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Facility NPI Number Fax I am aware of the member s condition and have been provided sufficient information to determine this level of care is appropriate. City Click here to enter city. Zip Click here to zip code AHCCCS ID Click here to enter AHCCCS ID. CIS Click here to enter CIS. AM PM LEVEL OF CARE REQUESTED Inpatient-Hospital Arizona State Hospital ASH Extended Care Unit ECU Behavioral Health Inpatient Facility Sub-Acute Services BHIF-SAF MEMBER INFORMATION Mailing Address Click here to...
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