Dental Request for Prior Approval for Treatment or Referral to a Specialist
Form ID
D0986
Audience
For providers
Dental prosthetist
Dental specialist
Dentist
Medical specialist
Request for prior approval for treatment or referral to a specialist. Form may be referred to as D0986 or D986.
If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.
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Form file format