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CONTAINS CONFIDENTIAL PATIENT INFORMATION Drug Request Form Complete form in its entirety and fax to: Prior Authorization of Benefits (PAB) Center at (888) 831 2243 1. PATIENT INFORMATION Patient
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Health care facilities such as hospitals, clinics, and nursing homes may require providers to ensure they have a qualified and competent workforce to deliver quality care to patients.
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Overall, providers are required to by various entities to ensure compliance with regulations, maintain quality standards, and establish a network of qualified professionals or services for their customers or patients.
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Providers are required to report certain information to comply with regulations and fulfill their obligations.
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