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Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA)

Assigned number Title Release date Language Available to order
F-11033 Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) (Word) 07/01/2012 English No
F-11033 Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) (PDF) 07/01/2012 English No
F-11033A Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) Completion Instructions (PDF) 10/01/2008 English No

Glossary

 
Last revised September 25, 2026