Access key forms for authorizations, claims, pharmacy and more.
Refund Check Information Sheet* (RCIS)
You must complete the attached baseline form before the member begins the program.
Please complete the OUTCOME* and DATE* columns of the form with the member’s current outcome data.
In order to begin the program, members will need to have you complete the attached baseline form.
Alternative Therapies for Chronic Pain Management Referral Form
Chlamydia is the most common sexually transmitted bacterial infection (STI) in the United States. The best way to detect chlamydia in its early stages is to conduct screenings at yearly physicals for patients who are sexually active.