Provider Forms
Authorization Forms
Behavioral Health – Prior Authorization Form
General Rx – Prior Authorization Form
Medical Services – Prior Authorization Form
Radiology Authorization Online Form
Residential Psychiatric Treatment Authorization Form
Synagis – Weight Change/Prior Authorization Form
Medical Forms
Request Form for Multi-Source Brand Drug
SIPP/STGC Discharge Notification Form
Health Information Forms
AUD Consent Form (Ongoing sharing of information)
AUD Consent Form (Release for specific information)
Appeals Forms
Prescription Drug Forms
Antidepressants – Under 6 years of age
Antipsychotic – Under 6 years of age
Antipsychotic – 6 to under 18 years of age
Adult Antipsychotic- High dose
Human Growth Hormone Diagnosis
Neupogen Leukine Neulasta Diagnosis
For Magellan Complete Care of Florida Pharmacy prior authorizations, please fax or mail completed forms to:
Magellan Complete Care of Florida
c/o Magellan Pharmacy Solutions
11013 West Broad Street
Suite 500
Glen Allen, VA 23060
Fax: 800-424-7982
Phone: 800-327-8613 (TTY 711)