Get the free CDPH/OA/ADAP Treatment Exception PA Request Form
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California Department of Public Health, Office of AIDS, AIDS Drug Assistance Program
Prior Authorization Form
Treatment Exception RequestAccess this PA form at https://cdph.magellanrx.com
Phone: 18004245906Fax:
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How to fill out cdphoaadap treatment exception pa
How to fill out cdphoaadap treatment exception pa
01
To fill out the cdphoaadap treatment exception pa, follow these steps:
02
Visit the official website of CDPH (California Department of Public Health).
03
Navigate to the ADAP (AIDS Drug Assistance Program) section.
04
Look for the 'Treatment Exception Request' form.
05
Download and print the form.
06
Fill in your personal information accurately, such as name, contact details, and date of birth.
07
Provide the relevant medical information, including the name of the prescribed drug, dosage, and duration.
08
Explain the reason for requesting a treatment exception in detail.
09
Attach any supporting documents, such as medical reports or letters from healthcare providers.
10
Review the filled form for any errors or missing information.
11
Sign the form and date it.
12
Submit the completed form to the designated address mentioned on the form or on the website.
13
Wait for the response from CDPH regarding your treatment exception request.
Who needs cdphoaadap treatment exception pa?
01
Individuals who are enrolled in the cdphoaadap program and require a treatment exception for their prescribed medication need to fill out the cdphoaadap treatment exception pa.
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