Incidental/Residential Pre-Authorization Request Form
Descriptions of Required Fields in Pre-Authorization Request Form
For any questions or concerns on the pre-authorization process, you may contact:
Incidental Expenses– Miralys Martinez, Risk Management Specialist, email: mmartinez@cfchs.org
Forensic Residential– Stephanie Smith, Forensic Coordinator, email: ssmith@cfchs.org
Civil State Hospital– Stephanie Smith, Adult Behavioral Health Specialist, email: ssmith@cfchs.org
PRTS– Elisa Bustamante, Children’s Behavioral Specialist, email: ebustamante@cfchs.org