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Get HI DHS 1144 2014-2024

St  New Request PA No.: REQUEST FOR MEDICAL AUTHORIZATION Check only ONE – Different Types of Services Must Be Requested on Separate 1144 Forms.  BH – Psych. Testing/ & Detox  DM – Appl./DME/ Supplies  GT – Transportation  HE- Home Health  LN – Sign Language Interpretation  LT – Long Term Care  MD- Professional Services  OP – Outpatient Facility  OS- Out of State Services  RE – Rehabilitation Services  SR – Hospice  SHOTT *** This .

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