Tonsillectomy Prior Approval application form

msword File
Filename: TONSILLECTOMY-APPLICATION-FORM-V1920-.DOC
File type: DOC
File size: 175 KB
Description: This is a Prior Approval application form.  Please complete the PA application form for all patients requiring this intervention.  IF the patient clearly meets the criteria, please forward the application to the EFR Team and await confirmation of funding before making a referral. Please also see Tonsillectomy Prior Approval policy

This is a Prior Approval application form.  Please complete the PA application form for
all patients requiring this intervention.  If the patient clearly meets the criteria, please forward the
application to the EFR Team and await confirmation of funding before making a
referral.

Please also see Tonsillectomy Prior Approval policy.