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

Form

UnitedHealthcare Clinical Services and Therapy Request Form

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 ...

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 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.

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.

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.