Get the free Phone: (541) 6721685 Fax: (541) 6775881

PRIOR AUTHORIZATION FORM Medications A Coordinated Care Organization Phone 541 672 1685 Fax 541 677 5881 RETRO medication has already been dispensed to patient DATE OF SERVICE // RUSH 24 hours patient s health is at immediate risk i.e. loss of life limb or eyesight imminent. By selecting the RUSH review and submitting this form I certify that applying the 72 hour standard review time may seriously jeopardize the life or health of the member or the member s ability to regain maximum function....

How to fill out phone 541 6721685 fax

How to fill out phone 541 6721685 fax

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The phone number associated with fax 541 6721685 is 541-6721685.

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