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Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA)

Assigned number Title Release date Language Available to order
F-11038 Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA) (PDF) 07/01/2012 English No
F-11038A Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA): Completion Instructions (PDF) 07/01/2012 English No
F-11038 Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA) (Word) 07/01/2012 English No

Glossary

 
Last revised September 9, 2026