Fax Referral Form

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Patients with UHC Compass, Humana HMO, TRICARE Prime Remote Require Prior Authorization

Once we schedule your patient, we will fax their appointment date back to you. We will fax our clinic notes after the patient’s visit. Please include patient labs and past clinic notes as appropriate. Thank you for partnering with us on your patient’s care!

For Allergy Institute Office Use Only:

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