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1230 US Highway 11 Governor, NY 13642 Phone: 18776359545 Prior Authorization Fax: 18447128129 Prior Authorization Request Form (Page 1 of 2) Member Information (required)Provider Information (required)Member
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How to fill out moderately to severely active

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Start with assessing your level of activity. Determine whether you fall under the moderately to severely active category based on your regular physical activities and exercise routines.
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Consult with a healthcare professional or a certified fitness trainer to accurately evaluate your activity level and discuss any potential health concerns or limitations.
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Moderately to severely active refers to individuals who engage in physical activity ranging from moderate to intense levels.
Individuals who meet the criteria of being moderately to severely active are required to file this type of activity level.
To fill out moderately to severely active, individuals can provide information on the type, duration, and intensity of their physical activities.
The purpose of reporting moderately to severely active is to track and monitor individuals' levels of physical activity.
Information such as type of activity, duration, intensity, and frequency must be reported on moderately to severely active.
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