Authorization Forms
| Authorization Request Form (ARF) - Handwritten - Page 1 03/08 |  |
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Authorization Request Form (ARF) - Handwritten - Page 2 03/08 | |
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| Authorization Request Form (ARF) - Electronic - Page 1 03/08 | |
Authorization Request Form (ARF) - Electronic - Page 2 03/08 | |
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| Authorization Request Form (ARF) - Psychiatric 03/08 | |
Authorization Request Form (ARF) Instructions 2/07/07 | |
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| CSS Beyond Limits of Benefit Plan-Adult 12/07 | |
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CSS beyond limits of Benefit Plan-Child 09/08 | |
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| How to Personalize your Electronic ARF | |
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OPC Adult SA IPRS Service Benefit Plan 07/08 | |
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OPC Adult MH IPRS Service Benefit Plan 08/08 |
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OPC Child SA IPRS Service Benefit Plan 08/08 | |
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| OPC Child MH IPRS Service Benefit Plan 08/08 | |
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OPC Developmental Disabilities Auth Form 04/08 | |
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| OPC DD Flex Fund Application 04/08 | |
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OPC DD Flex Fund Brochure 04/08 | |
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| OPC Level of Care Criteria 06/06 | |
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Request for Room & Board 05/08 | |
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*Please note that the forms above were saved in a Microsoft Office format and Portable Document Format (PDF). If you do not have a version of Office 97 or higher, please use the PDF links provided. PDF files can be viewed with Adobe's Acrobat Reader. The latest version of this program can be downloaded HERE. This is a free download.
For Information on Value Options and the authorization process for Medicaid funded services visit www.valueoptions.com.
