Sample: International SOS Authorization Form - TRICARE Overseas 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the provider's name and address in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the authorization number, date, and page count at the top of the form. This helps track your submission effectively.
4. In the section for services rendered, input the beneficiary's first name, last name, date of birth, and internal control number. This identifies the patient clearly.
5. Specify the service start and end dates along with priority level (urgent/routine) and specialty required for care.
6. Provide a preliminary diagnosis based on referral details. This is essential for medical necessity review.
7. Complete any additional comments or service requests as needed to ensure clarity in your submission.

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