Get Clinic Authorization Form Clinic Authorization ... - Uc Davis Health

The Clinic Authorization Form is an essential document that authorizes specific services related to occupational health screening. This guide provides step-by-step instructions on how to complete the form online, ensuring a smooth and efficient process.

Follow the steps to effectively complete the Clinic Authorization Form.

1. Press the ‘Get Form’ button to access the Clinic Authorization Form and open it in your preferred editor.
2. In the 'Employee’s Name' field, enter the full name of the individual for whom the authorization is being completed. Ensure that the name is spelled correctly to avoid any issues with processing.
3. Mark the box next to 'Non-DOT Drug Screen Collection' to indicate the service required. This signifies that the donor will provide a chain of custody form.
4. After completing the form, ensure to fax all related documents immediately to 1-888-247-8373 as stated under the clinic instructions. This step is crucial for timely processing.
5. Provide the employee with any chain of custody (COC) documents where remarks have been added. This must be shared along with the Donor Copy of the COC and remind them to call the provided phone number.
6. For payment, prepare all invoices and a copy of the documents related to the services provided. Mail these to Vertical Screen, Inc., P.O. Box 1674, Southampton, PA 18966, or fax to 1-888-247-8373.
7. If you have any inquiries, contact Certiphi’s OHS Department at 1-800-799-0945 or via email at OHS@verticalscreen.com for further assistance.
8. Once all fields are completed and verified, save any changes made to the form, then download, print, or share the document as required.

Complete the Clinic Authorization Form online today to ensure prompt processing of services.