| Assigned Number | Title | Release Date | File Type | Language | Available to Order |
|---|---|---|---|---|---|
| F-00212A | Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment Instructions | 12/16/2019 | English | No | |
| F-00212 | Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment | 02/01/2010 | English | No | |
| F-00212 | Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment | 02/01/2010 | Word | English | No |
Last revised July 2, 2025