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UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM, UNSOLD, NAVAL (/naloxone) Patient name: Medicaid ID #: Prescriber Name: Prescriber NPI#: Contact person: Prescriber Phone#: Extension/Option:
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The Utah Department of Health is a state government agency responsible for protecting and improving the health of the people in Utah.
Healthcare facilities and providers in Utah are required to file with the Utah Department of Health.
You can fill out the Utah Department of Health forms online or submit them through the mail.
The purpose of the Utah Department of Health is to monitor and improve public health in the state.
Information on patients, diseases, treatments, and healthcare providers must be reported on the Utah Department of Health forms.
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