Authorization Submission. The Alliance Prior Authorization (PA) Request Form is used for all services requiring prior authorization from the Alliance.Please completely fill in ALL areas to include the following: • Patient Information: Patient Name, Patient Date of Birth and Phone. Number. Phone Number: 1.510. An agent must have authorization to file an application at the time the application is filed; retroactive authorizations are not permitted. You may authorize someone 18 years of age or older to help your household with your benefits. Blank Application Forms. The below forms may be dropped at a secure drop box, at one of our offices, during regular business hours, am to pm. Local Forms, Adoption Forms, Family Law Forms, Juvenile Forms, Probate and Court Investigator's Forms, Small Claims Forms, Traffic Forms Contact Us: City Hall Address: 2263 Santa Clara Avenue Alameda, CA 94501 (510) 747-7400

Letter Of Authorization With In Alameda

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