21355c 2025

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The document is a Prior Authorization/Review Form for patients admitted to Acute Rehabilitation, Long-Term Acute Care (LTAC), Skilled Nursing Facilities (SNF), or Subacute Rehabilitation (SAR) under Priority Health products. It outlines the necessary information required for admission, continued stay, and discharge requests, including patient details, facility information, nursing needs, and discharge plans. The form emphasizes the importance of completing all fields for timely processing and includes instructions for submitting the form and related documents.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (200 Votes)

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