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CA-27 (Web) Authorization Request form and Certification/Letter of M
Authorization Request Form/Certification/Letter of Medical Necessity
CA-27 LMNOpioid-UAT with Burden Statement.PNG
OMB: 1240-0055
OMB.report
DOL/OWCP
OMB 1240-0055
ICR 202405-1240-002
IC 221978
CA-27 (Web) Authorization Request form and Certification/Letter of M
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