| Assigned number | Title | Release date Sort ascending | Language | Available to order |
|---|---|---|---|---|
| F-11010 | Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format (PDF) | 01/10/2019 | English | No |
| F-11010 | Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format (Word) | 01/10/2019 | English | No |
| F-11010A | Instructions: Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format (PDF) | 01/16/2018 | English | No |
Last revised August 8, 2026