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Geography of the United States / Honolulu County / Hawaii / Honolulu / Kapolei / Hawaii


Microsoft Word - Prior Authorization Form Quick Reference.doc
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Document Date: 2012-01-27 16:18:03

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File Size: 62,97 KB

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City

Honolulu / Kapolei / Atlanta / /

Company

Fiscal Agent ACS Inc. / PBM Fiscal Agent ACS Inc. / Medical Authorizations Drugs PBM Fiscal Agent ACS Inc. / /

Facility

ICFMR Intermediate Care Facility / Evaluation Intermediate Care Facility / Hospice Level / Intermediate Care Facility / /

/

IndustryTerm

taxi services / behavioral health services / /

MedicalTreatment

Physical Therapy / /

Organization

Long Term Care Services PRO/EQRO Mountain Pacific Quality Health Foundation / PRO/EQRO Mountain Pacific Quality Health Foundation / Reevaluation Long Term Care Services PRO/EQRO Mountain Pacific Quality Health Foundation / /

/

Product

Olanzapine / Clozapine / Risperidone / /

ProvinceOrState

Hawaii / Georgia / /

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