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Prior Authorization / Substance Abuse Day Treatment Attachment (PA/SADTA)

Assigned Number Title Release Date File Type Language Available to Order
F-11037 Prior Authorization / Substance Abuse Day Treatment Attachment (PA/SADTA) 07/01/2012 PDF English No
F-11037 Prior Authorization / Substance Abuse Day Treatment Attachment (PA/SADTA) 07/01/2012 Word English No
F-11037A Prior Authorization / Substance Abuse Day Treatment Attachment (PA/SADTA): Completion Instructions 07/01/2012 PDF English No
Last revised April 16, 2024