| Assigned number | Title | Release date Sort ascending | File type | Language | Available to order |
|---|---|---|---|---|---|
| F-11035A | Prior Authorization Dental Request Form (PA/DRF) Instructions | 06/14/2024 | English | No | |
| F-11035 | Prior Authorization Dental Request Form (PA/DRF) | 06/14/2024 | English | No | |
| F-11035 | Prior Authorization Dental Request Form (PA/DRF) | 06/14/2024 | Word | English | No |
Last revised September 7, 2025