№ lp_1_18819
This form is used to request prior authorization for individual and therapeutic support services for youth, detailing required information such as diagnosis, service type, and costs.
Year: 2023
Region/City: Illinois
Topic: Youth support services, Therapeutic support services, Prior authorization process
Document Type: Form
Organization: Illinois Department of Healthcare and Family Services (HFS)
Author: Unknown
Target Audience: Providers of therapeutic and individual support services
Period of Action: N/A
Approval Date: N/A
Amendment Date: N/A
Price: 8 / 10 USD
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