Forms and Other Resources for LaSalle Providers
| Resource Description | Link/Format |
|---|---|
| LaSalle PharMedQuest Treatment Request Forms- All 9 |  |
| LaSalle Provider Policy Manual – July 2015 | |
| San Bernardino County, High Desert Radiology Request Procedures | |
| San Bernardino County, High Desert Radiology Authorization Request Form | |
| San Bernardino County, Metro San Bernardino Radiology Request Procedures | |
| San Bernardino County, Metro San Bernardino Radiology Authorization Request Form | |
| San Bernardino County, Metro San Bernardino direct Referral Form – Temporary | |
| Riverside County, Radiology Request Procedures | |
| Riverside County, Radiology Authorization Form | |
| Inland Empire Radiology List of Codes Requiring Authorization or Direct Referral | |
| Inland Empire Radiology List of Maximum Patient Body Weight Exam Tables will Support | |
| Los Angeles Medical Service Authorization form | Link |
| Central Valley Medical Service Authorization form | Link |
| Inland Empire Medical Service Authorization form | Link |
| Web Portal for Authorizations, Claims and Eligibility | Link |
| Auth, Claims and Eligibility Web Portal User’s Guide | Link |
| CDC Link for Immunization Schedules | Link |