social development health services health services p o box 5500 fredericton n b e3b 5g4 toll free 1 844 551 3015 dietary supplement application fax 506 453 3960 d the ...
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...Social development health services p o box fredericton n b eb g toll free dietary supplement application fax d the purpose of this form is for to obtain enough medical information determine eligibility program process client presents authorized prescriber completes submitted pharmacy sends and cost estimate a decision est last name first date birth s card nb medicare sections are prescribers only physicians nurse practitioners registered dieticians speech therapists recommending thickening products must be completed incomplete forms will delay processing benefit check applicable conditions provide diagnosis explanation mandatory indicate at least one major physical trauma why patient cannot eat real food including pureed preoperative period surgery postoperative significant weight loss current bmi or other measure moderate severe immune suppression receiving chemotherapy radiation year treatment interferon gi malabsorption syndrome neurological degeneration no justification recommended...