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Forms

Access key forms for authorizations, claims, pharmacy and more.


Administrative Review

Authorization

Medical Drug Authorization Request

Ohana Oral Nutrition Request Form

Requests for prior authorization (with supporting clinical information and documentation) should be sent to ʻOhana 14 days prior to the date the requested services will be performed.

Behavioral Health

This tool is based on the American Academy of Child and Adolescent Psychiatry’s (AACAP) “Practice Parameter for the Use of Atypical Antipsychotic Medications in Children and Adolescents” (2011).

Claims

Refund Check Information Sheet* (RCIS)

Medical Records

Pharmacy

This form is used to determine coverage for prior authorizations and medications with utilization management rules.

Medical Drug Authorization Request

Other Provider Forms

Please use this form to refer a member to the Service Coordination / Disease Management Department


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Last Updated On: 5/9/2017
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