes)
2013	4.4 Satisfied (57 Votes)

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