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Get UHC UHCMV10765 2016-2024

Online option is not available. Fax complete form to UnitedHealthcare Military & Veterans at: 877-890-9309 Routine 877-890-8203 Urgent (Care needed within 72 hours) 877-578-2738 Inpatient Service Type: (Check one)  ER  Direct Admit  Elective Anticipated Date of Service: Specialty Referral Outpatient (Medical/Surgical/Home Health) Inpatient (Acute, SNF, or Rehab) DME Beneficiary Information (Completion of ALL fields is REQUIRED) .

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