San Francisco Health Plan: Providers: Provider Resources: Download Forms/

Providers: Provider Resources: Download Forms/

Download Forms

Choose a form:

Authorizations

Prior Authorization Request Form

Services Requiring Prior Authorization

Pharmacy Prior Authorization Request Form

Brand Medications Prior Authorization Form

Hepatitis B Medications Prior Authorization Form

Hydroxyprogesterone Caproate Prior Authorization Form

Formulary Modification Request Form

Community Based Adult Services (CBAS) Initiation and/or Prior Authorization Request Form

Below are the links to authorization forms for Anthem Blue Cross:

Anthem Blue Cross Pharmacy Authorization Form
Anthem Blue Cross Medical Services Authorization Form