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
CDC Link for Immunization Schedules Link