Georgia Department of Community Health

← Back to document page

Date PostedForm NameSizeDate June 23 2003ADA Dental FormFile Size (58k)Date September 23 2005Additional Location Application Form and InstructionsFile Size (256k)Date April 01 2003Anesthesia Base UnitsFile Size (60k)Date June 23 2003Attachment FormFile Size (67k)Date June 26 2008Atypical Antipsychotic Prior Authorization FormFile Size (57k)Date August 12 2008COB Carrier Listing AlphaFile Size (479k)Date August 12 2008COB Carrier Listing NumericFile Size (506k)Date July 20 2006COB Reference GuideFile Size (103k)Date May 01 2003Disclosure of Ownership and Control Interest StatementFile Size (77k)Date October 23 2006DMA 285: Third-Party Liability QuestionnaireFile Size (20k)Date January 10 2005DMA 6 PhysicianG\xC7\xD6s Recommendation For Nursing Facility CareFile Size (64k)Date June 23 2003DMA-276: Acknowledgement of Prior Receipt of Hysterectomy File Size (59k)Date June 23 2003DMA-292: Request for FormsFile Size (97k)Date May 19 2004DMA-311: Certification of Necessity for Abortion File Size (19k)Date May 01 2006DMA-312: COB/TPL Accident Information ReportFile Size (17k)Date February 26 2007DMA-322 Exceptional Transportation Prior Authorization RequestFile Size (221k)Date March 15 2005DMA-380 Optical Device PrescriptionFile Size (70k)Date February 08 2005DMA-410: COB Notification FormFile Size (132k)Date June 03 2004DMA-460 Medicare N

Date February 22 2008 SXC 835 Payment Advice Request Form File Size (27k) Date March 26 2008 SXC Payer Specification Sheet File Size (72k) Date October 01 2007 SXC Provider Portal Registration Form File Size (79k) Date September 14 2007 Synagis Order Form File Size (155k) Date November 23 2004 TEFRA/Katie Beckett Care Plan Application File Size ...

  Health, Department, Care, Community, Payments, Georgia, Advice, Georgia department of community health, Payment advice