Rehabilitative Services Prior Review and Authorization Request - Form must be completed and submitted for a PA request - Fillable - 11/6/17

Medicaid Agency

This government document is issued by Medicaid Agency for use in Alabama

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File Details: PDF (470 KB)
Downloads: 20
Source
https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.14_PA_Forms/9.4.14_PA_Rehabilitative_Services_fillable-11-6-17.pdf

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