Use this form when requesting prior authorization for medical drugs in Oregon.

This form allows an individual to provide consent for sterilization. Statements are also included for an interpreter, a person obtaining consent, and a physician. The form begins with a cover page describing the purpose of the form and its ...

Forms and other resources for Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, and Arizona Long Term Care care providers.

Forms and other resources for providers of the the UnitedHealthcare Community Plan - IA Health Link and Iowa UnitedHealthcare Community Plan hawk-i plans.

Access popular forms, billing information and reference guides for Ohio Community Plan providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Arizona Community Plan care providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Florida Community Plan care providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Hawaii Community Plan care providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Iowa Community Plan care providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Louisiana Community Plan care providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Maryland Community Plan care providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Michigan Community Plan care providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Nebraska Community Plan care providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of New Jersey Community Plan care providers.

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of New York Community Plan care providers.