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Page 1 of 2PRESCRIPTION DRUG PRIOR AUTHORIZATION REQUEST FORM Plan/Medical Group Name: Care1st Health Lankan/Medical Group Phone#: (877) 7922731 Plan/Medical Group Fax#: (323) 8896254 or (866) 7122731Instructions:
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Planmedical group name care1st is a health insurance plan offered by Care1st Health Plan.
Employers who offer the plan to their employees are required to file planmedical group name care1st.
Planmedical group name care1st can be filled out online through the Care1st Health Plan portal or submitted manually via paper forms.
The purpose of planmedical group name care1st is to provide health insurance coverage to employees of participating employers.
The planmedical group name care1st form requires information such as employee demographics, coverage details, and premium amounts.
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