Texas HHSC

Please select the desired link from the list below. 

Title
2019-20 Synagis PA Form
 1 file(s)  150 downloads

TX

September 12, 2019

Download

Agents for Cystic Fibrosis Addendum
 1 file(s)  24 downloads

TX

May 17, 2017

Download

Emflaza PA Form
 1 file(s)  25 downloads

TX

September 19, 2017

Download

FDA MedWatch Form 3500
 1 file(s)  23 downloads

TX

May 15, 2017

Download

Hepatitis C – Initial Request
 1 file(s)  81 downloads

TX

May 17, 2017

Download

Hepatitis C – Refill Request
 1 file(s)  18 downloads

TX

May 17, 2017

Download

Hepatitis C Addendum
 1 file(s)  18 downloads

TX

May 17, 2017

Download

Increlex Addendum 2015
 1 file(s)  13 downloads

TX

November 16, 2016

Download

Makena Addendum
 1 file(s)  48 downloads

TX

November 16, 2016

Download

Makena Prior Authorization Form
 1 file(s)  110 downloads

TX

May 17, 2017

Download

Oxycontin Addendum 2015
 1 file(s)  23 downloads

TX

November 16, 2016

Download

PCSK9 Inhibitors Addendum
 1 file(s)  21 downloads

TX

May 17, 2017

Download

PCSK9 Inhibitors Prior Authorization Form
 1 file(s)  51 downloads

TX

May 17, 2017

Download

Phosphate Binders 2015
 1 file(s)  33 downloads

TX

November 16, 2016

Download

Reconsideration Form
 1 file(s)  2773 downloads

TX

November 15, 2017

Download

Standard PA Form
 1 file(s)  1997 downloads

TX

November 16, 2016

Download

Xyrem Addendum 2015
 1 file(s)  35 downloads

TX

May 17, 2017

Download