Crime Victims Compensation Subacute Opioid Request Form


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Title Crime Victims Compensation Subacute Opioid Request Form
Description Use this form for Crime Victims Compensation to request opioid coverage between 6 weeks and 12 weeks from date of injury or surgery.
Document number F800-119-000
How to get this document
Keywords crime victim, crime victim compensation, opioids, pain management, request
Alt Language(s)
Valid dates 10/2013
Contact information Claims and Insurance
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