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Get Hi Dhs 1144 2007-2024

New Request PA No.: REQUEST FOR MEDICAL AUTHORIZATION Check only ONE – Different Types of Services Must Be Requested on Separate 1144 Forms. BH – Psych. Testing/ & Detox DM – Appl./DME/ Supplies GT – Transportation HE- Home Health LN – Sign Language Interpretation LT – Long Term Care MD- Professional Services OP – Outpatient Facility OS- Out of State Services RE – Rehabilitation Services SR – Hospice *** This Form should NOT be used for: Incontinenc.

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