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) 137 downloads |
ALPA | January 11, 2022 | Download |
|
AL Medicaid EPSDT Form 1 file(s) 1323 downloads |
ALPA | April 4, 2017 | Download |
|
AL Short Acting Opiate Naiive Days supply Limit Override 1 file(s) 524 downloads |
ALPA | January 11, 2022 | Download |
|
Biological Injectables 1 file(s) 1543 downloads |
ALPA | January 31, 2022 | Download |
|
Child Growth Hormone / Mecasermin 1 file(s) 36 downloads |
ALPA | January 11, 2022 | Download |
|
Child Growth Hormone Deficiency 1 file(s) 116 downloads |
ALPA | January 11, 2022 | Download |
|
Child Growth Hormone-Chronic Renal Insufficiency 1 file(s) 42 downloads |
ALPA | January 11, 2022 | Download |
|
Child Growth Hormone-Turner, Prader-Willi, Noonan 1 file(s) 34 downloads |
ALPA | January 11, 2022 | Download |
|
FDA MedWatch Form 3500 1 file(s) 611 downloads |
ALPA | May 15, 2017 | Download |
|
Growth Failure for AIDS Wasting 1 file(s) 2 downloads |
ALPA | January 13, 2022 | Download |
|
Hepatitis C Antiviral Medications 1 file(s) 196 downloads |
ALPA | January 25, 2023 | Download |
|
Hepatitis C Patient Consent Form 1 file(s) 115 downloads |
ALPA | January 25, 2023 | Download |
|
Miscellaneous 1 file(s) 1132 downloads |
ALPA | January 11, 2022 | Download |
|
Morphine Milligram Equivalents (MME) Cumulative Daily Override 1 file(s) 14 downloads |
ALPA | January 13, 2022 | Download |
|
Opioid Dependence Treatment Agreement and Patient Consent Form 1 file(s) 464 downloads |
ALPA | January 11, 2022 | Download |
|
Opioid Dependence Treatment PA Request Form 1 file(s) 929 downloads |
ALPA | January 11, 2022 | Download |
|
Pharmacy Override 1 file(s) 3980 downloads |
ALPA | January 11, 2022 | Download |
|
Psychiatrist Specialty Notification 1 file(s) 13 downloads |
ALPA | January 31, 2022 | Download |
|
Quit Now Alabama Referral Form 1 file(s) 868 downloads |
ALPA | March 27, 2017 | Download |
|
Quit Now Alabama Referral Form – Spanish 1 file(s) 41 downloads |
ALPA | May 1, 2018 | Download |
|
Simple PA Form 1 file(s) 6978 downloads |
ALPA | January 11, 2022 | Download |
|
Smoking Cessation 1 file(s) 631 downloads |
ALPA | January 11, 2022 | Download |
|
Synagis 1 file(s) 117 downloads |
ALPA | October 3, 2022 | Download |