Submit completed authorization form via mail, Fax or e-mail. The address of San Antonio Regional Hospital is 999 San Bernardino.Authorization Process. Download, print and complete the authorization form. The authorization form must be signed and dated. Medi-Cal Rx Prior Authorization Request Form. Instructions: Fill out all applicable sections on all pages completely and legibly. By completing this form, you are submitting a written request for access to the PHI of the designated individual.