Forms
For immediate assistance, please call 844-289-2264 (TTY: 711).
Prior Authorization Forms
- YouthCare Inpatient Prior Auth Form (PDF)
- YouthCare Outpatient Prior Auth Form (PDF)
- Behavioral Health Prior Authorization Forms
- Prior Authorization Request Form for Prescription Drugs (PDF)
Medical Forms
- Abortion Request Authorization (HFS form 2390) (PDF)
- Sterilization Consent Form (HFS form 2189) (PDF)
- Hysterectomy Information (HFS form 1977) (PDF)
- Hospice Election Form (PDF)