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Form Title: Special Authorization (Allergen).
Form Number: 014-2772-87.
Edition Date: 2000/03.
Ministry: Health and Long-Term Care.
Branch/ABC: Exceptional Access Program Branch.
Program: Ontario Drug Benefit.
Purpose of Form: Used for obtaining authorization for allergen exact as an ODB benefit
Order Info: For paper copy contact MOHLTC Kingston warehouse 613-548-6232
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