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Disservice Provider Address City State, Zippier Colleague, California State University, Campus Project Name Agreement Number Project Number Extra Service Authorization #999As an extra service to the
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How to fill out extra service authorization suam

01
Obtain a copy of the Extra Service Authorization SUAM form from the relevant department or website.
02
Fill out the patient's personal information, including name, date of birth, and contact information.
03
Specify the requested extra services that require authorization, such as specialized treatments or procedures.
04
Provide detailed reasons for why these extra services are necessary for the patient's treatment.
05
Include supporting documentation, such as medical records or physician notes, to justify the need for the extra services.
06
Submit the completed Extra Service Authorization SUAM form to the appropriate department for review and approval.

Who needs extra service authorization suam?

01
Patients who require additional medical services beyond the standard care provided.

What is Extra Service Authorization. SUAM Appendix C Form?

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Extra Service Authorization SUAM is a form used to request authorization for additional services not included in an existing agreement or contract.
Any party seeking additional services beyond the scope of an existing agreement or contract is required to file Extra Service Authorization SUAM.
Extra Service Authorization SUAM can be filled out by providing details of the additional services requested, along with a justification for why they are necessary.
The purpose of Extra Service Authorization SUAM is to ensure that any additional services requested are properly documented and authorized.
Extra Service Authorization SUAM must include details of the additional services requested, justification for the request, and any relevant supporting documentation.
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