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Prior Authorization (PA) Helpdesk (for Provider PA inquiries): (p) 888-445-0497 (f) 888-879-6938

Pain Management Archives

Name Description Date
Pharmacy Referral Form 38.76 KB 2017/06/05
Physician Referral Form 31.11 KB 2017/06/05
PA Waiver Form 25.47 KB 2017/06/01
PA Waiver Form 183.21 KB 2016/08/26
Pharmacy Referral Form 217.14 KB 2016/08/26
Physician Referral Form 204.07 KB 2016/08/26
Pain Management Policy 224.41 KB 2016/01/12
PA Waiver Form 139.67 KB 2013/10/10
PA Waiver Form 50.82 KB 2012/06/26
Pharmacy Referral Form 63.02 KB 2012/06/26
Physician Referral Form 56.87 KB 2012/06/26