PRIOR AUTHORIZATION FORM

Air Pollution Control Division

This government document is issued by Air Pollution Control Division for use in Colorado

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File Details: PDF (934 KB)
Source
https://www.google.com/url?client=internal-element-cse&cx=0460fec3441b54e4f&q=https://cdphe.colorado.gov/sites/cdphe/files/PW_A35_Tobacco-Pharmacy-Prior-Authorization-Form-updated-Feb2017.pdf&sa=U&ved=2ahUKEwjXjpCd6eWKAxULVqQEHVYvOpE4KBAWegQIBhAC&usg=AOvVaw3bt_SnvGeApUaCsmEEZZuV

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