New Form Submission:
You can now fill out and submit your Prior Authorization and Override requests online.
Submit Request Online
Please select the desired link from the list below.
Title | Categories | Update Date | Download |
---|---|---|---|
Adult Growth Hormone Deficiency 1 file(s) 152 downloads |
ALPA | September 12, 2023 | Download |
AL Medicaid EPSDT Form 1 file(s) 1486 downloads |
ALPA | September 6, 2023 | Download |
AL Short Acting Opiate Naiive Days supply Limit Override 1 file(s) 592 downloads |
ALPA | September 12, 2023 | Download |
Biological Injectables 1 file(s) 1875 downloads |
ALPA | September 12, 2023 | Download |
Child Growth Hormone / Mecasermin 1 file(s) 43 downloads |
ALPA | September 12, 2023 | Download |
Child Growth Hormone Deficiency 1 file(s) 137 downloads |
ALPA | September 12, 2023 | Download |
Child Growth Hormone-Chronic Renal Insufficiency 1 file(s) 46 downloads |
ALPA | September 12, 2023 | Download |
Child Growth Hormone-Turner, Prader-Willi, Noonan 1 file(s) 41 downloads |
ALPA | September 12, 2023 | Download |
FDA MedWatch Form 3500 1 file(s) 645 downloads |
ALPA | September 12, 2023 | Download |
Growth Failure for AIDS Wasting 1 file(s) 6 downloads |
ALPA | September 12, 2023 | Download |
Hepatitis C Antiviral Medications 1 file(s) 209 downloads |
ALPA | September 12, 2023 | Download |
Hepatitis C Patient Consent Form 1 file(s) 128 downloads |
ALPA | September 12, 2023 | Download |
Miscellaneous 1 file(s) 1341 downloads |
ALPA | September 12, 2023 | Download |
Morphine Milligram Equivalents (MME) Cumulative Daily Override 1 file(s) 38 downloads |
ALPA | September 12, 2023 | Download |
Opioid Dependence Treatment Agreement and Patient Consent Form 1 file(s) 509 downloads |
ALPA | November 3, 2023 | Download |
Opioid Dependence Treatment PA Request Form 1 file(s) 1033 downloads |
ALPA | November 3, 2023 | Download |
Pharmacy Override 1 file(s) 4368 downloads |
ALPA | September 12, 2023 | Download |
Psychiatrist Specialty Notification 1 file(s) 25 downloads |
ALPA | September 12, 2023 | Download |
Quit Now Alabama Referral Form 1 file(s) 898 downloads |
ALPA | September 12, 2023 | Download |
Quit Now Alabama Referral Form – Spanish 1 file(s) 44 downloads |
ALPA | September 12, 2023 | Download |
Simple PA Form 1 file(s) 7782 downloads |
ALPA | September 12, 2023 | Download |
Smoking Cessation 1 file(s) 689 downloads |
ALPA | September 12, 2023 | Download |
Synagis 1 file(s) 132 downloads |
ALPA | September 12, 2023 | Download |