Request for Prior Approval for Funding of Sex-Reassignment Surgery
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English - 5041-77e - Request for Prior Approval for Funding of...PDF
French - 5041-77f - Request for Prior Approval for Funding of...PDF
|Title||Request for Prior Approval for Funding of Sex-Reassignment Surgery|
|Description||Form to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.|