Acute physical medicine and rehabilitation (PM&R) update form.

Use this form to request admission or extension for acute physical medicine and rehab services.

A step-by-step guide for providers on adding additional supporting documents to a request in “pend” or “approve/hold” status.

Use this form to request authorization. A copy of the COE evaluation, the prescription for ABA services, the Board Certified Applied Behavior Analyst’s (BCABA) assessment with the functional analysis, and the BCBA’s treatment plan must be attached to this request.

Use this form to request stage 2 bariatric surgery services.

Use this form to request and provide medical justification for bathroom equipment.