Get the free RUSS BARRON Director - healthandwelfare idaho

Idaho. gov Fax 208-364-1811 Attn EPSDT Request Mail EPSDT Request IDHW Division of Medicaid P. O. Box 83720 Boise ID 83720-0036 If you have questions about EPSDT or about completing this packet please contact our EPSDT Coordinator at 208 364-1983 or by email to EPSDTRequest dhw. Idaho. gov. Revised June 14 2017 EPSDT PRIOR AUTHORIZATION REQUEST FORM Received Date Authorized Y N PA Number STEP 1 Provide information regarding the Medicaid participant you are requesting services for. C. L....

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