| Assigned number | Title | Release date Sort ascending | Language | Available to order |
|---|---|---|---|---|
| F-00212A | Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment Instructions (PDF) | 12/16/2019 | English | No |
| F-00212 | Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment (PDF) | 02/01/2010 | English | No |
| F-00212 | Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment (Word) | 02/01/2010 | English | No |
Last revised July 3, 2026