| Assigned Number | Title | Release Date Sort ascending | File Type | Language | Available to Order |
|---|---|---|---|---|---|
| F-11033 | Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) | 07/01/2012 | Word | English | No |
| F-11033 | Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) | 07/01/2012 | English | No | |
| F-11033A | Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) Completion Instructions | 10/01/2008 | English | No |
Last revised June 3, 2025