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Get and Sign Rapid Response System RRS 2015-2022 Form
A referral from a healthcare provider for treating this patient? .X. yes 2. What is the requested Start Date for this authorization? .M. .M. / .D. .D. / .Y. .Y. .Y. .Y. 3. Is this authorization request for a new episode or continuation of care? .X. new 4. Is this condition new, recurring or chronic? .X. new .X. recurring .X. chronic 5. What type of injury or condition is this request related to? [check all that apply] .X. work .X. no .X. continuation .X. auto .X. other...Show details
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