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APRN/PA Competency Form (PDF)
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Behavioral Health Injectable Antipsychotic Prior Authorization Form (Genoa Pharmacy) (DOC)
Claims Reconsideration Form (PDF)
Hospital Based Provider Enrollment Form (PDF)
HPN and SHL Provider Demographic Update Form (PDF)
HPN BH Initial Review Form for Inpatient, RTC, Inpatient SUD Residential, PHP and IOP
Initial Credentialing Form (PDF)
Medical Necessity Request Form (PDF)
New Prescription Fax Order Form (PDF)
New Prescription Mail-in Order Form (PDF)
Nevada Claim Form (PDF)
Oncology Step Therapy Exception Prior Authorization Form (DOC)
Behavioral Health Outpatient Treatment Request Form (DOC)
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QOC Internal Referral Form (PDF)
Substance Abuse Records Release Form
Transition of Care and Continuity of Care Form (PDF)
Transplant Referral Fillable Form (PDF)
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