Department of Vermont Health Access Forms
Documents:
99
PDF 
Word
This Form is used for requesting prior authorization for long-acting opioids in the state of Vermont.
This form is used for applying for a medical exemption for public transportation in Vermont.
This Form is used for requesting an exception to Medicaid's vehicle rules in Vermont.
This Form is used for requesting a waiver of mileage requirements for hardship situations in Vermont.
This form is used for requesting a referral to a physician in Vermont.
This Form is used for submitting a prior authorization request for Cimzia medication in the state of Vermont.
This document is used for establishing an agreement between parties for the ownership, operation, and maintenance of recycled durable medical equipment in the state of Vermont.
This Form is used for requesting prior authorization for Car-T therapy in Vermont.
This Form is used for requesting prior authorization for Spinal Muscular Atrophy (SMA) therapy in Vermont.
This form is used for requesting an extension of rehabilitation therapy services in Vermont.
