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Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA)

Assigned Number Title Release Date File Type Language Available to Order
F-11038 Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA) 07/01/2012 PDF English No
F-11038 Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA) 07/01/2012 Word English No
F-11038A Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA): Completion Instructions 07/01/2012 PDF English No
Last revised April 16, 2024