" Auth DHA-MNT-4782556 #

! Status : APPROVED

List of Authorizations
$ Request Received On : 2021-06-09 20:37:22

Responded On : 2021-06-09 20:39:31

$DHA-MNT-4782556
APPROVED
ASTER PHARMACY 133...
% Principal Diagnosis
2021-06-09 20:37:22 !
20 weeks gestation of pregnancy

% Other
HowDiagnoses
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Urinary tract infection, site not speciJed

Supervision of high risk pregnancy, unsp, second trimester

RAHTAK
& Drugs
A new service of MedNet to get your medicines delivered at
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- Gaviscon - Powder For Suspension - 80mg, 250mg, 133.5mg -
200.00 Liquids Bottle (x1)
Status: Approved

- Ranpime - Capsule - 400mg - 5.00 Tablets Blister Pack (x1)

Status: Approved

' Comments : n/a