Forms & publications

Notice: If you are looking for Apple Health (Medicaid) client forms and publications, please visit our Free or low-cost forms library.

Opdivo request form

Use this form to request prior authorization for prescribing Opdivo.
Alternate language versions:

Oral enteral nutrition exception to rule request (ETR): adults

For metabolic disorders: oral enteral nutrition – adults. Oral enteral nutrition is not a covered benefit for adults 21 and older. Use this form to request an Exception to Rule (ETR). Complete the form in its entirety. A typed and completed General Authorization for Information form must be the cover sheet for your request in order to be processed by the Health Care Authority.

Oral enteral nutrition expedited prior authorization (EPA) worksheet: products for clients 20 years of age and younger

Use EPA when the client has an immediate need for an urgent supply of oral enteral nutrition product. The EPA can be used for a one-time, one-month supply to address a severe nutrition disorder. The prescribing provider must clearly identify the urgent condition and provide justification for why an immediate supply of the product is medically necessary.