Request for Participation

• AzAHP Practitioner Practice – Change Form
• Request for Participation – AzAHP Practitioner Data Form
• AzAHP Organizational/Facility Application
• Non Delegated Group AzAHP Roster
• Delegated Group AzAHP Roster

Prior Authorization Forms

• Medical Services and Behavioral Health Prior Authorization Form
  
• Pharmacy Prior Authorization Request Form
• Residential Services PA Request Form 
  
• Prior Authorization and Continued Stay Request Form for Psychiatric Inpatient and Sub-acute Facilities
• BHIF, BHRF, TFC, and SUD BHRF Prior Authorization and Continued Stay Request Form

Other Forms

• Care Management Referral Form
• Fraud Waste & Abuse Referral Form
• Maternal Risk Assessment
• Pediatric NICU Case Management Referral Form
• Federal Sterilization Consent Form
• Newborn Reporting Form
• Hysterectomy Consent Form
• Dental Specialty Request form