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PA17 NOT required for recipients less than 21 years of age. Executive Office of Health & Human Services PRIOR AUTHORIZATION REQUEST FORM for RI MEDICAID FEE FOR SERVICE (FFS) Gain well Technologies
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Visit the Minnesota Department of Human Services website
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The Minnesota Department of Human Services oversees programs and services that help improve the quality of life for Minnesotans.
Individuals or organizations that receive funding or provide services from the Minnesota Department of Human Services may be required to file reports.
The Minnesota Department of Human Services provides instructions and forms on their website for filling out the required reports.
The purpose of the Minnesota Department of Human Services is to support and enhance the health and well-being of all Minnesotans.
The specific information that must be reported on the Minnesota Department of Human Services forms will depend on the program or service being provided.
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