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Authorization Form/Letter of Medical Necessity for Compounded Drugs
Authorization Request Form and Certification /Letter of Medical Necessity for Compounded Drugs (OWCP-26)
OMB: 1240-0062
IC ID: 267907
OMB.report
DOL/OWCP
OMB 1240-0062
ICR 202405-1240-007
IC 267907
( )
Documents and Forms
Document Name
Document Type
Form OWCP-26
Authorization Form/Letter of Medical Necessity for Compounded Drugs
Form and Instruction
OWCP-26 Authorization Request form/Letter of Medical Necessity for Compounded Drugs
Letter of Medical Necessity for Compounded Drugs (OWCP-26).pdf
owcprx.dol.gov/portal/main.do
Form and Instruction
Information Collection (IC) Details
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