Alabama

New Form Submission:
You can now fill out and submit your Prior Authorization and Override requests online.
Submit Request Online

Please select the desired link from the list below. 

Title
Adult Growth Hormone Deficiency
 1 file(s)  77 downloads

ALPA

November 10, 2016

Download

AL Medicaid EPSDT Form
 1 file(s)  749 downloads

ALPA

April 4, 2017

Download

AL Short Acting Opiate Naiive Days supply Limit Override
 1 file(s)  225 downloads

ALPA

February 15, 2019

Download

Biological Injectables
 1 file(s)  710 downloads

ALPA

February 13, 2019

Download

Child Growth Hormone / Mecasermin
 1 file(s)  25 downloads

ALPA

November 15, 2016

Download

Child Growth Hormone Deficiency
 1 file(s)  68 downloads

ALPA

November 15, 2016

Download

Child Growth Hormone-Chronic Renal Insufficiency
 1 file(s)  26 downloads

ALPA

November 15, 2016

Download

Child Growth Hormone-Turner, Prader-Willi, Noonan
 1 file(s)  22 downloads

ALPA

November 15, 2016

Download

FDA MedWatch Form 3500
 1 file(s)  344 downloads

ALPA

May 15, 2017

Download

Hepatitis C Antiviral Medications
 1 file(s)  124 downloads

ALPA

February 15, 2019

Download

Hepatitis C Patient Consent Form
 1 file(s)  68 downloads

ALPA

March 27, 2017

Download

Miscellaneous
 1 file(s)  657 downloads

ALPA

November 15, 2016

Download

Opioid Dependence Treatment Agreement and Patient Consent Form
 1 file(s)  334 downloads

ALPA

June 21, 2017

Download

Opioid Dependence Treatment PA Request Form
 1 file(s)  541 downloads

ALPA

May 1, 2018

Download

Pharmacy Override
 1 file(s)  2640 downloads

ALPA

November 15, 2016

Download

Quit Now Alabama Referral Form
 1 file(s)  668 downloads

ALPA

March 27, 2017

Download

Quit Now Alabama Referral Form – Spanish
 1 file(s)  29 downloads

ALPA

May 1, 2018

Download

Simple PA Form
 1 file(s)  4247 downloads

ALPA

February 15, 2019

Download

Smoking Cessation
 1 file(s)  413 downloads

ALPA

May 12, 2017

Download

Synagis
 1 file(s)  61 downloads

ALPA

March 19, 2019

Download