CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications

Authorization Request Forms/Certification/Letter of Medical Necessity

OMB: 1240-0055

IC ID: 221978

Documents and Forms

Document Name Document Type
Form CA-27 CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications Form and Instruction
Form CA-27 CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications Form and Instruction
CA-27 Authoriization/Request Form and Certification/Letter of Medical Necessity for Opioid Medications CA 27 LMN Opioids.pdf Form and Instruction
CA 27 LMN Opioids Instructions.pdf Instruction
CA-27 (Web) Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications CA-27 LMNOpioid-UAT with Burden Statement.PNG Form and Instruction