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LAST MODIFIED 09.28.2018

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

PDF
LAST MODIFIED 12.21.2018

Form

PDF
LAST MODIFIED 01.09.2019

UnitedHealthcare Clinical Services and Therapy Request Form

PDF
LAST MODIFIED 08.29.2018

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 ...

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LAST MODIFIED 04.30.2018

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

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LAST MODIFIED 05.03.2018

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.

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LAST MODIFIED 05.03.2018

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.

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LAST MODIFIED 05.04.2018

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.

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LAST MODIFIED 05.03.2018

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.

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LAST MODIFIED 05.03.2018

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.

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LAST MODIFIED 05.03.2018

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.

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LAST MODIFIED 05.03.2018

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.

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LAST MODIFIED 09.10.2018

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.

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LAST MODIFIED 05.03.2018

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.

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LAST MODIFIED 09.10.2018

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

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LAST MODIFIED 05.03.2018

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

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