| Assigned number | Title | Release date Sort ascending | Language | Available to order |
|---|---|---|---|---|
| F-11021 | Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS2) (Word) | 07/01/2012 | English | No |
| F-11021 | Prior Authorization Request / Hearing Instrument and Audiological Services (PDF) | 07/01/2012 | English | No |
| F-11021A | Prior Authorization Request / Hearing Instrument and Audiological Services (PA/HIAS2) Completion Instructions (PDF) | 11/01/2008 | English | No |
Last revised October 26, 2026