Some of our most-requested forms are available for you to view and print online. Our downloadable forms require Adobe Reader in order to view and print. Get Adobe Reader.
Advance Directive
Advance Directive Form
Advanced Imaging Authorization Forms
CT/CTA Authorization Form
MRI/MRA Authorization Form
PET/Spectroscopy Authorization Form
Sentara Medical Solutions Form
Billing Services
Billing Services Form Instructions
Billing Services Form
Diabetes
Diabetes Supply Order Form
DME
DME Authorization Form
Drug Authorization Forms
(Need an authorization for an Optima Medicare Preferred Plus member? Visit Medicare Drug Authorization Forms.)
Aceon Authorization
Achthar Gel Authorization
Actiq Authorization
Adderall XR Authorization
Ambien CR Authorization
Amevive Authorization
Aranesp Authorization
Atacand/Atacand HCT Authorization
Avapro/Avalide Authorization
Avastin Authorization
Avonex Authorization
Azor Authorization
Benicar/Benicar HCT Authorization
Betaseron Authorization
Boniva IV Authorization
Botox Authorization
Brovana Authorization
Byetta Authorization
Caduet Authorization
Celebrex Authorization
Cozaar/Hyzaar Authorization
Crestor Authorization
Cymbalta Authorization
Daytrana Authorization
Desoxyn Authorization
Differin Authorization
Diovan/Diovan HCT Authorization
Effexor XR Authorization
Emsam Authorization
Enbrel Authorization
Epogen Authorization
Euflexxa Authorization
Exforge Authorization
Fentora Authorization
FluMist Authorization
Focalin XR Authorization
Growth Hormone Authorization
Hyalgan Authorization
Humira Authorization
Implanon Authorization
Invega Authorization
IVIG Authorization
Janumet Authorization
Januvia Authorization
Kepivance Authorization
Keppra Authorization
Kineret Authorization
Lescol, XL Authorization
Leukine Authorization
Lexapro Authorization
Lipitor Authorization
Lovaza Authorization
Lucentis Authorization
Lunesta Authorization
Lyrica Authorization
Macugen Authorization
Medical Necessity Request Form
Metadate CD Authorization
Micardis/Micardis HCT Authorization
Neulasta Authorization
Neumega Authorization
Neupogen Authorization
Nexavar Authorization
Norfolk Consortium For Smoking Cessation
Opana ER Authorization
Opana Authorization
Orencia Authorization
Orthovisc Authorization
Oxycontin Authorization
Paxil CR Authorization
Pegasys Authorization
Perforomist Authorization
Pharmacy Pre-Authorization
PharmaCare Request Form for Injectables
PPI Step-Edit/Prior Authorization Request Form
Prialt Authorization
Procrit Authorization
Provigil Authorization
Raptiva Authorization
Reclast Authorization
Remicade Authorization
Retin-A Authorization
Revatio Authorization
Revlimid Authorization
Risperdal Consta Authorization
Ritalin LA Authorization
Rituxan Authorization
Rozerem Authorization
Sandostatin Authorization
Serostim Authorization
Singulair Authorization
Sonata Authorization
Stadol Authorization
Strattera Authorization
Supartz Authorization
Sutent Authorization
Symlin Authorization
Synagis Authorization
Synarel Authorization
Synvisc Authorization
Tekturna/Tekturna HCT Authorization
Teveten/Teveten HCT Authorization
Tykerb Authorization
Thyrogen Authorization
Torisel Authorization
Tysabri Authorization
Vectibix Authorization
Vivaglobin Authorization
Vytorin Authorization
Vyvanse Authorization
Wellbutrin XL Authorization
Xolair Authorization
Xopenex Authorization
Zetia Authorization
Drug Lists
Preferred and Standard Drug List
Optima Medicare Drug List
Optima Medicare Appeal and Grievance Process
Prior Authorization, Step-Edit and Quantity Limits Drug List
Generics Plus Formulary
Electronic Funds/Remittance Transfers
EDI Transaction Overview
EDI Setup form - Providers
GYN Authorization
GYN Procedure Request Form
Lab
In-Office Lab List
Medical Record Documentation Standards
Medical Record Documentation Standards
NPI Submission
NPI Information
NPI Online Submission
NPI Submission Form
NPI Contingency Plan
OB Forms
OB Certification Form
Oxygen
Medical Necessity Ordering Form for Oxygen
Pediatric
Pediatric Health Maintenance Guidelines
Recommendations for Preventive Pediatric Health Care (EPSDT)
Pharmacy Order Forms
PharmaCare Request Form for Injectables
Caremark Mail Service Form
Mirena Eligibility Form
Mirena Order Form
Pre-Existing Condition
Pre-Existing Condition Form
Provider Connection Forms
Minimum system requirements
Provider Connection Optima Health Enrollment Form
Reconsiderations
(Do not use this form for Medicare claims. Medicare guidelines for claim reconsiderations require a new claim be submitted.)
Provider Reconsideration Form
Referral and Authorization Request
Referral and Authorization Request Form
Authorization Request Form
Medicare Part D Coverage Determination Request Form
Release of Information
Release of Information Form
Site Evaluation
PCP/OB/Gyn Practice Site Evaluation Form
Therapy
Authorization for Therapy Worksheet
Transitional Care Request Form
Transitional Care Request Form
Well Child Forms
Well Child and Adolescent Well Child Forms