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HMSA Care Access Assistance Program Request Form The referring physician should fill out section B C Please fax completed form to 808 944-5600 Or Mail to Phone No Precertification Care Access Assistance Care Access Assistance Only HMSA / Medical Management Dept. P. O. Box 2001 Honolulu Hawaii 96805-2001 808 948-6464 Oahu 800 344-6122 Neighbor Islands Parent/Legal Guardian for Minor Patient CONTACT INFORMATION Any questions or concerns regarding this request may be directed to Contact Name...
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