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MS.8 Form #[removed]R:12.13 State of Maine Department of Health & Human Services MaineCare/MEDEL Prior Authorization Form
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Document Date: 2014-04-21 09:30:55

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File Size: 46,00 KB

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Company

IgG / /

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IndustryTerm

imaging / clinical attack involving different site / /

MedicalCondition

MS / /

Organization

Department of Health / /

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Product

COPAXONE / TYSABRI / REBIF / Betaseron / AVONEX / /

Technology

Magnetic resonance imaging / MRI / /

URL

www.mainecarepdl.org_ / /

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