Prior Approval Request for Alcohol & Other Substance Abuse treatment

Form ID
D9314
Audience
For providers
Clinical psychologist
Hospitals & day procedure centres
Medical specialist
Neuropsychologist
Psychologist
Social worker (mental health)

Prior approval request for alcohol & other substance abuse treatment

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

How can I access this form?
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Form (PDF or Word)