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Behavioral Health Service Request Form
Routine Outpatient Services
Please Submit to the Dedicated Fax Line Below
Medicare
Arizona 18888348404
Arkansas 18557100160
Connecticut 18883655607
Florida 18557100168
Georgia
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What is weve retired fax numbers?
We've retired fax numbers is the process of discontinuing the use of fax numbers.
Who is required to file weve retired fax numbers?
Any organization or individual who has discontinued the use of fax numbers.
How to fill out weve retired fax numbers?
To fill out weve retired fax numbers, one must provide information about the fax numbers that have been discontinued.
What is the purpose of weve retired fax numbers?
The purpose of weve retired fax numbers is to inform relevant parties that fax numbers are no longer in use.
What information must be reported on weve retired fax numbers?
The information that must be reported on weve retired fax numbers includes the discontinued fax numbers and the date they were retired.
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