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LAST MODIFIED 09.28.2018

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

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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 11.08.2018

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.

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LAST MODIFIED 11.13.2018

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

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LAST MODIFIED 08.15.2018

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

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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 05.18.2018

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.

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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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